title: Efficacy of irrigation for removal of particulate debris after cemented total knee arthroplasty.
abstract: We studied the amount of particulate debris removed with pulsatile lavage irrigation before and after component implantation in 13 consecutive patients undergoing primary cemented total knee arthroplasty (TKA) done by a single surgeon. Before component implantation, the knees were copiously lavaged with 3 L of pressurized irrigant; all fluid was collected in 1 aliquot using standard wall suction canisters. After cementing the components in place, another 3 L of pressurized irrigant was used; this fluid was collected in 3 sequentially labeled 1-L aliquots. Collected fluids were centrifuged, and the residue was washed, recentrifuged, and dried. Residual particulate debris was quantitated by weight. An average of 537 mg/L (range, 16-1,406 mg/L) of debris were removed before implantation with 3 L of irrigation. An average of 217 mg/L (range, 31-999 mg/L), 52 mg/L (range, 0-189 mg/L), and 49 mg/L (range, 1-185 mg/L) of debris was removed after implantation with each of the additional liters. Using analysis of variance testing, there was a statistically significant difference between the amount of debris removed with 3 L and after 4 L (P = .02) and 5 L (P = .03) of irrigant. There was no statistical difference between irrigation with 5 L and 6 L of irrigation (P = .92). The residua particulate debris was also analyzed to determine the relative amounts of bone-soluable organics and polymethyl methacrylate (PMMA). Before implantation, the residual debris, by weight, consisted of 79% bone and 21% soluable organics. We found on average that after implantation of components the specimens contained 53% bone and 47% PMMA and soluable organics by weight. We believe that despite careful implantation and meticulous cement technique, large amounts of debris, including bone and PMMA, remain after TKA, which require at least several liters of pulsatile lavage to remove. Removal of this particulate debris may decrease third-body polyethylene wear.
authors.affiliation: Department of Orthopaedic Surgery, Naval Medical Hospital, San Diego, California, USA.
authors.forename: S
authors.initials: S
authors.lastname: Helmers
authors.forename: P F
authors.initials: PF
authors.lastname: Sharkey
authors.forename: F X
authors.initials: FX
authors.lastname: McGuigan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements; D006801:Humans; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D011184:Postoperative Period; D007507:Therapeutic Irrigation
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate