Efficacy of irrigation for removal of particulate debris after cemented total knee arthroplasty

We studied the amount of particulate debris removed with pulsatile lavage i rrigation before and after component implantation in 13 consecutive patient s undergoing primary cemented total knee arthroplasty (TKA) done by a singl e surgeon. Before component implantation, the knees were copiously lavaged with 3 L of pressurized irrigant; all fluid was collected in 1 aliquot usin g standard wall suction canisters. After cementing the components in place, another 3 L of pressurized irrigant was used; this fluid was collected in 3 sequentially labeled l-L aliquots. Collected fluids were centrifuged, and the residue was washed, recentrifuged, and dried. Residual particulate deb ris was quantitated by weight. An average of 537 mg/L (range, 16-1,406 mg/L ) of debris were removed before implantation with 3 L of irrigation. An ave rage of 217 mg/L (range, 31-999 mg/L), 52 mg/L (range, 0-189 mg/L), and 49 mg/L (range, 1-185 mg/L) of debris was removed after implantation with each of the additional liters. Using analysis of variance testing, there was a statistically significant difference between the amount of debris removed w ith 3 L and after 4 L (P = .02) and 5 L (P = .03) of irrigant. There was no statistical difference between irrigation with 5 L and 6 L of irrigation ( P = .92). The residua particulate debris was also analyzed to determine the relative amounts of bone-soluable organics and polymethyl methacrylate (PM MA). Before implantation, the residual debris, by weight, consisted of 79% bone and 21% soluable organics. We found on average that after implantation of components the specimens contained 53% bone and 47% PMMA and soluable o rganics by weight. We believe that despite careful implantation and meticul ous cement technique, large amounts of debris, including bone and PMMA, rem ain after TKA, which require at least several liters of pulsatile lavage to remove. Removal of this particulate debris may decrease third-body polyeth ylene wear.