title: An in vitro comparison of tibial tray cementation using gun pressurization or pulsed lavage.
abstract: OBJECTIVE
  Aseptic loosening of the tibial component remains a limitation to the highly successful procedure of total knee arthroplasty (TKA). Pulsed lavage improves bone cement penetration and interface strength in tibial tray cementation. This study tested whether pressurized cement application with a cement gun can compensate the use of jet lavage for bone surface preparation.
  
  
  METHODS
  Tibial components were implanted in six pairs of cadaveric tibiae. On one side, pulsed lavage of the tibial bone was combined with finger packing of bone cement; on the other side, syringe lavage and gun cementing was used. Cement penetration into the bone was determined from computed tomography scans, and Interface strength was determined by pull-out testing.
  
  
  RESULTS
  Cement penetration was greater (p = 0.004) and interface strength was higher (p = 0.028) in the pulsed lavage group.
  
  
  CONCLUSIONS
  Pressurization of cement by gun application could not compensate for the omission of pulsed lavage. Thus, pulsed lavage should be considered a crucial factor in TKA to improve implant fixation, which cannot be compensated for by cement application technique.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany, ulf.schlegel@gmx.net.
authors.forename: Ulf J
authors.initials: UJ
authors.lastname: Schlegel
authors.forename: Klaus
authors.initials: K
authors.lastname: Püschel
authors.forename: Michael M
authors.initials: MM
authors.lastname: Morlock
authors.forename: Katrin
authors.initials: K
authors.lastname: Nagel
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001843:Bone Cements; D002484:Cementation / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D007507:Therapeutic Irrigation / Q000379:methods; D013977:Tibia / Q000601:surgery*
chemical_list: D001843:Bone Cements