No Added Advantage of High-Pressure Pulsatile Lavage Over Manual Lavage for Cement Penetration in TKR: Study

Written By : Dr Supreeth D R Published On 2025-12-28T20:00:50+05:30 | Updated On 28 Dec 2025 8:01 PM IST

Bone irrigation is a crucial step in cemented total knee arthroplasty procedures to promote maximal cement penetration and interdigitation into the cancellous bone. However, it is not clear which type of bone irrigation achieves the best results. Ramirez‑Bermejo et al conducted a study to compare the efficacy of high-pressure pulsatile lavage versus manual rinsing in promoting bone cement penetration during total knee arthroplasty. The article has been published in ‘Knee Surgery & Related Research.’

The authors conducted a single-center, prospective, randomized, controlled clinical trial in 100 patients undergoing primary total knee arthroplasty during 1 year. All patients were randomly allocated to either the pulsed lavage group or the non-pulsed lavage group. The authors assessed total cement penetration depth across all zones radiologically using anteroposterior and lateral radiographic views in postoperative X-rays taken on the first day after surgery and segmenting them into ten zones according to the Knee Society Scoring System (KSSS).

The key findings of the study were

• The patient cohort included 100 individuals with an average age of 75 years (standard deviation [SD] 5.7); 73% were female.

• No statistical differences were found between groups for any patient characteristics.

• The mean total bone cement penetration values in both anteroposterior (AP) and lateral views were 10.77 mm (SD 5.95) and 4.85 mm (SD 3.33) for manual lavage, and 11.34 mm (SD 6.26) and 5.23 mm (SD 3.50) for pressurized lavage.

• There were no significant differences between the two groups after adjusting for multiple variables.

The authors concluded that - “High-pressure pulsatile lavage did not demonstrate significant differences in enhancing bone cement penetration compared with manual lavage, as measured by the KSSS TKA bone cementation scale in X-rays taken on the first postoperative day.”

Level of Evidence Level I—Therapeutic randomized controlled trial.

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.