Bone-cement interface strength in distal radii using two medullary canal preparation techniques: carbon dioxide jet cleaning versus syringed saline

Does Additive Pressurized Carbon Dioxide Lavage Improve Cement Penetration and Bond Strength in Cemented Arthroplasty?

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.

The Effect of Tourniquet Use and Sterile Carbon Dioxide Gas Bone Preparation on Cement Penetration in Primary Total Knee Arthroplasty

BACKGROUND

Tourniquetless total knee arthroplasty (TKA) is experiencing resurgence in popularity due to potential pain control benefits. Furthermore, optimal cement technique and implant fixation remain paramount to long-term cemented TKA success, as aseptic loosening continues to be a leading cause of revision. The purpose of this study is to determine how tourniquet use and/or novel bone preparation using sterile, compressed carbon dioxide (CO₂) gas affected cement penetration in TKA.

METHODS

A retrospective review was performed on 303 consecutive primary TKAs with the same implant in 3 groups: (1) a tourniquet without sterile CO₂ compressed gas used for bone preparation, (2) no tourniquet with CO₂ gas, and (3) tourniquet use and CO₂ gas bone preparation. Cement penetration was measured on radiographs by two independent, blinded raters across 7 zones defined by the Knee Society Radiographic Evaluation System.

RESULTS

The 3 groups did not differ on age, body mass index, or gender (P ≥ .1). Cement penetration was greater in 6 of 7 zones with significantly greater cement penetration in 3 zones (tibial anteroposterior zone 2, femoral lateral zones 3A and 3P) in groups that utilized CO₂ gas bone preparation compared to the tourniquet only group (P ≤ .039).

CONCLUSION

Bone prepared with CO₂ gas showed significantly more cement penetration in 3 zones with greater cancellous bone. The results suggest that use of CO₂ gas bone preparation may achieve greater cement penetration than using a tourniquet with lavage only.

Effectiveness of Lavage Techniques in Removing Immunogenic Elements from Osteochondral Allografts

Objective This study aimed to compare standard saline lavage to combination saline and high-pressure carbon dioxide (CO₂) lavage in removing marrow elements from osteochondral allografts. Design Six fresh hemicondyles were obtained. Three osteochondral allograft plugs (15-mm diameter, 6-mm depth) were harvested from each hemicondyle and randomized to 1 of 3 treatment arms: A, no lavage; B, 1 L standard saline lavage; C, simultaneous saline (1 L) and 1-minute high-pressure CO₂ lavage. After hematoxylin and eosin staining, a "percentage fill" of remaining marrow elements was calculated for each overall sample and then repeated in 3 distinct compartments for each sample based on depth from surface: 1, deepest third; 2, middle third; and 3, most superficial third. Trial arms B and C were compared with 1-tailed Student t tests. Results Group A had an overall percentage fill of 51.2% ± 8.8%. While both lavage techniques decreased overall remaining marrow elements, group B yielded significantly higher percentages of remaining marrow elements than group C (28.6% ± 16.5%, 14.6% ± 8.7%, P = 0.045). On depth analysis, group A exhibited homogenous filling of trabecular space (63.0% ± 15.5%, 67.6% ± 13.7%, and 55.2% ± 10.1% in zones 1, 2, and 3, respectively). Both lavage arms equally removed marrow elements from superficial zone 3 (B, 17.4% ± 9.2%; C, 15.6% ± 12.4%, P = 0.41) and middle zone 2 (B, 30.2% ± 17.7%; C, 21.4% ± 15.5%, P = 0.18). However, group C lavage removed significantly more marrow elements in deep zone 1 than group B (29.7% ± 10.9%, 58.5% ± 25.2%, P = 0.01). Conclusion Combination saline and high-pressure CO₂ lavage more effectively clears marrow elements from osteochondral allografts than saline alone.