Biomet Cementing Technologies AB

Bone bed preparation in Total Hip Replacement

Reaming

The bone cavity should be shaped to provide an even cement layer between the bone and prosthesis. An even cement layer provides better stress distribution and reduces the risk of cement mantle failure. Size of reaming should be determined at preoperative planning.

It is important to save the transversal ligament in order to optimize pressurization for acetabular cementing.

Brushing

Mechanical cleaning with a brush is recommended. Accidental introduction of blood and tissue debris into the cement may cause laminations, which can lower the effective strength of the bone cement by 8-16%. Acetabular and femoral brushes are used to remove soft tissue and loose cancellous bone from the cavity.

Pulse Lavage

Using high-pressure pulse lavage to remove remaining bone particles and debris in a joint arthroplasty produces a clean surface.
The risk of blood lamination is reduced and the mechanical strength of the cement is increased.

The procedure also prevents circulatory changes. In order to obtain micro-interlock between the bone and the cement use high pressure pulse lavage repeatedly.²

It was concluded that the use of high volume pressurized jet-lavage for cleaning of the intramedullary cavity prior to cement application in THR should be routinely used in cemented THR.³

A study concludes that meticulous high volume, high pressure pulsative lavage reduces both pulmonary physiological derangements and fat emboli.