Researchers from the Indiana University School of Medicine have found that using a sterile CO2 compressed gas to clean bone surfaces prior to deploying cement in total knee arthroplasty (TKA) results in a more robust cement mantle and penetration depth.
Their work, “The Effect of Tourniquet Use and Sterile Carbon Dioxide Gas Bone Preparation on Cement Penetration in Primary Total Knee Arthroplasty,” appears in the August 2019 edition of The Journal of Arthroplasty.
Co-author Michael Meneghini, M.D., director of the Indiana University Health Hip and Knee Center and associate professor of Orthopaedic Surgery at the Indiana University School of Medicine, explained his hypothesis to OTW, “Sterile CO2 gas is not used universally in TKA, however, the increased interest in tourniquetless TKA techniques has created an interest in innovative and adjunctive technologies to augment. So, interest and adoption has increased, but it is not widespread currently.”
The researchers pulled data from 303 consecutive primary TKAs cases—all with the same implant. They then divided the cases into in three groups:
- tourniquet without sterile CO2 compressed gas used for bone preparation,
- no tourniquet with CO2 gas, and
- tourniquet use and CO2 gas bone preparation.
The authors found that cement penetration was greater in 6 of 7 zones with significantly greater cement penetration in 3 zones (tibial anteroposterior zone 2, femoral lateral zones 3A and 3P) in those patient groups where the surgeon had used CO2 gas bone preparation compared to the tourniquet only group).”
Dr. Meneghini summarized the results of his study: “The most important results were the maintenance of the cement mantle as measured by cement penetration in the cancellous bone regions when performing TKA without using a tourniquet at any time during the surgery.”
“The results confirmed our hypothesis, as this technology is used in other fields (such as dentistry) with similar results. There are benefits to not putting up a tourniquet and causing limb ischemia for patients in terms of pain control and function recovery. We were encouraged that by using sterile CO2 compressed gas to clean the bone surfaces prior to cementation that we were able to maintain the robust cement mantle and penetration depth that we would expect with using a tourniquet. This allows us to provide value to our patients in terms of narcotic reduction and function recovery.”
