Pressurized carbon dioxide lavage reduces the incidence of a radiolucent line around the tibial component two years after total knee arthroplasty

INTRODUCTION: In cemented total knee arthroplasty (TKA), pressurized carbon dioxide (CO(2)) lavage prior to cement fixation can eliminate debris at the bone-cement interface and is considered effective for increasing cement penetration and preventing aseptic loosening. Regarding the risk of a preliminary diagnosis of implant loosening, a radiolucent line (RLL) is a valuable sign. The purpose of this study was to compare the incidence of a tibial RLL at 2 years after TKA with and without pressurized CO(2) lavage. METHODS: This is a retrospective study. One hundred knees from 98 patients were enrolled in this study. TKA was performed without pressurized CO(2) lavage (CO(2)− group) for the first 47 knees, and with pressurized CO(2) lavage (CO(2)+ group) for the next 53 knees. The depth of cement penetration was measured just after surgery, and the incidence of tibial RLL > 2 mm at 2 years after TKA was determined. RESULTS: Significant differences between groups were not seen regarding pre- and postoperative clinical factors. The depth of cement penetration in each area was significantly higher in the CO(2)+ group. The frequency of knees with RLL > 2 mm was significantly lower in the CO(2)+ group than in the CO(2)− group (p < 0.001). CONCLUSIONS: Pressurized CO(2) lavage improved cement penetration and decreased the incidence of tibial RLL > 2 mm at 2 years after TKA.