Loose bone and cement can promote polyethylene wear that may lead to failure in total knee arthroplasty. The authors propose a technique to enhance the debridement of loose bodies by distracting the cemented components with a lamina spreader following standard debridement with pulsatile lavage. Cement and bone/soft tissue debris was recovered from 51 consecutive primary total knee arthroplasty patients. This technique facilitated the removal of hidden debris in 80% of patients (41/51). On average, 2.6 fragments measuring 158 mm3 were removed per patient. The authors advocate that distraction with a lamina spreader be used to reduce potential sources of wear.
1. Pavone V, Boettner F, Fickert S, Sculco TP. Total condylar knee arthroplasty: a long-term followup. Clinical orthopaedics and related research. 2001(388):18-25. http://dx.doi.org/10.1097/00003086-200107000-00005
2. Ritter MA, Meneghini RM. Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty. The Journal of arthroplasty. 2010;25(4):507-13. http://dx.doi.org/10.1016/j.arth.2009.04.018
3. Gill GS, Joshi AB. Long-term results of Kinematic Condylar knee replacement. An analysis of 404 knees. The Journal of bone and joint surgery British volume. 2001;83(3):355-8. http://dx.doi.org/10.1302/0301-620x.83b3.11288
4. Buechel FF, Sr., Buechel FF, Jr., Pappas MJ, D'Alessio J. Twenty-year evaluation of meniscal bearing and rotating platform knee replacements. Clinical orthopaedics and related research. 2001(388):41-50. http://dx.doi.org/10.1097/00003086-200107000-00008
5. Dixon MC, Brown RR, Parsch D, Scott RD. Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. A study of patients followed for a minimum of fifteen years. The Journal of bone and joint surgery American volume. 2005;87(3):598-603. http://dx.doi.org/10.2106/jbjs.c.00591
6. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. The Journal of bone and joint surgery American volume. 2007;89(4):780-5. http://dx.doi.org/10.2106/jbjs.f.00222
7. Dalury DF, Pomeroy DL, Gorab RS, Adams MJ. Why are total knee arthroplasties being revised? The Journal of arthroplasty. 2013;28(8 Suppl):120-1. http://dx.doi.org/10.1016/j.arth.2013.04.051
8. Schmalzried TP, Callaghan JJ. Wear in total hip and knee replacements. The Journal of bone and joint surgery American volume. 1999;81(1):115-36.
9. Hirakawa K, Bauer TW, Yamaguchi M, Stulberg BN, Wilde AH. Relationship between wear debris particles and polyethylene surface damage in primary total knee arthroplasty. J Arthroplasty. 1999;14(2):165-71. http://dx.doi.org/10.1016/s0883-5403(99)90120-1
10. Que L, Topoleski LD. Third-body wear of cobalt-chromium-molybdenum implant alloys initiated by bone and poly(methyl methacrylate) particles. Journal of biomedical materials research. 2000;50(3):322-30. http://dx.doi.org/10.1002/(sici)1097-4636(20000605)50:3<322::aid-jbm5>3.0.co;2-u
11. Davidson JA, Poggie RA, Mishra AK. Abrasive wear of ceramic, metal, and UHMWPE bearing surfaces from third-body bone, PMMA bone cement, and titanium debris. Bio-medical materials and engineering. 1994;4(3):213-29.
12. Horowitz SM, Doty SB, Lane JM, Burstein AH. Studies of the mechanism by which the mechanical failure of polymethylmethacrylate leads to bone resorption. J Bone Joint Surg Am. 1993;75(6):802-13.
13. Thiele K, Perka C, Matziolis G, Mayr HO, Sostheim M, Hube R. Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. The Journal of bone and joint surgery American volume. 2015;97(9):715-20. http://dx.doi.org/10.2106/jbjs.m.01534
14. Schroer WC, Berend KR, Lombardi AV, Barnes CL, Bolognesi MP, Berend ME, et al. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. The Journal of arthroplasty. 2013;28(8 Suppl):116-9. http://dx.doi.org/10.1016/j.arth.2013.04.056
15. Lombardi AV, Jr., Berend KR, Adams JB. Why knee replacements fail in 2013: patient, surgeon, or implant? The bone & joint journal. 2014;96-b(11 Supple A):101-4. http://dx.doi.org/10.1302/0301-620x.96b11.34350
16. Schroeder C, Grupp TM, Fritz B, Schilling C, Chevalier Y, Utzschneider S, et al. The influence of thirdbody particles on wear rate in unicondylar knee arthroplasty: a wear simulator study with bone and cement debris. Journal of materials science Materials in medicine. 2013;24(5):1319-25. http://dx.doi.org/10.1007/s10856-013-4883-8
17. Helmers S, Sharkey PF, McGuigan FX. Efficacy of irrigation for removal of particulate debris after cemented total knee arthroplasty. J Arthroplasty. 1999;14(5):549-52. http://dx.doi.org/10.1016/s0883-5403(99)90075-x
18. De Baets T, Waelput W, Bellemans J. Analysis of third body particles generated during total knee arthroplasty: is metal debris an issue? Knee. 2008;15(2):95-7. http://dx.doi.org/10.1016/j.knee.2008.01.002
19. Niki Y, Matsumoto H, Otani T, Tomatsu T, Toyama Y. How much sterile saline should be used for efficient lavage during total knee arthroplasty? Effects of pulse lavage irrigation on removal of bone and cement debris. J Arthroplasty. 2007;22(1):95-9. http://dx.doi.org/10.1016/j.arth.2006.02.078
Available at: http://works.bepress.com/ali_oliashirazi/10/