Medical Instruments and Tools for Bone Cement Remove in Knee Revision Arthroplasty: A comparative Review

Abstract

Revision Total knee arthroplasty (rTKA) implies significant surgical difficulty and removal of cement is still considered one of the most technically-challenging elements. Retention of cement is associated with peri-prosthetic infection (PJI) which may be responsible in cases of bone wasting away and loosening of the implant. Modern methods of cement removal in rTKA are discussed with a critical approach, namely non-powered manual equipment; powered equipment such as high-speed burrs, flexible reamers, ultrasonic based equipment, endoscopy-assisted surgery, and surgical procedures such as cortical windows and bone episiotomies. The comparisons between the benefits and limitations of both of the methods are based on efficacy, bone preservation, the invasiveness of the method, and the possibility of complications. The following synthesis provides an insight that personalized intervention that considers patient anatomy, characteristics of cement and fixation of implants is vital to good results. The recent innovations in ultrasonic and endoscopic technologies present an effective way forward when it is safer and more effective in extracting cement during the future rTKA surgeries.