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. 2024 Mar 18;15(3):293-301.
doi: 10.5312/wjo.v15.i3.293.

Pulsed lavage in joint arthroplasty: A systematic review and meta-analysis

Mohammad Daher  1 , Gaby Haykal  2 , Marven Aoun  2 , Marc Moussallem  2 , Ali Ghoul  2 , Jean Tarchichi  2 , Amer Sebaaly  2
Affiliations

Pulsed lavage in joint arthroplasty: A systematic review and meta-analysis

Mohammad Daher et al. World J Orthop. .

Abstract

Background: Knee and hip osteoarthritis affects millions of people around the world and is expected to rise even more in frequency as the population ages. Joint arthroplasty is the surgical management of choice in these articulations. Heterotopic ossification and radiolucent lines formation are two frequent problems faced in hip and knee replacements respectively. Some studies show that the usage of pulsed lavage may prevent their formation.

Aim: To compare pulsed lavage to standard lavage in joint arthroplasty.

Methods: PubMed, Cochrane, and Google Scholar (page 1-20) were searched till December 2023. Only comparative studies were included. The clinical outcomes evaluated were the heterotopic ossification formation in hip replacements, radiolucent lines formation, and functional knee scores in knee replacements.

Results: Four studies met the inclusion criteria and were included in this meta-analysis. Pulsed lavage was shown to reduce the formation of radiolucent lines (P = 0.001). However, no difference was seen in the remaining outcomes.

Conclusion: Pulsed lavage reduced the formation of radiolucent lines in knee replacements. No difference was seen in the remaining outcomes. Furthermore, the clinical significance of these radiolucent lines is poorly understood. Better conducted randomized controlled studies and cost-effectivity studies are needed to reinforce these findings.

Keywords: Heterotopic ossification; Hip arthroplasty; Knee arthroplasty; Pulsed lavage; Radiolucent lines; Syringe lavage.

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Conflict of interest statement

Conflict-of-interest statement: All authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PRISMA flowchart for article selection process.
Figure 2
Figure 2
Risk of bias. A: Risk of bias summary: review authors' judgements about each risk of bias item for each included study; B: Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 3
Figure 3
Forest plot. A: Forest plot showing the overall heterotopic ossification (HO) formation in pulsed lavage (PL) and standard lavage (SL); B: Forest plot showing the Brooker grade 1 HO formation in PL and SL; C: Forest plot showing the Brooker grade 2 HO formation in PL and SL; D: Forest plot showing the Brooker grade 3 HO formation in PL and SL; E: Forest plot showing the Brooker grade 4 HO formation in PL and SL.
Figure 4
Figure 4
Forest plot showing the formation of radiolucent lines in pulsed lavage and standard lavage.
Figure 5
Figure 5
Forest plot. A: Forest plot showing the knee society score in pulsed lavage (PL) and standard lavage (SL); B: Forest plot showing the knee function score in PL and SL.
See this image and copyright information in PMC

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