Cement Group Research Articles

Clinical and radiologic study of total knee replacement arthroplasty using Doujet GF bone cement (liquid-powder bone cement containing gentamicin)

Gentamicin-loaded bone cement used in total joint arthroplasty is indispensable, as it provides stability by directly binding the surfaces of implants and bones. Depending on multiple factors, including the material of the bone cement used, common complications, such as aseptic loosening, osteolysis, and infection can occur postoperatively. In clinical practice, Doujet bone cement is easy to handle (pre-packed all-in-one system), and has shown low failure rates and non-inferior results compared with similar available products. We conducted a retrospective comparative study to analyze the clinical and radiological results of each bone cement group to establish the safety and usefulness of Doujet bone cement. From July 2020 to July 2022, we enrolled 198 patients in this study after an average follow-up period of 37 months (range, 6–48 months). In 99 patents, Doujet® bone cement (Injecta, Gunpo, Korea) was used for total knee arthroplasty (TKA), while Refobacin® bone cement (Biomet, Warsaw, IN, USA) was used in 99 patients. The average range of motion (ROM) of the knee increased by 2.4° (from 127.0° preoperatively to 129.4° postoperatively) in the Doujet group, and by 0.1° (from 128.7° to 128.8°) in the Refobacin group (P=0.701). The Western Ontario and McMaster Universities (WOMAC) osteoarthritis index scores decreased from 44.1 to 7.8 in the Doujet group, and from 44.2 to 6.3 in the Refobacin group (P=0.162). Complications, such as osteolysis or post-operative wound infection, did not occur in more than two cases in both groups. The WOMAC and ROM of the knee in both groups had no clinical differences. Both Doujet and Refobacin similarly showed low complication rates after TKA.

High-dose dual-antibiotic loaded cement for hip hemiarthroplasty in the UK (WHiTE 8): a randomised controlled trial

Hip fracture is the most common injury requiring treatment in hospital. Controversy exists regarding the use of antibiotic loaded bone cement in hip fractures treated with hemiarthroplasty. We aimed to compare the rate of deep surgical site infection in patients receiving high-dose dual-antibiotic loaded cement versus standard care single-antibiotic loaded cement. We included people aged 60 years and older with a hip fracture attending 26 UK hospitals in this randomised superiority trial. Participants undergoing cemented hemiarthroplasty were randomly allocated in a 1:1 ratio to either a standard care single-antibiotic loaded cement or high-dose dual-antibiotic loaded cement. Participants and outcome assessors were masked to the treatment allocation. The primary outcome was deep surgical site infection at 90 days post-randomisation as defined by the US Centers for Disease Control and Prevention in an as-randomised population of consenting participants with available data at 120 days. Secondary outcomes were quality of life, mortality, antibiotic use, mobility, and residential status at day 120. The trial is registered with ISRCTN15606075. Between Aug 17, 2018, and Aug 5, 2021, 4936 participants were randomly assigned to either standard care single-antibiotic loaded cement (2453 participants) or high-dose dual-antibiotic loaded cement (2483 participants). 38 (1·7%) of 2183 participants with follow-up data in the single-antibiotic loaded cement group had a deep surgical site infection by 90 days post-randomisation, as did 27 (1·2%) of 2214 participants in the high-dose dual-antibiotic loaded cement group (adjusted odds ratio 1·43; 95% CI 0·87-2·35; p=0·16). In this trial, the use of high-dose dual-antibiotic loaded cement did not reduce the rate of deep surgical site deep infection among people aged 60 years or older receiving a hemiarthroplasty for intracapsular fracture of the hip. Heraeus Medical. Supported by the UK National Institute for Health and Care Research Oxford Biomedical Research Centre.

Cemented versus Cementless Femoral Fixation for Elective Primary Total Hip Arthroplasty: A Nationwide Analysis of Short-Term Complication and Readmission Rates.

Cementless fixation during total hip arthroplasty (THA) is the predominant mode of fixation utilized for both acetabular and femoral components during elective primary THAs performed in the United States. This study aims to compare early complication and readmission rates between primary THA patients receiving cemented versus cementless femoral fixation. The 2016-2017 National Readmissions Database was queried to identify patients undergoing elective primary THA. Postoperative complication and readmission rates at 30, 90, and 180 days were compared between cemented and cementless cohorts. Univariate analysis was conducted to compare differences between cohorts. Multivariate analysis was performed to account for confounding variables. Of 447,902 patients, 35,226 (7.9%) received cemented femoral fixation, while 412,676 (92.1%) did not. The cemented group was older (70.0 vs. 64.8, p < 0.001), more female (65.0% vs. 54.3%, p < 0.001), and more comorbid (CCI 3.65 vs. 3.22, p < 0.001) compared to the cementless group. On univariate analysis, the cemented cohort had decreased odds of periprosthetic fracture at 30 days postoperatively (OR: 0.556, 95%-CI 0.424-0.729, p < 0.0001), but higher odds of hip dislocation, periprosthetic joint infection, aseptic loosening, wound dehiscence, readmission, medical complications, and death at all timepoints. On multivariate analysis, the cemented fixation cohort demonstrated reduced odds of periprosthetic fracture at all postoperative timepoints: 30 (OR: 0.350, 95%-CI 0.233-0.506, p < 0.0001), 90 (OR: 0.544, 95%-CI 0.400-0.725, p < 0.0001), and 180 days (OR: 0.573, 95%-CI 0.396-0.803, p = 0.002). Cemented femoral fixation was associated with significantly fewer short-term periprosthetic fractures, but more unplanned readmissions, deaths, and postoperative complications compared to cementless femoral fixation in patients undergoing elective THA.

Cemented total knee arthroplasty provides greater knee range of motion at 2years than cementless technique.

Optimal fixation method between cemented, cementless, and hybrid techniques for total knee arthroplasty (TKA) is still debated. The purpose of this study is to evaluate the clinical outcomes of patients undergoing cemented versus cementless TKA. We reviewed 168 patients who underwent a primary TKA at a single academic institution between January 2015 and June 2017. Patients were categorized into cemented (n = 80) or cementless (n = 88) groups. Only patients with greater than or equal to 2-year follow-up were included in the study. Multivariate regressions were performed to analyze the relationship between the surgical fixation technique and the clinical outcomes. There were no differences in demographics or baseline operative characteristics between the two groups. The cemented group had fewer manipulations under anesthesia (MUA) (4 vs. 15, p = 0.01), longer intraoperative tourniquet times (101.30 vs. 93.55min, p = 0.02), and increased knee range of motion (ROM) at final follow-up (111.48 vs. 103.75°, p = 0.02) compared to the cementless group. Both cemented and cementless component fixation are viable options for (TKA). This study found that patients who underwent a cemented TKA required fewer MUA's and had greater final ROM compared to patients undergoing cementless TKA. Additional research is required regarding cementless and cemented fixation. We believe that the choice of which fixation technique to use ultimately comes down to patient characteristics and surgeon preference.

Study on the Mechanical Properties and Hydration Behavior of Steel Slag–Red Mud–Electrolytic Manganese Residue Based Composite Mortar

The functional and mechanical properties of steel slag (SS)–red mud (RM)–electrolytic manganese residue (EMR)-based composite mortar under different matching ratio conditions were investigated in this paper to examine the synergistic cementing effect among multiple solid wastes. The hydration characteristics of the composite mortar and its microstructure were characterized by the heat of hydration assessment, X-ray diffraction, thermogravimetric analysis, and other tests. The results of the study showed that compared with the pure cement group, 30% SS alone will inhibit the hydration reaction of the slurry, thus reducing the mechanical properties of the mortar, while compounding the appropriate amount of RM, and EMR can effectively reduce the negative impact of SS on the mechanical properties of the mortar. The flexural and compressive strengths of the composite mortar at 28 d were the highest when 15% of SS, 12% of RM, and 3% of EMR were mixed, which were 7.2 MPa and 41.4 MPa at 28 d, respectively. Compared with the test group with 30% SS alone, the flexural and compressive strengths increased by 18.0% and 25.5%. This is mainly because the incorporation of RM and EMR not only plays the role of physical filling, but the free alkali in RM and sulfate material in EMR can also compoundly stimulate the hydration activity of SS to produce more calcium alumina (AFt) and hydrated calcium silicate (C–S–H gel), thus improving the microstructure of mortar, which makes the overall decrease of 26.35% of multiharmful and harmful pores and the overall increase of harmless and less harmful pores of composite mortar specimens of 43.57%.

Physicochemical and histological analysis of an experimental endodontic repair material containing 45S5 bioactive glass.

This study aimed to evaluate the maximum compressive strength, the modulus of elasticity, pH variation, ionic release, radiopacity and biological response of an experimental endodontic repair cement based on 45S5 Bioglass®. An in vitro and in vivo study with an experimental endodontic repair cement containing 45S5 bioactive glass was conducted. There were three endodontic repair cement groups: 45S5 bioactive glass-based (BioG), zinc oxide-based (ZnO), and mineral trioxide aggregate (MTA). In vitro tests were used to evaluate their physicochemical properties: compressive strength, modulus of elasticity, radiopacity, pH variation, and the ionic release of Ca+ and PO4. An animal model was used to evaluate the bone tissue response to endodontic repair cement. Statistical analysis included the unpaired t-test, one-way ANOVA and Tukey's test. BioG showed the lowest compressive strength and ZnO showed the highest radiopacity among the groups, respectively (p < 0.05). There were no significant differences in the modulus of elasticity among the groups. BioG and MTA maintained an alkaline pH during the 7days of evaluation, both at pH 4 and in a pH 7 buffered solutions. PO4 was elevated in BioG, peaking at 7days (p < 0.05). Histological analysis showed less intense inflammatory reactions and new bone formation in MTA. BioG showed inflammatory reactions that decreased over time. These findings suggest that the BioG experimental cement had good physicochemical characteristics and biocompatibility required for bioactive endodontic repair cement.

Cemented versus Cementless Total Hip Arthroplasty for Femoral Head Osteonecrosis: A Study Based on National Claim Data in South Korea.

The purpose of this study was to compare the rates of revision, periprosthetic joint infection (PJI), and periprosthetic fracture (PPF) between patients with osteonecrosis of the femoral head (ONFH) undergoing noncemented total hip arthroplasty (THA) and cemented THA using a national claim data in South Korea. We identified patients who received THA for ONFH from January 2007 to December 2018 using ICD diagnosis codes and procedural codes. Patients were categorized into two groups according to the fixation method: with or without cement. The survivorship of THA was calculated using the following end points: revision of both the cup and stem, revision of the single component, any type of revision, PJI, and PPF. A total of 40,606 patients: 3,738 patients (9.2%) with cement and 36,868 patients (90.7%) without cement, received THA for ONFH. The mean age of the noncemented fixation group (56.2 ± 13.2 years) was significantly lower than that of the cemented fixation group (57.0 ± 15.7 years, P = 0.003). The risk of revision and PJI was notably higher in cemented THA (hazard ratio: 1.44 [1.21 to 1.72] and 1.66 [1.36 to 2.04], respectively). Noncemented THA had a higher 12-year survivorship compared with cemented THA with any revision and PJI as the end point. Noncemented fixation had better survivorship than cemented fixation in patients with ONFH.

Spontaneous immunomodulation and regulation of angiogenesis and osteogenesis by Sr/Cu-borosilicate glass (BSG) bone cement to repair critical bone defects

Injectable bone biomaterials like bone cement should be designed and fabricated with certain biological criteria, which include: 1) recruitment and polarization of the macrophages from M1 (pro-inflammatory) to M2 (anti-inflammatory) phenotype, 2) enhance vascularization, and 3) activate osteogenic differentiation of bone marrow-derived stem cells to promote bone healing. So far, no injectable biomaterials could spontaneously regulate the entire bone healing process that involves inflammation, angiogenesis, and osteogenesis. Therefore, in this study, we designed bone cement comprised of strontium and copper-incorporated borosilicate glass (Sr/Cu-BSG) in the liquid phase of chitosan to modulate bone healing. In vitro studies showed that the controlled release of Sr and Cu ions up-regulated anti-inflammatory genes(IL-1Ra and TGF-β1) while down-regulating pro-inflammatory genes(IL-1β and IL-6) in macrophages at 3 days. Sr and Cu ions also increased the expressions of angiogenic genes (VEGF and bFGF) in HUVECs at 5 days and osteogenic genes (Runx-2, OCN, and OPN) in hBMSCs at 7, 14, and 21 days. 5Sr3Cu-BSG bone cement exhibited the best anti-inflammatory, angiogenic, and osteogenic properties among the bone cement groups with different Sr and Cu ratios. Short-term and long-term implantation of Sr/Cu-BSGs in femoral condylar bone defects of rats and rabbits confirmed the in vitro results, where the degradation rate of Sr/Cu-BSG matched the bone healing rate. Similar to in vitro, the 5Sr3Cu-BSG group also showed the highest bone formation in vivo. Excellent physical and chemical properties, along with its bone repairing ability, make the Sr/Cu-BSG bone cement a good candidate biomaterial for treating bone defects.

A COMPARATIVE EVALUATION OF ENAMEL SURFACE ROUGHNESS OF TWO DIFFERENT BONDING ADHESIVES AFTER DEBONDING WITH ATOMIC FORCE MICROSCOPY

Introduction: The goal of this research was to evaluate the pain felt by patients after veneers were debonded and gum remnants were removed using a tungsten carbide (TC) brush from two different cement frameworks: light fix composite and glass ionomer concrete glues. So long as we assume the null hypothesis is true, the two adhesive solutions do not vary in their ability to smooth out imperfections on the enamel surface.&#x0D; Materials and methods :- Based on the consideration and prohibition models, this in vitro study examined sixty newly removed human premolar teeth (n = 60) to assess orthodontic plans. Light fix cement (Trans bond XT, 3M Unitek, Monrovia, CA) was used to strengthen the metal portions in Group I (n = 30), whereas light glass ionomer concrete (GC Fuji Ortho LC, Tokyo, Japan) was used to accomplish the same in Group II (n = 30). The dried residues of the concrete glue were removed using a TC brush and a slow-speed handpiece. Maximum roughness (Rmax), root mean square roughness (Rq), and roughness (Ra) were all determined at time zero (before holding). and their attributes were compared to those at time two (after debonding and completion).&#x0D; Results:-The two groups had very different experiences with the roughness of the polished surface when held. The composite resin and glass ionomer cement groups had statistically significant (p0.001) differences in surface roughness.&#x0D; Conclusion:- After debonding the sections and finishing with a TC brush, the surface roughness of the veneer significantly increased with both the light fix and the glass ionomer strong concrete structures. The enamel surface roughness of the light cure group was worse than that of the glass ionomer cement group.

Enhancing both strength and permeability of pervious concrete by optimizing pore structure: An experimental study

AbstractThe large porosity enables pervious concrete to obtain water permeability, but seriously decreases its strength. Hence, how to coordinate the contradiction between strength and permeability is a critical challenge for pervious concrete. This research was mainly aimed at mix design of pervious concrete for enhancing both strength and permeability by optimizing the pore structure. Six groups of pervious concrete with 15% target porosity were prepared by 10–15 mm coarse aggregate and different fine aggregate (natural sand, basalt aggregate, and steel slag). Moreover, a group of pervious concrete with 20% target porosity as control samples was prepared by 4.75–9.5 mm aggregate. The compressive strength and permeability coefficient of these samples were tested. Based on CT scanning and image analysis, the influence of pore structure optimization on permeability and compressive strength was analyzed. The results show that though the porosity is reduced by 5% after pore structure optimization, the porosity of large pores and medium pores changes little, the porosity of small pores decreased significantly, and finally the average pore size is still increased. This can explain why the experimental groups gain a similar/better permeability as the control group. The experimental groups of cement or steel slag have an increased compressive strength compared to the control group, which is due to the decrease of porosity and “small pores” content, as well as more abundant hydration products.

A NOVEL SILORANE-BASED BONE CEMENT FOR LOCAL DELIVERY OF CHEMOTHERAPY AGENTS

Osteosarcoma and other types of bone cancers often require bone resection, and backfill with cement. A novel silorane-based cement without PMMA's drawbacks, previously developed for dental applications, has been reformulated for orthopedic use. The aim of this study is to assess each cement's ability to elute doxorubicin, maintain its potency, and maintain suitable weight-bearing strength.The silorane-based epoxy cement was synthesized using a platinum-based Lamoreaux's catalyst. Four groups of cement were prepared. Two PMMA groups, one without any additives, one with 200 mg of doxorubicin. Two silorane groups: one without any additive, one with doxorubicin, added so that the w% of drug into both cements were equal. Pellets 6 × 12 mm were used for testing (ASTM F451). n=10. Ten pellets from each group were kept dry. All others were placed into tubes containing 2.5 mL of PBS and stored at 37 °C. Elution from doxorubicin-containing groups were collected every day for 7 days, with daily PBS changeout. Antibiotic concentrations were determined via HPLC. Compressive strength and compressive modulus of all groups were determined for unsoaked specimens, and those soaked for 7 and 14 days. MTT assays were done using an MG63 osteosarcoma cell line.Both cements were able to elute doxorubicin over 7 days in clinically-favorable quantities. For PMMA samples, the incorporation of doxorubicin was shown to significantly affect the compressive strength and modulus of the samples (p&lt;0.01). Incorporation of doxorubicin into silorane had no significant effect on either (p&gt;.05). MTT assays indicated that doxorubicin incorporated into the silorane cement maintained its effectiveness whereas that into PMMA did not. At the dosing used, both cements remained above the 70 MPa.Both PMMA and silorane-based cements can deliver doxorubicin. Doxorubicin, however, interacts chemically with PMMA, inhibiting polymerization and lowering the chemotherapeutic's effectiveness.

Can Selected Use of Cemented and Uncemented Femoral Components in a Broad Population Produce Comparable Results Following Primary Total Hip Arthroplasty for Osteoarthritis?

BackgroundRegistry data have demonstrated lower rates of revision and periprosthetic fracture in select cohorts with cemented femoral fixation at primary total hip arthroplasty. Whether this is true of all component designs is not known. We hypothesized that selected use of ream-and-broach triple-tapered uncemented stem designs may provide comparable results to cemented stems. MethodsFrom 2000 to 2018, 5,809 primary total hip arthroplasties were performed with either a cemented (1,304) or ream-and-broach triple-tapered uncemented stem (4,505). Implant choice was at surgeon discretion. The cemented group was older, more often women, and had slightly lower body mass index. A subgroup analysis was performed on patients ≥75 years of age. Statistical weighting accounted for baseline cohort differences. ResultsAt 10 years, there was a trend toward higher all-cause revision (hazards ratio (HR) 1.6, P = .053) and higher all-cause reoperation (HR 1.6, P = .02) in the cemented fixation cohort. The cemented fixation group had fewer intraoperative periprosthetic fractures (HR 0.21, P < .001) but no difference in postoperative fractures (HR 0.99, P = .96). The same was true in patients ≥75 years. In the ≥75-years subgroup, there was no difference in revision or reoperation at 10 years. ConclusionCompared to cemented stems, the use of ream-and-broach triple-tapered uncemented stems in select patients, including those ≥75 years, was associated with more intraoperative fractures but no difference in 10-year implant survivorship. These findings are different than some registry data and suggest that specific uncemented components, implanted in selected patients by experienced surgeons, can perform as well as cemented implants in a broad patient population.

COMPARISON OF FUNCTIONAL OUTCOMES BETWEEN UNCEMENTED UNIPOLAR AND CEMENTED BIPOLAR HEMIARTHROPLASTY FOR INTRACAPSULAR NECK FEMUR FRACTURES IN ELDERLY

Background: Femoral neck fractures (FNF) are a growing problem in our ageing society and have been associated with high morbidity and mortality. Hemiarthroplasty is the most commonly used treatment for displaced femoral neck fractures in the elderly. There is limited evidence in the literature of functional outcome with cemented implants compared to AMP in aged more than 70 years. Hence an attempt is made to compare the outcome with unipolar vs cemented bipolar prosthesis for displaced fracture neck of femur in patients aged more than 70years. Ours is a prospective comparative st Materials And Method: udy conducted, involving 40 patients with short term follow up of one year. Elderly patients above 70 years of age, with displaced fracture neck of femur were included. 20 patients were operated with Austin Moore Prosthesis (AMP) and 20 with bipolar prosthesis. The functional hip score was assessed using Harris Hip Score (HHS). The statistical software SPSS 15.0 (Statistical Package for Social Sciences) was used for the analysis of our data. In our study, Result: mean duration of surgery in uncemented group was 70 minutes and mean duration of surgery in cemented group was 82 minutes. On the basis of HHS the results were at 6 weeks follow up we had 70.2 for uncemented group and 77.5 for cemented group and in the last follow up at 6 months, we found HHS 84.2 for uncemented group and 85.6 for cemented group. There were 3 complications in cemented as a cement reaction and 2 supercial infection one in cemented and other in uncemented group. Both cemented Conclusion: and uncemented prostheses can be recommended according to our study because they were equally good regarding functional outcome and health-related quality of life, contrary to the generalized and limited published evidence. The seeming advantages of shorter duration of surgery and potentially less blood loss with the uncemented implant are of little importance compared with the important ndings of equivalent functional results. Both implants may be used with good results after displaced femoral neck fractures.

Tantalum Cementless Versus Cemented Total Knee Arthroplasty: A Meta-analysis of Level 1 Studies

Controversy exists on the ideal type of fixation in total knee arthroplasty (TKA). Noncemented fixation has been theorized to improve patient outcomes and longevity of implantation without increased risk of aseptic loosening or radiolucent lines. We sought to compare (1) patient-reported outcomes, (2) survivorship, and (3) revision rates for all-cause and aseptic loosening in a noncemented tantalum total knee with its cemented counterpart. Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were searched using a combination of keywords "trabecular metal," "tantalum knee," "total knee arthroplasty," and "cementless trabecular." Patient demographics such as age, sex, and body mass index were collected. Outcomes such as Knee Society Scores (KSSs), revisions, and radiolucent lines were recorded for analysis. Four randomized controlled trials involving 507 patients with an average 5-year follow-up were eligible for meta-analysis. No differences were observed in any demographics such as age, sex, body mass index, nor preoperative KSS. Patients in the cemented cohort improved from preoperative KSS 46.4 to postoperative KSS 90.4 while the tantalum cohort improved from 46.4 to 89.3. No statistical difference was observed in postoperative KSS mean difference between groups. Six patients from the tantalum group underwent revision with one patient for aseptic loosening. Twelve patients from the cemented group underwent revision with four patients for aseptic loosening. No statistical difference was observed between rates of revision, aseptic loosening, or radiolucent line development. Patient-reported outcomes improved postoperatively in both groups. No differences were detected between the cemented and noncemented TKAs in patient-reported outcomes, revision rates, or radiolucent line development. Noncemented tantalum fixation seems equivalent to cemented TKA survivorship. Longer term follow-up of these randomized controlled trials may provide a clearer understanding whether a difference exists.

A novel supplementary cementitious material based on calcined drill cuttings with waste glass to accelerate cement hydration

Water-based drill cuttings, a solid waste from oil and gas fields, have been utilized as supplementary cementitious material after calcination and grinding. However, the comparatively low silica of water-based drill cuttings limits the replacement of ordinary Portland cement. The issue can be solved by mixing water-based drill cuttings with waste glass residue, which contains high silica and can melt during calcination. This paper investigates the effects of calcination temperature and waste glass residue on cured specimens' compressive strength. Experimental results indicated that the best product was obtained by mixing 20wt% waste glass residue and 80wt% water-based drill cuttings, calcinating at 1000 °C, then sieving through 1600 mesh. The 90-day compressive strength of the specimen was 57.12MPa, which was better than the 51.19MPa of the pure cement group. X-ray fluorescence spectroscopy and scanning electron microscopy showed that the waste glass residue melted above 800 °C, which increased the product's glass phase and improved its internal structure. Besides, the Isothermal conduction calorimeter and X-ray diffraction spectroscopy indicated that the hydration process has an advanced hydration rate, high total heat release in the early stage, and novel crystalline Chloritoid generation, all of which can enhance mechanical performance.

Cementless and Cemented Dual-Pivot Total Knee Arthroplasty: A Matched Comparison With a Minimum Two-Year Follow-Up

BackgroundWith the use of newer biomaterials, many authors have reported similar results between cementless and cemented total knee arthroplasty (TKA). The purpose of this study was to compare the early clinical and radiographic outcomes of cementless and cemented TKA using the same dual-pivot articulation. MethodsA consecutive series of 806 TKAs were implanted by a single surgeon using the same dual-pivot articulation. There were 634 TKAs (79%) cemented and 172 (21%) uncemented. One patient in the cementless group was lost before two years. The remaining 171 cementless TKAs were matched 1:1 with cemented TKAs with respect to age, sex, and body mass index. All patients were followed for a minimum of two years (range, 24-66 months) using the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement , and Knee Society clinical and radiographic evaluation. The average follow-up was 3.8 years (range, 24-66 months) in the cemented group and 3.4 years (range, 24-56 months) in the cementless group. ResultsAt final follow-up, the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement was higher in the cementless group (86 points (range, 64-100) versus 80 points (range, 57-100). Postoperative Knee Society scores (including pain and function) were similar. There was one deep infection (cemented TKA). The manipulation rate was 1.2% in the cementless group and 2.4% in the cemented TKA group. Excluding infection, two knees (1.2%) were revised in each group. No cases of femoral or tibial component loosening were identified. ConclusionPatients implanted with either a cemented or cementless TKA using the same conforming dual-pivot articulation design had similar early outcomes and functional improvements. The type of fixation did not appear to influence the early clinical results.

Comparative Evaluation of Microleakage in Hall's with SDF, Hall's, and Conventional Technique Using Different Luting Cements.

Thakur NS, Tyagi P, Tiwari S, et al. Comparative Evaluation of Microleakage in Hall's with SDF, Hall's, and Conventional Technique Using Different Luting Cements. Int J Clin Pediatr Dent 2023;16(1):16-21.

John N. Insall Award: Randomized Clinical Trial of Cementless Versus Cemented Tibial Components: Durable and Reliable at a Mean 10-Years Follow-Up

BackgroundCementless fixation is gaining popularity for primary total knee arthroplasties (TKAs). The prior 5-year results of our randomized clinical trial that included 3 different tibial designs found minimal differences. The purpose of the current study was to investigate the 10-year results in the same cohort. MethodsBetween 2003 and 2006, 389 primary TKAs were randomized: traditional modular cemented tibia (135); hybrid (cemented baseplate with uncemented pegs) monoblock tibia (128); and cementless monoblock tibia (126). Implant survivorships, radiographs, and clinical outcomes were analyzed. Mean age at TKA was 68 years (range, 41 to 85), 46% were male, and mean body mass index was 32 (range, 21 to 59). The mean follow-up was 10 years. ResultsThe 10-year survivorship free of any revision was similar between the hybrid monoblock and cementless monoblock groups at 96%, but lower (89%) for the traditional modular cemented tibia (P = .05). The traditional modular cemented tibia group had significantly more revisions for aseptic tibial loosening than the other 2 groups (7 versus 0%) at 10 years (P = .003). The traditional modular cemented tibia group had significantly more nonprogressive radiolucent lines than the hybrid and cementless monoblock groups (24, 12, and 9%, respectively). Clinical outcomes were similar and excellent between all 3 groups. ConclusionCementless and hybrid monoblock tibial components have excellent implant survivorship (96%) with no cases of aseptic tibial loosening to date. The traditional cemented modular tibial group had a 7% cumulative incidence of aseptic loosening at 10 years. Level of EvidenceLevel I, Prospective Randomized Control Trial.

Comparative Evaluation of Physicomechanical Properties and Antimicrobial Activity of White Portland Micro- and Nanoparticulate Peruvian Cement, Mineral Trioxide Aggregate, and Neomineral Trioxide Aggregate.

To compare the surface microhardness, compressive strength, and antimicrobial activity of white Portland nanoparticle and microparticle Peruvian cement, mineral trioxide aggregate (MTA), and neomineral trioxide aggregate (NeoMTA) at 24 hours and 28 days. Twenty specimens were prepared for each group of cement microparticulated powder (PCm), nanoparticulated cement (PCn), MTA, and NeoMTA to be evaluated at two different times, 24 hours and 28 days for the surface microhardness test and compressive strength. For the antimicrobial activity tests, another 20 specimens were prepared for each group of cement where they were subdivided into two subgroups according to the different periods at 24 hours and 48 hours. For the surface microhardness and compressive strength, the specimens, and the cement groups were mixed according to the manufacturer's instructions and transferred to a cylindrical polyethylene mold of 6-mm diameter and 4-mm height. The compressive strength test was conducted using a universal testing machine. Moreover, the agar diffusion technique was to evaluate the antibacterial and antifungal activity of the American Type Culture Collection (ATCC) Enterococcus faecalis and Candida albicans. Finally, the data were statistically analyzed. The highest microhardness values for the 24-hour subgroup were recorded for NeoMTA cement (16.99 ± 2.02), followed by MTA, PCn, and PCm, respectively. As for the 28-day subgroup, PCn cement (41.64 ± 3.20) presented the highest microhardness, followed by NeoMTA, PCm, and MTA, respectively, with statistically significant differences among them. The compressive strength of both subgroups 24 hours and 28 days exhibited the highest mean for PCn (41.3 ± 4.29, 65.74 ± 3.06), followed by PCm, NeoMTA, and the lowest value for MTA cement. Finally, for the antimicrobial activity, the highest mean for the 24-hours and 48-hours subgroup was recorded for NeoMTA cement (17.6 ± 1.26, 17.8 ± 1.44), followed by PCn, PCm, and the lowest value for MTA, with significant differences between them. It is highly recommended, Portland cement (PC) as a viable substitute since it has very similar components and properties, but at a lower cost. Regardless of the evaluation time, PCn produced higher surface microhardness and compressive strength; however, NeoMTA showed higher antimicrobial activity.

The Effect of Body Mass Index on the Relative Revision Rates of Cemented and Cementless Unicompartmental Knee Replacements: An Analysis of Over 10,000 Knee Replacements from National Databases.

Unicompartmental knee replacements (UKRs) are being performed in an increasingly overweight population. There are concerns that cemented fixation will not last. Cementless fixation may offer a solution, but the relative performance in different body mass index (BMI) groups remains unknown. Ten thousand, four hundred and forty cemented and cementless UKRs were propensity matched. Patients were stratified into 4 BMI groups: underweight (<18.5 kg/m 2 ), normal weight (18.5 to <25 kg/m 2 ), overweight (25 to <30 kg/m 2 ), and obese (≥30 kg/m 2 ). The effect of BMI on the relative performance of UKR fixation groups was studied. Cox regression was used to compare revision and reoperation rates. The revision rate per 100 component-years significantly increased (p < 0.001) with BMI for the cemented UKRs. Revision rates per 100 component-years for the normal, overweight, and obese groups were 0.92 (95% confidence interval [CI], 0.91 to 0.93), 1.15 (95% CI, 1.14 to 1.16), and 1.31 (95% CI, 1.30 to 1.33), respectively. This was not observed for the cementless UKR, with revision rates of 1.09 (95% CI, 1.08 to 1.11), 0.70 (95% CI, 0.68 to 0.71), and 0.96 (95% CI, 0.95 to 0.97), respectively. The 10-year implant survival rates for the matched cemented and cementless UKRs in the normal, overweight, and obese groups were 93.8% (95% CI, 89.1% to 96.5%) and 94.3% (95% CI, 90.9% to 96.5%) (hazard ratio [HR], 1.17; p = 0.63), 88.5% (95% CI, 84.2% to 91.7%) and 93.8% (95% CI, 90.2% to 96.2%) (HR, 0.61; p = 0.005), and 90.7% (95% CI, 88.2% to 92.6%) and 91.8% (95% CI, 88.9% to 94.0%) (HR, 0.74; p = 0.02), respectively. There were insufficient numbers in the underweight group for analysis (n = 13). Obese patients had less than half the rates of aseptic loosening (0.46% vs. 1.31%; p = 0.001) and pain (0.60% vs. 1.20%; p = 0.02) in the cementless group as compared with the cemented group. Higher-BMI groups had higher revision rates for the cemented UKRs but not for the cementless UKRs. Cementless fixation was associated with reduced long-term revision rates compared with cement fixation in the overweight and obese groups. In the obese group, the rates of aseptic loosening and pain were at least 50% lower in the cementless UKR group. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.