Does Pressurized Carbon Dioxide Lavage Improve Bone Cleaning in Cemented Arthroplasty?

Knappe, Kevin; Stadler, Christian; Innmann, Moritz M.; Schonhoff, Mareike; Gotterbarm, Tobias; Renkawitz, Tobias; Jaeger, Sebastian

doi:10.3390/app11136103

Cited by 3 publications

(2 citation statements)

References 37 publications

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“…One limitation to this study is the usage of an established standardized carbon foam model [ 35 , 36 , 37 ] since it does not contain human bone marrow. To overcome this, industrial grease with comparable properties was used.…”

Section: Discussionmentioning

confidence: 99%

“…To determine the cleaning effect of the investigated lavage systems, we used validated and standardized carbon foam specimens (RVC foam; ERG Materials and Aerospace, Oakland, CA, USA) as substitutes for human cancellous bone [ 35 , 36 , 37 ]. Carbon specimens showed a porosity of 30 pores per inch, which correspond to 1.2 pores per millimeter.…”

Section: Methodsmentioning

confidence: 99%

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Pulsatile Lavage Systems with High Impact Pressure and High Flow Produce Cleaner Cancellous Bone Prior to Cementation in Cemented Arthroplasty

Knappe

Bitsch²,

Schonhoff

et al. 2021

JCM

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In cemented joint arthroplasty, state-of-the-art cementing techniques include high-pressure pulsatile saline lavage prior to cementation. Even with its outstanding importance in cementation, there are surprisingly few studies regarding the physical parameters that define pulsatile lavage systems. To investigate the parameters of impact pressure, flow rate, frequency and the cleaning effect in cancellous bone, we established a standardized laboratory model. Standardized fat-filled carbon foam specimens representing human cancellous bone were cleaned with three different high-pressure pulsatile lavage systems. Via CT scans before and after cleaning, the cleaning effect was evaluated. All systems showed a cleaning depth of at least 3.0 mm and therefore can be generally recommended to clean cancellous bone in cemented joint arthroplasty. When comparing the three lavage systems, the study showed significant differences regarding cleaning depths and volume, with one system being superior to its peer systems. Regarding the physical parameters, high impact pressure in combination with high flow rate and longer distance to the flushed object seems to be the best combination to improve the cleaning of cancellous bone and therefore increase the chances of a deeper cement penetration that is required in cemented joint arthroplasty. In summary, this study provides the first standardized comparison of different lavage systems and thus gives initial guidance on how to optimally prepare cancellous bone for cemented joint arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Pulsatile Lavage Systems with High Impact Pressure and High Flow Produce Cleaner Cancellous Bone Prior to Cementation in Cemented Arthroplasty

Knappe

Bitsch²,

Schonhoff

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

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Special Issue on Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases

Welke

Seehaus

2022

Applied Sciences

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

Knappe

Stadler²,

Innmann

et al. 2021

JCM

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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.

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Does Pressurized Carbon Dioxide Lavage Improve Bone Cleaning in Cemented Arthroplasty?

Cited by 3 publications

References 37 publications

Pulsatile Lavage Systems with High Impact Pressure and High Flow Produce Cleaner Cancellous Bone Prior to Cementation in Cemented Arthroplasty

Pulsatile Lavage Systems with High Impact Pressure and High Flow Produce Cleaner Cancellous Bone Prior to Cementation in Cemented Arthroplasty

Special Issue on Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases

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

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