title: Effect of lavage and brush preparation on cement penetration and primary stability in tibial unicompartmental total knee arthroplasty: An experimental cadaver study.
abstract: BACKGROUND
  Unicompartmental total knee arthroplasty (UKA) is a well-established treatment option for unicondylar osteoarthritis, and generally leads to better functional results than tricompartimental total knee arthroplasty (TKA). However, revision rates of UKAs are reported as being higher; a major reason for this is aseptic loosening of the tibial component due to implant-cement-bone interface fatigue. The objective of this study was to determine the effects of trabecular bone preparation, prior to implantation of tibial UKAs, on morphological and biomechanical outcomes in a cadaver study.
  
  
  METHODS
  Cemented UKAs were performed in 18 human cadaver knees after the bone bed was cleaned using pulsed lavage (Group A), conventional brush (Group B) or no cleaning at all (Group C, control). Morphologic cement penetration and primary stability were measured.
  
  
  RESULTS
  The area proportion under the tibial component without visible cement penetration was significantly higher in Group C (21.9%, SD 11.9) than in both Group A (7.1%, SD 5.8), and Group B (6.5%, SD 4.2) (P=0.007). The overall cement penetration depth did not differ between groups. However, in the posterior part, cement penetration depth was significantly higher in Group B (1.9mm, SD 0.3) than in both Group A (1.3mm, SD 0.3) and Group C (1.4mm, SD 0.3) (P=0.015). The mode of preparation did not show a substantial effect on primary stability tested under dynamic compression-shear test conditions (P=0.910).
  
  
  CONCLUSIONS
  Bone preparation significantly enhances cement interdigitation. The application of a brush shows similar results compared with the application of pulsed lavage.
authors.affiliation: Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany. Electronic address: C-Scheele@web.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Scheele
authors.affiliation: Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany.
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Pietschmann
authors.affiliation: Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schröder
authors.affiliation: Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany; Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Grupp
authors.affiliation: Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Holderied
authors.affiliation: Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany.
authors.forename: Volmar
authors.initials: V
authors.lastname: Jansson
authors.affiliation: Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Müller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D001843:Bone Cements; D002102:Cadaver; D002484:Cementation; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000379:methods; D013977:Tibia / Q000601:surgery*
chemical_list: D001843:Bone Cements
keywords: Brush preparation; Cement penetration; Primary stability; Pulsed lavage; Unicompartmental knee arthroplasty