Carbon dioxide

Tourniquetless total knee arthroplasty (TKA) is experiencing resurgence in popularity due to potential pain control benefits. Furthermore, optimal cement technique and implant fixation remain paramount to long-term cemented TKA success; as aseptic loosening continues to be a leading cause of revision. The purpose of this study is to determine how tourniquet use and/or novel bone preparation using sterile; compressed carbon dioxide (CO2) gas affected cement penetration in TKA.

Significantly more cement penetration seen in three Knee Society Radiographic Evaluation System zones; with greater cancellous bone in patients who had bone prepared with carbon dioxide gas in total knee arthroplasty; compared to those who had tourniquet with lavage only, according to recently published results.

Carbon dioxide gas

A retrospective review performed on 303 consecutive primary TKAs with the same implant in 3 groups: (1) a tourniquet without sterile CO2 compressed gas used for bone preparation, (2) no tourniquet with CO2 gas, and (3) tourniquet use and carbon dioxide gas bone preparation. Cement penetration was measured on radiographs by two independent; blinded raters across 7 zones defined by the Knee Society Radiographic Evaluation System.

“These results suggest that a movement toward [carbon dioxide] gas bone preparation in cemented TKA could achieve improved implant fixation via greater cement penetration than using a tourniquet with lavage only,” the authors wrote. “The improved cement penetration when using [carbon dioxide] gas for bone preparation may lead to less implant loosening; and therefore better patient outcomes.”

Researchers performed a retrospective review of 303 consecutive primary TKAs performed with the same implant in three different groups: a tourniquet without sterile carbon dioxide compressed gas used for bone preparation; no tourniquet with carbon dioxide gas; and tourniquet use and carbon dioxide gas bone preparation. Radiographs used to measure cement penetration based on zones described; by the Knee Society Radiographic Evaluation System.

Greater cancellous bone

Results showed the treatment groups were not significantly different with regard to age; BMI and gender. Investigators noted the cement penetration was greater in six of seven zones in patients who received carbon dioxide gas bone preparation compared to those who had tourniquet only.

Significantly greater cement penetration seen in three zones in patients who had carbon dioxide gas bone preparation vs. those who only had a tourniquet. Bone prepared with CO2 gas showed significantly more cement penetration in 3 zones with greater cancellous bone. The results suggest that use of CO2 gas bone preparation may achieve greater cement penetration than using a tourniquet with lavage only.