Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 May 20;11(3):e12027.
doi: 10.1002/jeo2.12027. eCollection 2024 Jul.

Pulsed lavage is associated with better quality of bone-cement-implant interface in knee arthroplasties (TKA/UKA) compared to syringe lavage in vitro; however, clinical data are missing: A systematic review

Fabrizio Di Maria  1   2 , Saubhik Das  1   2 , Elisabeth Abermann  1   2 , Christian Hoser  1   2 , Christian Fink  1   2
Affiliations
Review

Pulsed lavage is associated with better quality of bone-cement-implant interface in knee arthroplasties (TKA/UKA) compared to syringe lavage in vitro; however, clinical data are missing: A systematic review

Fabrizio Di Maria et al. J Exp Orthop. .

Abstract

Purpose: The purpose of this systematic review is to analyse the available literature to ascertain the optimal method of bone preparation to improve the quality of bone-cement-implant interface with either pulsed lavage or syringe lavage in both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA).

Methods: A comprehensive search was conducted across MEDLINE, Scopus and Embase databases until July 2023. Both inclusion and exclusion criteria were clearly stated and used to identify all the published studies. Subsequent screening throughout the title, abstract and full text was made, followed by complete critical appraisal and data extraction. This sequential process was performed by two reviewers independently and summarised following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines). A quality assessment of the systematic review was performed according to the Quality Appraisal for Cadaveric Studies scale (QUACS), reaching a quality level ranging from 69% to 85%.

Results: A total of 10 articles, out of 47, nine biomechanical cadaveric studies and one human clinical study were analysed. A total of 196 UKA tibial components, 74 patellar components, 36 TKA tibial components and 24 UKA femoral components were retrieved, and a high level of heterogeneity resulted overall. The pulsed lavage group showed better cement penetration and higher pull-out force than the syringe lavage group; a higher interface temperature was also found in the pulsed lavage group. No differences were found regarding tension ligament forces between the groups.

Conclusion: Our systematic review suggests that pulsed lavage is superior to syringe lavage in terms of the quality of bone-cement-implant interface in knee arthroplasties (TKA/UKA). However, translation of these results from cadaveric studies to individual clinical settings may be hazardous; therefore, clinical in vivo prospective studies are highly needed.

Prospero crd: PROSPERO CRD number CRD42023432399.

Level of evidence: Level III.

Keywords: TKA; UKA; jet lavage; knee arthroplasty; pulsed lavage; syringe lavage.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analysis) flowchart of the systematic search.
Figure 2
Figure 2
Mean cement penetration (mm) in pulsed and syringe lavage groups. A statistical difference was found in all studies except Scheele et al. [26].
Figure 3
Figure 3
Mean pull‐out force (N) in pulsed and syringe lavage groups. A statistical difference was found in all studies except Scheele et al. [26].
Figure 4
Figure 4
Mean interface temperature (Celsius degrees) in pulsed and syringe lavage groups. A statistical difference was found in both studies.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Abdeen, A.R. , Collen, S.B. & Vince, K.G. (2010) Fifteen‐year to 19‐year follow‐up of the insall‐burstein‐1 total knee arthroplasty. The Journal of Arthroplasty, 25(2), 173–178. Available from: 10.1016/j.arth.2009.01.009 - DOI - PubMed
    1. Cawley, D.T. , Kelly, N. , McGarry, J.P. & Shannon, F.J. (2013) Cementing techniques for the tibial component in primary total knee replacement. The Bone & Joint Journal, 95‐B(3), 295–300. Available from: 10.1302/0301-620X.95B3.29586 - DOI - PubMed
    1. Clarius, M. , Hauck, C. , Seeger, J.B. , James, A. , Murray, D.W. & Aldinger, P.R. (2009) Pulsed lavage reduces the incidence of radiolucent lines under the tibial tray of Oxford unicompartmental knee arthroplasty: pulsed lavage versus syringe lavage. International Orthopaedics, 33(6), 1585–1590. Available from: 10.1007/s00264-009-0736-y - DOI - PMC - PubMed
    1. Clarius, M. , Seeger, J.B. , Jaeger, S. , Mohr, G. & Bitsch, R.G. (2012) The importance of pulsed lavage on interface temperature and ligament tension force in cemented unicompartmental knee arthroplasty. Clinical Biomechanics, 27(4), 372–376. Available from: 10.1016/j.clinbiomech.2011.10.006 - DOI - PubMed
    1. Eriksson, R.A. & Albrektsson, T. (1984) The effect of heat on bone regeneration: an experimental study in the rabbit using the bone growth chamber. Journal of Oral and Maxillofacial Surgery, 42(11), 705–711. Available from: 10.1016/0278-2391(84)90417-8 - DOI - PubMed