The Reamer/Irrigator/Aspirator Reduces Femoral Canal Pressure in Simulated TKA

• Published in: Clinical orthopaedics and related research Vol. 467; no. 3; pp. 805 - 809
• Main Authors: Van Gorp, Cornel C., Falk, James V., Kmiec, Stanley J., Siston, Robert A.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.03.2009; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - instrumentation; Biological and medical sciences; Bone Marrow - surgery; Cadaver; Conservative Orthopedics; Diseases of the osteoarticular system; Embolism, Fat - etiology; Embolism, Fat - prevention & control; Equipment Design; Female; Femur - surgery; Humans; Male; Materials Testing; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original; Original Article; Orthopedic surgery; Orthopedics; Pressure; Sports Medicine; Suction - instrumentation; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Orthopedics; Therapeutic Irrigation - instrumentation; Femoral Canal; Conventional Instrumentation; Total Knee Arthroplasty; Step Drill; Intramedullary Pressure; Knee; Femur; Prosthesis; Reamer; Orthopedics
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-008-0258-8

Inserting the femoral intramedullary alignment rod during total knee arthroplasty (TKA) can generate high intramedullary pressure, which increases the risk of intraoperative complications caused by fat embolism. Despite modifications to the surgical procedure, the best method to prevent this increase in pressure remains unknown. The reamer/irrigator/aspirator is a surgical instrument designed for use during femoral canal entry to increase the canal size and remove intramedullary fat and may prevent this pressure increase. We posed two hypotheses: (1) using the reamer/irrigator/aspirator system will result in lower maximum femoral intramedullary pressure than using only conventional instrumentation during the initial steps of a TKA; and (2) using the reamer/irrigator/aspirator system in the initial steps of TKA will result in a mean maximum intramedullary pressure less than 200 mm Hg. We simulated a TKA on 14 cadaveric femurs to compare the femoral intramedullary pressure using both methods. Considerable decreases in femoral intramedullary pressure of 86% proximally and 87% distally were obtained by using the reamer/irrigator/aspirator system. The mean maximum pressure using the reamer/irrigator/aspirator system was less than 200 mm Hg. Additional clinical studies are needed to confirm any reduction in complications using the reamer/irrigator/aspirator system.