Cement delivery depends on cement gun performance and cement viscosity

Aim: Retrograde cement application is considered an integral part of the modern femoral cementing technique. Both pressurisation and rapid cement application reduce the risk of interface bleeding and blood laminations. In this context cement gun performance has received little attention. Method: In our study we examined the handling characteristics of four different cement delivery systems (Syringe(R), Vaku-Mix(R), Optivac(R) and MixOR(R)-System). To allow for cement viscosity as another variable, six different bone cements (Palacos(R) R, Palamed G(R), CMW 1 Radiopak(R), CMW 20001, Simplex(R) P, VersaBond(R)) were used with each system. We recorded cement gun performance and measured extrusion times and maximum cement delivery speeds of all possible combinations (gun/mixing system plus cement type). Results: The fastest cement application could be achieved with the Vaku-Mix(R) cement delivery system and the corresponding cement gun (Mark III). With regard to cement type, VersaBond(R) and prechilled Palacos(R) yielded significantly shorter extrusion times than most of the other cements due to their lower viscosities. Conclusion: Our results have shown significantly different efficacies of commonly used cement delivery systems/guns in clinical routine. Improved systems should be provided by the suppliers.