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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mercredi 20 février 2019
Doi : 10.1016/j.otsr.2018.11.022
Received : 27 June 2018 ;  accepted : 19 November 2018
Bone cement usage modalities at a multi-site university hospital centre
 

Marine Barral a, Laure Lalande a, Anthony Viste b, c, Jean-Luc Besse b, c, Michel-Henri Fessy b, c, Emmanuelle Carre a,
a Service de Pharmacie, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France 
b Service de Chirurgie Orthopédique et Traumatologique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France 
c Laboratoire de Biomécanique et Mécanique des Chocs, Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, 69675 Bron cedex, France 

Corresponding author. Service de Pharmacie, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France.Service de Pharmacie, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud165, chemin du Grand Revoyet Pierre-Bénite cedex69495France
Abstract
Background

Although cements are widely used during arthroplasty procedures, few recommendations exist regarding their optimal usage modalities, which, nevertheless, govern the long-term surgical outcomes. No detailed information is available on how cements are used in French hospitals. The objectives of this questionnaire survey among surgeons working at a multi-site university hospital in France were to describe practices, determine whether these varied with surgeon experience, and look for differences compared to recommendations.

Hypothesis

Cementing techniques vary widely among surgeons at a university hospital.

Material and methods

A questionnaire was sent to the five orthopaedic departments of our university hospital to collect data on the surgeons (age, sex, years of experience), their practice (type of implants used, annual number of arthroplasties with each arthroplasty type and each indication, and proportion of cemented arthroplasties), the type of cement used, and the cementing technique.

Results

Of the 34 surgeons, 21 completed the questionnaire, 20 males and 1 female with a mean age of 41 years (range, 31–59 years) and a mean of 11 years (range, 1–29 years) of experience. High-viscosity antibiotic-loaded cement was preferred by 20 (95%) surgeons, notably for knee arthroplasties, of which the median annual numbers were 55 (range, 0–218) and 8 (range, 1–40) for primary and revision cemented procedures, respectively. Various cementing techniques in ambient air were used: 12/21 (57%) surgeons used pulsed lavage to prepare the bone before cementation and 18/21 (86%) applied the cement to both the bone cuts and the implant. Of the 18 surgeons who performed knee arthroplasties, 12 used pulsed lavage, including 9 of the 11 surgeons with more than 5 years of experience and only 3 of the 7 less experienced surgeons. Similarly, of the 12 surgeons who used pulsed lavage for cemented arthroplasties, 11 were among the 12 surgeons who performed more than 15 cemented arthroplasties annually and 1 was among the 6 who performed fewer cemented arthroplasties.

Discussion

Cementing techniques varied widely, reflecting the dearth of recommendations and controversial results of published studies. In our centre, the use of pulsed lavage to improve bone preparation and cement application to both the bone and the implant should be promoted, as both techniques are universally advocated. Our study demonstrates the need to provide surgeons with opportunities to exchange their experiences about the other aspects of cementing in order to harmonise practices and to optimise the use of cement.

Level of evidence

IV, questionnaire survey.

The full text of this article is available in PDF format.

Keywords : Bone cement, Survey, Cementing technique, Guidelines




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