This article is more than 5 years old. Information may no longer be current.
Results support carbon dioxide bone preparation vs tourniquet alone for TKA
Significantly more cement penetration was seen in three Knee Society Radiographic Evaluation System zones with greater cancellous bone in patients who had bone prepared with carbon dioxide gas in total knee arthroplasty compared to those who had tourniquet with lavage only, according to recently published results.
“These results suggest that a movement toward [carbon dioxide] gas bone preparation in cemented TKA could achieve improved implant fixation via greater cement penetration than using a tourniquet with lavage only,” the authors wrote. “The improved cement penetration when using [carbon dioxide] gas for bone preparation may lead to less implant loosening and therefore better patient outcomes.”
Researchers performed a retrospective review of 303 consecutive primary TKAs performed with the same implant in three different groups: a tourniquet without sterile carbon dioxide compressed gas used for bone preparation; no tourniquet with carbon dioxide gas; and tourniquet use and carbon dioxide gas bone preparation. Radiographs were used to measure cement penetration based on zones described by the Knee Society Radiographic Evaluation System.
Results showed the treatment groups were not significantly different with regard to age, BMI and gender. Investigators noted the cement penetration was greater in six of seven zones in patients who received carbon dioxide gas bone preparation compared to those who had tourniquet only. Significantly greater cement penetration was seen in three zones in patients who had carbon dioxide gas bone preparation vs. those who only had a tourniquet. – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to Top
This interesting study compared cement penetration in TKRs performed with a tourniquet, with a tourniquet and CO2 gas preparation, and without a tourniquet and CO2 gas preparation. The findings suggest better cement penetration with the use of CO2 gas preparation in tibial AP zone 2 and femoral lateral zones 3A and 3P. These findings are logical given that those zones are the areas of cancellous bone that are most accessible to the CO2 device.
One notable omission in the manuscript is the protocol by the anesthesia team for managing intraoperative blood pressure. Marrow contents include both blood and lipid, both of which are removed as the bone is prepared for cementation, but without proper blood pressure management, the blood continues to enter the cancellous bone. For this reason, it is also logical that the greatest average cement penetration occurred when both tourniquet and CO2 was used, because that would more consistently control the influx of additional blood.
This is a study performed retrospectively on a successive series of patients. One possible bias might be found in the process of learning to use the CO2 gas device. As more attention is being paid to the cancellous interface, the judgement as to when enough preparation has been performed with either the pulsatile saline or the CO2 gas may have evolved during the course of the series of patients.
Hospital for Special Surgery
Read more about