title: An experimental comparison of different devices for pulsatile high-pressure lavage and their relevance to cement intrusion into cancellous bone.
abstract: BACKGROUND
  Some of the systems marketed for pulsatile high-pressure lavage are clearly different in their mechanical pulse characteristics. To take the matter further we set up an experimental in vitro model to determine whether these different lavage systems might produce different cementation results because of their differing pulse characteristics, and whether the systems differed significantly in terms of cement depth penetration.
  
  
  METHODS
  A total of 48 femoral heads were obtained at operation from patients who had undergone endoprosthetic hip replacement. The specimens were subjected to manual rinsing or semiautomatic cleansing procedures with five different pulsatile lavage devices. After the cleansing procedures, polymethylmetacrylate bone cement was intruded into the cancellous bone under standardised conditions. Determination of cement penetration was done by computed tomography using an image processing software.
  
  
  RESULTS
  Irrespective of the nature of the lavage system tested, superficial cement penetration, both up to 2 mm and up to 3 mm, was significantly better after pulsatile high-pressure lavage than it was after manual rinsing of the specimens with a bladder syringe (P < 0.001 in each case). Whereas our experimental model did not show any significant differences between the lavage systems as regards the cementation results to a depth of up to 2 mm (P = 0.996), there were significant differences at a target depth of 3 mm (P < 0.05).
  
  
  CONCLUSIONS
  As compared with manual rinsing, pulsatile high-pressure lavage in vitro makes highly significant improvements in cement penetration into cancellous bone and should be regarded as an indispensable component of modern cementation techniques for endoprosthetic surgery. Up to the present we have not been able to ascertain what influence the different pulse characteristics of a pulsatile lavage system may have on the intended cementation result, whether it is impact force, pulse shape, pulse duration, flow rate or frequency. Appropriate investigations will be necessary.
authors.affiliation: Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Kaiser-Karl V-Allee 3, 93077, Bad Abbach, Germany. thomas.kalteis@klinik.uni-regensburg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Kalteis
authors.forename: Dominik
authors.initials: D
authors.lastname: Pförringer
authors.forename: Thomas
authors.initials: T
authors.lastname: Herold
authors.forename: Martin
authors.initials: M
authors.lastname: Handel
authors.forename: Tobias
authors.initials: T
authors.lastname: Renkawitz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Plitz
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001843:Bone Cements; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D019904:Polymethyl Methacrylate; D011312:Pressure; D007507:Therapeutic Irrigation / Q000295:instrumentation* / Q000379:methods; D036542:Tomography, Spiral Computed
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate