Saturday, June 22, 2024

Pulsed Lavage Outperforms Syringe Lavage in Knee Arthroplasty: A Systematic Review

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The quest for enhancing the bone-cement-implant interface in knee arthroplasty has led to a comprehensive systematic review, scrutinizing the effectiveness of pulsed lavage versus syringe lavage. This analysis, drawing from a considerable range of studies, illuminates the superiority of pulsed lavage in achieving better outcomes in both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA).

The study encompassed a detailed search through MEDLINE, Scopus, and Embase databases up to July 2023. By employing rigorous inclusion and exclusion criteria, the researchers meticulously selected relevant studies, proceeding through title, abstract, and full-text screening. This methodical approach was independently conducted by two reviewers and followed the PRISMA guidelines. The quality of the systematic review was assessed using the Quality Appraisal for Cadaveric Studies scale (QUACS), achieving a quality range of 69% to 85%.

Research Methodology

A total of 47 studies were initially identified, out of which 10 met the inclusion criteria. These comprised nine biomechanical cadaveric studies and one human clinical study. The data extracted included 196 UKA tibial components, 74 patellar components, 36 TKA tibial components, and 24 UKA femoral components. This diverse set of data highlighted a significant level of heterogeneity across the studies.

The comparative analysis revealed that the pulsed lavage method resulted in superior cement penetration and higher pull-out force compared to the syringe lavage method. Additionally, a higher interface temperature was recorded in the pulsed lavage group. However, no significant differences were observed in the tension ligament forces between the two groups.

Key Findings

The results underscore the efficacy of pulsed lavage in enhancing the bone-cement-implant interface quality in knee arthroplasties. Despite the promising results from the cadaveric studies, the translation of these findings to clinical practice requires caution. The need for in vivo clinical prospective studies is strongly emphasized to validate these findings in practical settings.

Practical Implications

– Pulsed lavage demonstrates better cement penetration and higher pull-out force compared to syringe lavage.
– Higher interface temperature with pulsed lavage potentially indicates better polymerization.
– The lack of differences in tension ligament forces suggests both methods maintain ligament integrity.

The systematic review concludes that pulsed lavage offers superior outcomes in knee arthroplasty procedures. Nonetheless, the findings from cadaveric studies may not directly translate to clinical applications without further validation through in vivo studies.

Original Article: J Exp Orthop. 2024 May 20;11(3):e12027. doi: 10.1002/jeo2.12027. eCollection 2024 Jul.

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