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The Effect of Bone Lavage on Femoral Cement Penetration and Interface Temperature During Oxford Unicompartmental Knee Arthroplasty with Cement
J.B. Seeger, MD1; S. Jaeger, MSc2; R.G. Bitsch, MD, PhD2; G. Mohr, MD3; E. Röhner, MD4; M. Clarius, MD, PhD3
1 Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstraße 33, 35392 Giessen, Germany
2 Department of Orthopaedics, Traumatology and Paraplegiology, Heidelberg University Hospital, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
3 Department of Orthopaedic and Trauma Surgery, Vulpius Klinik GmbH, Vulpiusstraße 29, 74906 Bad Rappenau, Germany. E-mail address for M. Clarius: clarius@vulpiusklinik.de
4 Department of Traumatology and Orthopaedics, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Investigation performed at the Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg, Germany

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jan 02;95(1):48-53. doi: 10.2106/JBJS.K.01116
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Aseptic loosening is the most common cause for revision unicompartmental knee arthroplasty and is associated with failure of the bone-cement or cement-implant interface. The purpose of the present study was to analyze different bone lavage techniques for the bone-cement and cement-implant interfaces of the femoral component and to study the effect of these techniques on cement penetration and on interface temperature.


In an experimental cadaver study, Oxford unicompartmental knee arthroplasty was performed in twenty-four matched-paired knees to study the effect of pulsed lavage compared with syringe lavage on femoral cement penetration and interface temperature. Interface temperature, cement penetration pressure, and ligament tension forces were measured continuously during the procedure, and cement penetration was determined by performing sagittal bone cuts.


Cleansing the femoral bone stock with use of pulsed lavage (Group B) led to increased femoral cement penetration (mean, 1428 mm2; 95% confidence interval, 1348 to 1508 mm2) compared with syringe lavage (Group A) (mean, 1128 mm2; 95% confidence interval, 1038 to 1219 mm2) (p < 0.001). Interface temperature was higher in Group B (mean 22.6°C; 95% confidence interval, 20.5°C to 24.1°C) than in Group A (mean, 21.0°C; 95% confidence interval, 19.4°C to 23.0°C) (p = 0.028), but temperatures never reached critical values for thermal damage to the bone.


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

Clinical Relevance: 

Pulsed lavage techniques should be strongly considered for use as a routine procedure for unicompartmental knee arthroplasty with cement to increase bone cement penetration of the implant.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Lamont Wooten, MD
    Posted on January 03, 2013
    CO2 Gas Bone Preparation for cementing
    Orthopaedics East, ECU School of Medicine, Greenville, NC, USA

    Anecdotally, it seems that the pressurized CO2 cleansing of the cut bone surface when performing TKR's, appears to be a superior method of cleaning out the interstices in the cancellous bone to allow for better and deeper cement penetration.

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