Using Suction in Back-Bleeding Conditions Increases Cement Penetration without the Need for a Tourniquet

Background
The majority of total knee arthroplasties are performed with a tourniquet as it is perceived this gives rise to superior cement fixation. Tourniquets, however, have been associated with increased pain, post-operative swelling, and reduced knee range of movement which can all detrimentally impact patient recovery. This laboratory-based study aimed to assess if it is possible to achieve equivalent (or even enhanced) cementation without a tourniquet using a novel suction device.

Methods
Cement penetration was compared between conditions simulating bone with back-bleeding with and without the use of suction in open-cell rigid foam tibia models and porcine specimens. Suction was applied via a urinary catheter inserted into the tibial recess created for the implant’s stem. Cement penetration depth was measured from micro-CT scans. The pull-off strength of cemented tibial implant analogues in porcine specimens with and without suction was also assessed.

Results
Suction gave rise to a significant (p=0.028) increase in cement penetration depth in both the rigid foam, 5.4 to 6.6 mm, and porcine specimens, 0.7 to 1.0 mm. A non-significant increase in implant pull-off strength was also observed.

Conclusion
Suction during cementation in a back-bleeding model resulted in significantly greater cement penetration depth. Using suction surgeons can avoid potential disadvantages of tourniquet use without compromising cementation.