Effectiveness Testing of Combined Innovative Pressurized
Carbon Dioxide Lavage and Pulsatile Normal Saline
Irrigation to Enhance Bone Cement Penetration in
Total Knee Replacement: A Cadaveric Study
Krit Boontanapibul MD*, Pakpoom Ruangsomboon MD**,
Chaturong Pornrattanamaneewong MD**, Keerati Charoencholvanich MD**
Affiliation :
* Department of Orthopaedic Surgery, Chulabhorn International College of Medicine,
Thammasat University, Pathum Thani, Thailand
** Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : The cementing technique in total knee arthroplasty (TKA) is essential for a successful outcome. Previous
studies have shown that deeper cement penetration results in greater tensile and shear strength between the bony part and
the prosthetic parts.
Objective : To investigate the effectiveness of combined innovative pressurized carbon dioxide lavage and pulsatile normal
saline irrigation for enhancing cement penetration into cancellous bone, as compared with standard pulsatile normal
irrigation alone.
Material and Method: An intra-individual comparative cadaveric study was conducted at the Department of Orthopaedic
Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University in April 2015. Ten fresh cadavers underwent TKA via
the medial parapatellar approach. The proximal tibia was cut perpendicular to its anatomical axis at a point nine millimeters
inferior to the lateral plateau. After randomization of knees, the proximal tibia of one side was prepared with pulsatile
normal saline irrigation followed by innovative pressurized carbon dioxide lavage. The contralateral side was then prepared
using standard pulsatile normal saline irrigation alone. After completing bilateral cemented TKA, the tibial prostheses were
removed from both knees. The proximal tibia was then cut on three planes. The posterior coronal plane cut, the medial
sagittal oblique plane cut, and the lateral sagittal oblique plane cut facilitated visualization and measurement of the depth
of cement penetration into the posterior, middle, and lateral columns, respectively. A bone sample from each column was
measured by digital vernier caliper to evaluate bone cement penetration.
Results : Combined innovative pressurized carbon dioxide lavage and pulsatile normal saline irrigation produced significantly
deeper cement penetration into cancellous bone, as compared with pulsatile normal irrigation alone (1.90±0.39 mm vs.
1.21±0.21 mm, p = 0.04).
Conclusion : Combined innovative pressurized carbon dioxide lavage and pulsatile normal saline irrigation produced
significantly deeper bone cement penetration than pulsatile normal saline irrigation alone.
Keywords : Carbon dioxide, Therapeutic irrigation, Arthroplasty, Replacement, Knee, Prostheses and implants, Lavage,
Cemented, Knee arthroplasty, Prostheses
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