Abstract
Background
Tourniquetless total knee arthroplasty (TKA) is experiencing resurgence in popularity
due to potential pain control benefits. Furthermore, optimal cement technique and
implant fixation remain paramount to long-term cemented TKA success, as aseptic loosening
continues to be a leading cause of revision. The purpose of this study is to determine
how tourniquet use and/or novel bone preparation using sterile, compressed carbon
dioxide (CO2) gas affected cement penetration in TKA.
Methods
A retrospective review was performed on 303 consecutive primary TKAs with the same
implant in 3 groups: (1) a tourniquet without sterile CO2 compressed gas used for bone preparation, (2) no tourniquet with CO2 gas, and (3) tourniquet use and CO2 gas bone preparation. Cement penetration was measured on radiographs by two independent,
blinded raters across 7 zones defined by the Knee Society Radiographic Evaluation
System.
Results
The 3 groups did not differ on age, body mass index, or gender (P ≥ .1). Cement penetration was greater in 6 of 7 zones with significantly greater
cement penetration in 3 zones (tibial anteroposterior zone 2, femoral lateral zones
3A and 3P) in groups that utilized CO2 gas bone preparation compared to the tourniquet only group (P ≤ .039).
Conclusion
Bone prepared with CO2 gas showed significantly more cement penetration in 3 zones with greater cancellous
bone. The results suggest that use of CO2 gas bone preparation may achieve greater cement penetration than using a tourniquet
with lavage only.
Keywords
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Article info
Publication history
Published online: March 28, 2019
Accepted:
March 20,
2019
Received in revised form:
March 11,
2019
Received:
January 7,
2019
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.03.050.
Source of Funding: The Indiana University Hip and Knee Center Research Program is supported by the Indiana University Health, United States - Indiana University School of Medicine Strategic Research Initiative.
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