Effect of high-pressure pulsatile lavage versus manual rinsing on bone cement penetration in total knee arthroplasty: a randomized clinical trial.

BACKGROUND: Bone irrigation is a crucial step in cemented total knee arthroplasty procedures to promote maximal cement penetration and interdigitation into the cancellous bone. However, it is not clear which type of bone irrigation achieves the best results. This study aimed to compare the efficacy of high-pressure pulsatile lavage versus manual rinsing in promoting bone cement penetration during total knee arthroplasty. METHODS: We conducted a single-center, prospective, randomized, controlled clinical trial in 100 patients undergoing primary total knee arthroplasty during 1 year. All patients were randomly allocated to either the pulsed lavage group or the non-pulsed lavage group. We assessed total cement penetration depth across all zones radiologically using anteroposterior and lateral radiographic views in postoperative X-rays taken on the first day after surgery and segmenting them into ten zones according to the Knee Society Scoring System (KSSS). RESULTS: The patient cohort included 100 individuals with an average age of 75 years (standard deviation [SD] 5.7); 73% were female. The mean total bone cement penetration values in both anteroposterior (AP) and lateral views were 10.77 mm (SD 5.95) and 4.85 mm (SD 3.33) for manual lavage, and 11.34 mm (SD 6.26) and 5.23 mm (SD 3.50) for pressurized lavage. We observed no significant differences between the two groups after adjusting for multiple variables. CONCLUSIONS: High-pressure pulsatile lavage showed no significant differences in enhancing bone cement penetration compared with manual lavage as measured by the KSSS total knee arthroplasty bone cementation scale in X-rays taken on the first postoperative day. Level of Evidence Level I-Therapeutic randomized controlled trial. Trial registration Clinicaltrials.gov Register-NCT06032507.