Die pulsierende Jet Lavage zur Hochdruckspülung in der zementierten Hüftendoprothetik

摘要

By the introduction of PMMA (poly-methylmethacrylate) in total hip arthroplasty through Sir John Charnley the technique of implantation became significantly better in regard of the durability. Hereby the lavage of the marrow before the PMMA application is evidently important. After syringe lavage of the bone marrow the interdigitation of the spongiosus bone and the cement becomes more close as well as the reduction of the potential thrombembolic material before the implantation. Aim of the experimental study was to compare the difference in vitro of two mainly used lavage techniques. Therefore the simple syringe lavage was used in direct comparison to the pulsatile jet lavage and analysed along the cemented implant in pairs of femoral bones. After implantation the distribution of the cement was quantified and faced to each other. We described a local benefit of the jet lavage technique all along the implant. The clinical study included the detection of cardiac thrombembolic material by the use of transoesophageal echocardiography (TEE). Therefore we documented all operative steps of a cemented total hip arthroplasty in four cases. The main question was to quantify weather the use of the pulsatile high pressure jet lavage itself induces thrombembolic incidents. We divided five grades of embolic incidents (grade 0 to IV). Assumed we detected micro- and macroembolic incidents up to grade IV by using the bone marrow stopper, the application of the PMMA and implantation of the stem as well as after reposition of the leg after implantation. The use of the jet lavage did not rise the detection of embolic incidents above grade two. Therefore the use of the tested lavage technique does not lead to a higher risk of thrombembolic incident.Thus the use of the tested pulsatile jet lavage technique should be seen as an important and basic instrument of cemented hip implantation to improve the durability of the implant as well as to reduce the risk of thrombembolic incident in the operation.