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

Gapinski, Zachary A.; Yee, Elliott J.; Kraus, Kent R.; Deckard, Evan R.; Meneghini, R. Michael

doi:10.1016/j.arth.2019.03.050

Cited by 15 publications

(12 citation statements)

References 30 publications

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“…In 2019, Gapinski et al revealed that using sterile compressed carbon dioxide in addition to the established pulsatile jet lavage, resulted in a deeper cement penetration in six of seven defined zones (Knee Society Radiographic Evaluation System) in 303 total knee endoprostheses. This difference was significant in three out of seven zones [31].…”

Section: Discussionmentioning

confidence: 84%

“…A cadaveric study demonstrated that a combination of pressurized carbon dioxide and common pulsatile saline lavage produced a significantly deeper bone cement penetration than saline lavage alone [30]. Another study from 2019 showed that by using sterile compressed CO 2 in addition to the established pulsatile lavage, a significantly deeper cement penetration in three of seven defined zones (Knee Society Radiographic Evaluation System) could be achieved in 303 total knee endoprosthesis [31]. In addition bone cement interface was stronger in an experimental study using human radii [32].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Cemented implant fixation in total joint arthroplasty has been proven to be safe and reliable with good long-term results. However, aseptic loosening is one of the main reasons for revision, potentially caused by poor cementation with low penetration depth in the cancellous bone. Aim of this prospective laboratory study was, to compare impact pressure and cleaning effects of pulsatile saline lavage to novel carbon dioxide lavage in a standardized carbon foam setup, to determine whether or not additional use of carbon dioxide lavage has any impact on cleaning volume or cleaning depth in cancellous bone. Carbon specimens simulating human cancellous bone were filled with industrial grease and then underwent a standardized cleaning procedure. Specimens underwent computed tomography pre- and post-cleaning. Regarding the impact pressure, isolated carbon dioxide lavage showed significant lower pressure compared to pulsatile saline lavage. Even though the combination of carbon dioxide lavage and pulsatile saline lavage had a positive cleaning effect compared to the isolated use of pulsatile saline lavage or carbon dioxide lavage, this was not significant in terms of cleaning volume or cleaning depth.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…The remaining 12 articles were deemed appropriate. Finally, we identified 1231 patients (1231 knees) assessed in (8 RCTs [7,10,(13)(14)(15)17,22,24] and 4 NRSIs [9,11,12,16])…”

Section: Search Resultsmentioning

confidence: 99%

“…The potential benefit of tourniquet use was to aid in preparing the bone surface for cementation by reducing the blood and fat in the field and offers better visualization due to bloodless field, which would facilitate cementing quality [8]. Some literature found tourniquet use will increase the bone cement penetration [7,[9][10][11][12]. However, some studies suggest that tourniquet use does not affect cement mantle penetration [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

The impact of tourniquet on tibial bone cement penetration in different zones in primary total knee arthroplasty: a meta-analysis

et al. 2021

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Background Cement mantle penetration and the cement–bone interface strength were critical to a successful primary total knee arthroplasty (TKA). It remained unclear whether decreased blood and fat in the cancellous bone achieved with the use of a tourniquet increases tibial cement mantle penetration in different zones on AP and lateral view in TKA according to criteria defined by the Knee Society Scoring System (KSS). The purpose of this study was to determine whether tourniquet use influences tibial cement mantle penetration in different zones on AP and lateral view in TKA according to KSS. Methods We conducted a meta-analysis to identify studies involving the impact of tourniquet use and no tourniquet use on tibial bone cement penetration in primary TKA in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, VIP, Wanfang database, up to January 2021. Finally, we identified 1231 patients (1231 knees) assessed in twelve studies. Results Tourniquet use increases the cumulative cement mantle penetration (P < 0.00001), mean cement mantle penetration (P = 0.004), and cement mantle in zone 3(P < 0.0001) on AP view. However, there were no significant differences in cement mantle in zone 1(P = 0.5), zone 2(P =0 .54), zone 4(P = 0.07) on AP view, and zone 1(P = 0.32), zone 2(P = 0.38) on lateral view between two groups. There were also no significant differences in length of surgery(P = 0.7), change in hemoglobin(P = 0.4), transfusion rates(P = 0.47), and complications such as muscular calf vein thrombosis(P = 0.21), superficial infection (P = 0.72), and deep vein thrombosis (P = 0.66) between two groups. Conclusion The application of a tourniquet increases the thickness of the tibial bone cement penetration—the increase in the thickness of bone cement penetration mainly located in zone 3 on the anteroposterior (AP) view.

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“…Cementation technique was evaluated using a modified version of the procedures outlined by Meneghini et al. [ 18 ] and Ozkunt et al [ 19 ]. We did not manually measure cement penetration as there has been no study definitively showing that there is an optimal depth of cementation for rTKA.…”

Section: Methodsmentioning

confidence: 99%

Are there avoidable causes of early revision total knee arthroplasty?

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Kreinces

Schwarzkopf

et al. 2022

Knee Surg & Relat Res

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Introduction Surgeons can improve their practice by understanding potentially avoidable reasons for early revision total knee arthroplasty (rTKA). The purpose of this study is to describe potentially avoidable indications for rTKA within 5 years of the index procedure. Methods This retrospective observational analysis utilized the rTKA database at a large, academic orthopedic specialty hospital to identify 167 consecutive rTKA from 2014 to 2019 performed within 5 years after primary TKA (pTKA). Two fellowship-trained arthroplasty surgeons reviewed the cases to classify them as potentially avoidable or unavoidable. Unavoidable indications for rTKA included infection/wound complication, arthrofibrosis, instability due to underlying collagen disease or significant weight loss, and any traumatic event leading to pTKA failure. Potentially avoidable indications included atraumatic instability, intraoperative fracture, metal allergy, and atraumatic patellar instability or maltracking. Aseptic loosening was considered avoidable if it occurred in the presence of component malpositioning or poor cementation technique. Results There were 112 (67.1%) unavoidable cases and 55 avoidable cases (32.9%). Of the unavoidable cases, there were 68 rTKA for infection or wound complications (60.7%), 23 for arthrofibrosis (20.5%), 6 for instability (5.4%), 6 for postoperative fracture (5.4%), 6 for aseptic loosening (5.4%), and 3 for extensor mechanism pathology following trauma (2.6%). Of the potentially avoidable rTKA, 24 were for aseptic loosening (43.7%), 23 for atraumatic instability (41.8%), 6 for atraumatic extensor mechanism pathology (10.9%), 1 for nickel allergy (1.8%), and 1 for intraoperative fracture (1.8%). Conclusion These findings indicate that over 30% of early rTKA are potentially avoidable. Interventions should focus on addressing potentially avoidable causes such as short-term aseptic loosening and instability to reduce the need for costly and resource-intensive rTKA. Level of evidence III, retrospective observational analysis

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

Cited by 15 publications

References 30 publications

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

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

The impact of tourniquet on tibial bone cement penetration in different zones in primary total knee arthroplasty: a meta-analysis

Are there avoidable causes of early revision total knee arthroplasty?

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