RT Journal Article SR Electronic T1 Effect of hand packing versus cement gun pressurization on cement mantle in total knee arthroplasty JF Canadian Journal of Surgery JO CAN J SURG FD Canadian Medical Association SP 490 OP 494 VO 52 IS 6 A1 Michael Kopec A1 Joseph C. Milbrandt A1 Todd Duellman A1 Doug Mangan A1 D. Gordon Allan YR 2009 UL http://canjsurg.ca/content/52/6/490.abstract AB Background: Gun pressurization in total knee arthroplasty (TKA) may result in better cement penetration than hand packing, leading to fewer tibial plate failures. We compared cement intrusion characteristics between vacuum mixing and gun pressurization versus hand mixing and packing in the proximal tibia among patients undergoing TKA.Methods: We analyzed 6-week radiographs from 77 consecutive patients for cement area and zone-specific intrusion using computer-assisted image analysis.Results: Penetration into tibial anteroposterior zones 1–6 was not significantly different between the techniques. Intrusion depths in anteroposterior zone 7 and lateral zone 2 were significantly increased with gun pressurization, but this increase was associated with significantly longer operating room and tourniquet times.Conclusion: We identified no obvious advantage of vacuum mixing with gun pressurization, suggesting that continued use of the hand-packing technique may be warranted. Additional long-term failure studies must be completed to compare these techniques.