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

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.