Pulse-Lavage Brushing Followed by Hydrogen Peroxide-Gauze Packing for Bone-Bed Preparation in Cemented Total Hip Arthroplasty: A Bovine Model

Abstract

Purpose. To compare the effectiveness of pulse-lavage brushing followed by hydrogen peroxide–gauze packing with either technique alone or normal-saline irrigation in bone-bed preparation for cemented total hip arthroplasty. Methods. 44 fresh-frozen ox femoral canals were prepared for cemented total hip arthroplasty using 4 techniques: normal-saline irrigation, pulse-lavage brushing, hydrogen peroxide–soaked gauze packing, and a combination of the latter 2 techniques. The maximum tensile pull-out force required to separate the prosthesis from the femoral canal was measured as an indicator of the strength of the cement-bone interface. Results. The mean pull-out force to separate the prosthesis from the femoral canal was significantly higher in specimens prepared with pulse-lavage brushing followed by hydrogen peroxide–soaked gauze packing or pulse-lavage brushing alone than those prepared with normal-saline irrigation or hydrogen peroxide–soaked gauze packing alone (p<0.001). Conclusions. Pulse-lavage brushing is more effective at cleansing the femoral canal and increasing mechanical strength at the cement-bone interface than preparation with normal-saline irrigation or hydrogen peroxide–soaked gauze packing.