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J Knee Surg 2023; 36(04): 417-423
DOI: 10.1055/s-0041-1735310
Original Article

Pulsatile Lavage Improves Tibial Cement Penetration and Implant Stability in Medial Unicompartmental Arthroplasty: A Cadaveric Study

Johannes A. Eckert 
1   Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
,
Rudi G. Bitsch
1   Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
2   Deutsches Gelenkzentrum in der ATOS Klinik Heidelberg GmbH & Co. KG, Heidelberg, Germany
,
Stefan Schroeder
1   Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
,
Martin Schwarze 
1   Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
,
Sebastian Jaeger
1   Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
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Abstract

Cemented unicompartmental knee arthroplasty (UKA) shows good survivorship and function. However, implant failure, causing the need for revision, can occur. Aseptic loosening is still among the most common reasons for revision. The purpose of this study was to assess the influence of preimplantation lavage technique on tibial cement penetration depth, tibial cement volume, and load to fracture in the tibial component of mobile-bearing UKA. In 10 pairs of fresh frozen human tibiae, cemented UKA was implanted by an experienced surgeon. Tibial components were then implanted, left and right tibiae were randomly allocated to group A or B. Prior to implantation, irrigation was performed with either syringe lavage or pulsatile jet lavage in a standardized manner. Cement surface was 4170.2 mm2 (3271.6–5497.8 mm2) in the syringe lavage group, whereas the jet lavage group showed 4499.3 mm2 (3354.3–5809.1 mm2); cement volume was significantly higher as well (4143.4 mm3 (2956.6–6198.6 mm3) compared with 5936.9 mm3 (3077.5–8183.1 mm3)). Cement penetration depth was 2.5 mm (1.7–3.2 mm) for the jet lavage, and 1.8 mm (1.2–2.4 mm) for the syringe lavage. The mean fracture load was 4680 N in the jet lavage group and 3800 N in the syringe lavage group (p = 0.001). Subsidence was significantly higher for syringe lavage. This study suggests a correlation of cement penetration depth and cement volume to implant failure in the tibial component of a UKA using a cadaveric model. The type of bone lavage most likely influences these two key parameters.

Keywords

oxford unicompartmental knee replacement - lavage - cementing


Publication History

Received: 08 November 2019

Accepted: 22 July 2021

Article published online:
10 September 2021

© 2021. Thieme. All rights reserved.

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