Our study looked at the short and medium-term results of a new and cost-effective method of bone surface preparation and cement introduction. Early failure and loosening of components in knee arthroplasty has been attributed to inadequate bone-cement and prosthesis- cement interfaces, established at the time of surgery. Cement pressurisation and interosseus suction have been shown to achieve effective cement penetration and interdigitation into cancellous bone. We have devised a technique of cement pressurisation using a modified 20 ml syringe, combined with interosseus suction. Retrospective evaluation of a series of 50 post-operative radiographs of total knee replacements, undertaken without the use of tourniquet, have shown that even and effective penetration of cement to a depth of 8.0 10.6 mm can be achieved consistently using this technique. Evaluation of post-operative radiographs at a minimum of 5 years follow-up showed 16 knees with minor lucent lines about the tibial component with a maximum Knee Society Total Knee Arthroplasty Roentgenographic Score of 2. In conclusion, we propose that this simple technique of bone surface preparation and cement introduction produces good results in the short and medium term. Correspondence should be addressed to Major M Butler RAMC, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon.
To evaluate if adequate restoration of the medial cortical buttress reduces the high reported incidence of mechanical complications when using the AO unreamed femoral nail with spiral blade (UFN-SB) in the management of subtrochanteric femoral fractures. The clinical notes and radiographs of sixty-five patients treated with the UFN-SB between November 1996 and February 1999 were retrospectively reviewed. Twenty-eight of these fractures were subtrochanteric. Mean patient age was seventy-five and thirteen patients had metastatic disease. At the time of review the patients or their doctor were contacted by telephone to establish accurately the associated morbidity and mortality. Follow up information was obtained for every patient. Post-operative radiographs were assessed for accuracy of fracture reduction. The medial cortical buttress was adequately restored in every case. This required open fracture reduction in eleven patients and cerclage wires augmented the reduction in eight of these cases. Open reduction did not significantly increase time to fracture union or transfusion requirement. Every surviving patient was fully weight bearing within three months. One patient required a second operation for spiral blade migration but there were no implant breakages or other mechanical complications after a mean follow-up of thirty-seven months.
