The Adequate Amount Irrigation After Cemented Total Knee Arthroplasty

Shin, Ju Yong; Kim, Hyung Jun; Cha, Seung Han; Nam, Kyoung Mo; Kang, Dae Myung; Kim, Dong Heon

Abstract

PURPOSE
We studied the adequate amount of pulse lavage irrigation for removal of polymethyl methacrylate (PMMA) and bone particles after cemented total knee arthroplasty.
MATERIALS AND METHODS
A prospective study of 8 patients who received cemented total knee arthroplasty between March 2011 and November 2011, was done. The mean age of patients was 74.0 (range 65~84). After component implantation, the knees were lavaged with 10L of normal saline using pulsatile lavage; all fluid was collected in 1 liter using standard wall suction canisters. PMMA and bone particles within the irrigation fluids were quantitated by weight.
RESULTS
The average of 413 mg/L (range, 71~999 mg/L) of particle debris was removed after cemented total knee arthroplasty with 1L of irrigation. Average of 230 mg/L (range, 51~432 mg/L), 112 mg/L (range, 32~185 mg/L), 48 mg/L (range, 21~125 mg/L), 47 mg/L (range, 10~120 mg/L), 45 mg/L (range, 5~140 mg/L), 49 mg/L (range, 0~110 mg/L), 46 mg/L (range, 0~107 mg/L), 50 mg/L (range, 5~85 mg/L), 41 mg/L (range, 3~68 mg/L) of debris was removed after the second, third ,fourth, fifth, sixth, seventh, eighth, ninth and tenth liter of pulse lavage irrigation respectively. Using analysis of variance testing, there was a statistically significant difference between the debris removed with 1L and until 4L irrigation (p=0.03).
CONCLUSION
The bone debris and PMMA decreased as the amount of irrigation increased, especially most of remnants within more than 5L solution for irrigation were bone particles. 4L of irrigation through pulse lavage is appropriate for removing PMMA and bone particles after cemented total knee arthroplasty because a supplementary irrigation can cause a secondary bone loss.