The Effect of Bone Lavage on Femoral Cement Penetration and Interface Temperature During Oxford Unicompartmental Knee Arthroplasty with Cement

Seeger, Jörn Bengt; Jaeger, Sebastian; Bitsch, Rudi G.; Mohr, G.; Röhner, Eric; Clarius, Michael

doi:10.2106/jbjs.k.01116

Cited by 35 publications

(24 citation statements)

References 26 publications

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“…27 Thorough pulsatile lavage should be performed and cement should be pressurised into the central peg hole and multiple anchorage holes should be drilled into the sclerotic bone to facilitate penetration of the cement. 13,27 In order to create a reproducible experimental setup, we did not simulate adverse conditions such as poor cementing technique, or inaccuracies in the posterior saw cut. However, it may be that differences in stability between the two designs only become apparent in adverse conditions: this may be a subject for future studies.…”

Section: Discussionmentioning

confidence: 99%

“…12 Loosening is a result of mechanical failure at the interface between the cement and either the bone or the component. 13 In 2003, a new design of femoral component was introduced for the cemented Oxford UKR (OUKR, Biomet Ltd, Bridgend, UK). In an attempt to improve the primary stability of the component, this design included an additional peg placed anterior to the existing peg.…”

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confidence: 99%

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The stability of the femoral component in the Oxford unicompartmental knee replacement

Reiner

Jaeger

Schwarze

et al. 2014

The Bone & Joint Journal

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Aseptic loosening of the femoral component is an important indication for revision surgery in unicompartmental knee replacement (UKR). A new design of femoral component with an additional peg was introduced for the cemented Oxford UKR to increase its stability. The purpose of this study was to compare the primary stability of the two designs of component. Medial Oxford UKR was performed in 12 pairs of human cadaver knees. In each pair, one knee received the single peg and one received the twin peg design. Three dimensional micromotion and subsidence of the component in relation to the bone was measured under cyclical loading at flexion of 40° and 70° using an optical measuring system. Wilcoxon matched pairs signed-rank test was performed to detect differences between the two groups. There was no significant difference in the relative micromotion (p = 0.791 and 0.380, respectively) and subsidence (p = 0.301 and 0.176, respectively) of the component between the two groups at both angles of flexion. Both designs of component offered good strength of fixation in this cadaver study.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The stability of the femoral component in the Oxford unicompartmental knee replacement

Reiner

Jaeger

Schwarze

et al. 2014

The Bone & Joint Journal

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“…87 High-pressure pulsatile lavage may have potential benefits of being time saving and effective for removing necrotic tissue and debris, and may offer better mechanical stability for cemented arthroplasty by allowing better cement penetration in cancellous bone tissue. 88,89 However, concerns exist regarding mechanical damage to the tissues, propagation of bacteria into deeper layers of tissue, and negative influence on healing and new bone formation. 90,91 As for wound closure, there is no strong evidence demonstrating clear superiority of one method of closure over the others.…”

Section: Intraoperative Strategiesmentioning

confidence: 99%

Prevention of Periprosthetic Joint Infection: What Are the Effective Strategies?

2014

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Periprosthetic joint infection (PJI) following total knee arthroplasty is a major burden for patients and health systems. Prevention of this challenging complication through implementation of effective strategies should be a priority. These strategies should encompass various levels of patient care. Multiple modifiable risk factors such as uncontrolled hyperglycemia, obesity, smoking, substance abuse, and nasal colonization with Staphylococcus aureus have been described for PJI. Preoperative recognition and mitigation of these risk factors along with optimization of nonmodifiable risk factors such as kidney, liver, or immune system insufficiency can considerably decrease the risk of PJI. A comprehensive perioperative protocol should involve optimization of the operative environment to reduce the number of bacteria and particulates in the air. Several surgical and nonsurgical details of intraoperative care such as maintenance of normothermia, skin preparation, surgical field irrigation, wound closure, and duration of surgical and anesthetic procedure can influence the occurrence of PJI. Prophylactic perioperative antibiotic administration is probably one of the most important strategies in preventing PJI. Implementation of surgical safety checklist can diminish the risk of perioperative complications, particularly surgical site infection. Controversy regarding efficacy, efficiency, and optimization of some preventive measures continues to exist due to inconsistency or inadequacy of available evidence. Novel research has focused on designing PJI-resistant implants and developing vaccines that target molecule components with major role in the process of bacterial adhesion to the implant or periprosthetic tissues.

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“…Generally below 15 psi (103.4 kPa) and over 35 psi (241.3 kPa) are considered low or high pressure, respectively . High‐pulsatile lavage has been shown to improve cement penetration in cancellous bone and increase mechanical strength at the cement‐bone interface during in vitro studies . In vivo studies have also demonstrated fewer radiolucency zones in follow up X‐rays evaluation .…”

Section: Question 31: Is Irrigation Useful? How Should the Delivery Mmentioning

confidence: 99%

Operative Environment

Alijanipour¹,

Karam²,

Llinás³

et al. 2014

Journal Orthopaedic Research

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The Effect of Bone Lavage on Femoral Cement Penetration and Interface Temperature During Oxford Unicompartmental Knee Arthroplasty with Cement

Abstract: Pulsed lavage leads to an increased femoral cement penetration without the risk of heat necrosis at the bone-cement interface.

Cited by 35 publications

References 26 publications

The stability of the femoral component in the Oxford unicompartmental knee replacement

The stability of the femoral component in the Oxford unicompartmental knee replacement

Prevention of Periprosthetic Joint Infection: What Are the Effective Strategies?

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