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Less pain, better knee scores with calcium phosphate cement augmentation
Up to six months, patients treated with Norian SRS did better compared to those treated with bone graft.
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Patients with tibial plateau fractures augmented with calcium phosphate cement reported less pain and had better knee scores compared with their counterparts whose fractures were augmented with iliac crest bone graft, a Swedish study revealed.
“The development of new biomaterials such as calcium phosphate has made it possible to challenge the use of conventional bone graft in the augmentation of tibial plateau fractures,” said lead investigator Sune Larsson, MD, at the Orthopaedic Trauma Specialty Day meeting during the American Academy of Orthopaedic Surgeons 72nd Annual Meeting.
Larsson and his colleagues in the department of orthopaedics, Uppsala University Hospital, Uppsala, Sweden, studied 24 patients with lateral tibial plateau fractures who were randomized either to internal fixation augmented with injectable calcium phosphate cement (Norian SRS, Synthes) in the subchondral void or the same type of internal fixation augmented with conventional iliac crest bone graft.
RSA measured stability
The surgeons implanted tantalum markers during surgery to enable them to evaluate articular fragment stability via radiostereometry (RSA) technique, Larsson said. RSA is a precise radiologic technique that allows measurement of movement along and around three orthogonal axes with a precision of less than 0.5 mm and 0.7º, he explained.
Following surgery, weight-bearing was restricted to 20 kg for six weeks in the SRS group and for 12 weeks in the bone graft group. RSA was performed before weight-bearing and at one, six, and 12 weeks, and at six and 12 months.
A physiotherapist did clinical evaluations, Larsson said. Patients’ compliance with weight-bearing restrictions was evaluated using an F Scan (Tecscan Inc.) to look at the load during walking at each follow-up.
Less pain up to six months
Larsson reported that pain during activity was lower in the SRS group at one week (P<.01), six weeks (P<.0004), three months (P<.005), and at six months (P<.02), with no difference at one year. Lysholm knee scores were better at six weeks (P<.01), 12 weeks (P<.002) and six months (P<.02) in the SRS group, and there was no significant difference at one year.
RSA revealed articular fragment movement in all patients. The total translation was, on average, 1.5 mm in the SRS group and 3.5 mm in the bone graft group (P<.001), Larsson reported. In both groups, the most significant movement occurred during the fiirst six weeks.
“It seems that the calcium phosphate cement is a very attractive way of dealing with tibial plateau fractures,” Larsson said.
For more information
- Larsson S, Berg P, Sagerfors M. Augmentation of tibial plateau fractures with calcium phosphate cement: A randomized study using radiostereometry. Presented at the Orthopaedic Trauma Association Specialty Day. Feb. 26, 2005. Washington.