Pulsatile Lavage During Cementation of Total Knee Arthroplasty - Is Fixation Impaired? A Cadaver Study

Claudio Glowalla, Max Ertl, Ulrich Lenze, Igor Lazic, Rainer Burgkart, Jan J. Lang, Rudiger von Eisenhart-Rothe, Florian Pohlig

Research output: Contribution to journalArticlepeer-review


Background/Aim: Increasing economic pressure in modern healthcare necessitates an increase in efficiency in total knee arthroplasty (TKA) while maintaining high-quality outcomes. Removal of debris using pulsatile lavage (PL) during cement polymerization may considerably reduce the operative duration. However, water can penetrate the interface, resulting in impaired implant fixation. The aim of the present study was to investigate the impact of early-onset PL during bone cement polymerization on implant fixation and operative duration. Materials and Methods: Cemented implantation of tibial trays was performed in 20 fresh-frozen human tibiae from 10 donors in a matched-pair study design in two groups: 1) PL during cement polymerization; and 2) PL after completion of the polymerization process. The cement penetration depth was analysed by computed tomography (CT), and the pull-out force was measured to evaluate primary implant fixation. The duration of the procedure was recorded for both groups. Results: Comparable pull-out forces were observed in the experimental (2,213 N) and control groups (2,350 N; p=0.68). The mean depth of cement penetration was similar in both groups. PL during cement polymerization could decrease the operative duration by 10 min. Conclusion: The application of PL during cement polymerization could significantly reduce operative duration and had no adverse effect on the mechanical fixation of the tibial component.

Original languageEnglish
Pages (from-to)672-677
Number of pages6
JournalIn Vivo
Issue number2
StatePublished - Mar 2022
Externally publishedYes


  • Bone cement
  • PMMA
  • TKA
  • polymerization
  • pulsatile lavage
  • total knee arthroplasty


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