Abstract
The modern cementing technique in cemented arthroplasty is a highly standardized and, therefore, safe procedure. Nevertheless, aseptic loosening is still the main reason for revision after cemented total knee or cemented total hip arthroplasty. To investigate whether an additional carbon dioxide lavage after a high-pressure pulsatile saline lavage has a positive effect on the bone–cement interface or cement penetration, we set up a standardized laboratory experiment with 28 human femoral heads. After a standardized cleaning procedure, the test implants were cemented onto the cancellous bone. Subsequently, the maximum failure load of the bone–cement interface was determined using a material testing machine to pull off the implant, and the cement penetration was determined using computed tomography. Neither the maximum failure load nor cement penetration into the cancellous bone revealed significant differences between the groups. In conclusion, according to our experiments, the additive use of the carbon dioxide lavage after the high-pressure pulsatile lavage has no additional benefit for the cleaning of the cancellous bone and, therefore, cannot be recommended without restrictions.
Highlights
During the last few decades, cementless fixation in total hip arthroplasty in Germany increased [1]
Cemented endoprosthesis is still important in patients with osteoporosis, complex anatomy, hemiarthroplasty, or revision cases
We investigated implant stability and cement penetration in 14 pairs of fresh frozen humanfemoral femoralheads heads(28 (28inintotal)
Summary
During the last few decades, cementless fixation in total hip arthroplasty in Germany increased [1]. A significant deeper bone cement penetration could be shown in a cadaveric study using a combination of pressurized carbon dioxide and common pulsatile saline lavage [33]. Embolic events were reported using a carbon dioxide lavage in intramedullary cleaning during cemented THA [36,37] The aim of this experimental cadaver study was to investigate two different methods of bone cleaning and their effect on cement penetration and bone–cement interface stability. For this purpose, a conventional pulsatile lavage was compared with a combination of a pulsatile lavage and an additional compressed carbon dioxide lavage
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