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

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.

Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution.Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated. Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm3 vs. 4344 mm3, P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group. Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.

Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution. Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated. Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm 3 vs. 4344 mm 3 , P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group. Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.

No effect of femoral canal jet-lavage on the stability of cementless stems in primary hip arthroplasty: a randomised RSA study with 6 years follow-up

Introduction: In contrast to cemented hip prostheses, the effect of washing the bone bed with jet-lavage prior to insertion of cementless stem components in primary hip arthroplasty (THA) is unclear. Jet-lavage potentially decreases the risk of fat embolisation during rasping and stem insertion and might help in avoiding bacterial contamination. An earlier animal study has shown less debris and better-organised trabecular structure of new bone when jet-lavage was used. We hypothesised that the primary stability of cementless femoral stems implanted after jet-lavage of the femoral canal prior to stem insertion would improve with earlier stabilisation, as measured with Radiostereometry (RSA), compared with insertion without prior jet-lavage. Methods: 40 patients with primary osteoarthritis operated on with a cementless titanium grit blasted stem are included in the study. The patients were randomised to either jet-lavage or control without any lavage of the femoral canal prior to insertion of the prosthesis. The stem migration pattern was measured with RSA at 0, 3, 12, 24 and 72 months. Results: At 6 years, 19 patients remained for analysis in the jet-lavage and 18 in the control group. We found no difference in extent or pattern of migration as measured with RSA. Both groups seemed to have stabilised within 3 months after a slight subsidence and retroversion. No stem was revised or considered loose as measured with RSA. Conclusions: Washing the bone bed with jet-lavage prior to insertion of cementless stems does not affect the stability of cementless femoral components. No adverse effects were observed.

Der gefäßgestielte Omentumlappen zur Behandlung tiefer sternaler Wundinfekte

Zusammenfassung Zielsetzung Defektdeckung einer persistierenden, sternalen Wundheilungsstörung, die nach frustranem Deckungsversuch mittels eines gestielten Latissimus-dorsi-Lappens durch eine Omentumplastik zur Ausheilung gebracht wurde. Indikation Tiefe sternale Wundheilungsstörungen sind seltene, aber schwerwiegende Komplikationen nach medianer Sternotomie. Wenn reguläre Deckungsverfahren fehlschlagen oder nicht zu entfernendes Fremdmaterial wie „Drivelines“ oder Gefäßprothesen mittels Muskellappen nicht zur Ausheilung gebracht werden können, bildet der Omentumlappen, aufgrund seiner immunologischen Kompetenz, eine sinnvolle Alternative. Methode Nach Exploration des persistierenden, sternalen Defekts schießt sich das radikale tangentiale Débridement und die Spülung der Wunde mittels einer Jet-Lavage an. Das Gewebe des Omentums wird nach Medianlaparotomie und Präparation des Lappens durch einen im vorderen Diaphragma angelegten Tunnel in den Defekt verlagert und kann hier spannungsfrei zur Ummantelung der Prothese verwendet werden. Der im Vorfeld verwendete Latissimuslappen wird in diesem Fall für den oberflächlichen Weichteilverschluss wiederverwendet. Schlussfolgerung Insbesondere bei infiziertem, nicht entfernbarem Restmaterial stellt der Omentumlappen aufgrund seiner immunologischen Kompetenz eine gute Behandlungsalternative zu Muskellappen dar.