Primary cement debris in total knee arthroplasty: An exploratory study

Abstract Cement, cartilage, and bone debris are generated during the preparation and implantation steps of a prosthetic knee. It is not clear if all such debris, especially cement, generated during the procedure, is cleared from the joint after lavage at the time of closure. This residual cement debris present in the joint is embedded in the synovium or free floating and therefore has the potential to contribute to early third-body wear of polyethylene (PE) and synovitis. The purpose of this study is to qualitatively characterize such “primary” cement debris in the joint after total knee arthroplasty and discuss ways to decrease it further. To clarify, this refers to particles not generated by wear of the moving couple but cement particles present from day 1 in the joint. We have called this “primary debris” to distinguish from late wear debris which is a composite of PE, cement and congealed serum. The results revealed that some cement particles were present in all the patient samples. These findings also suggest that pulsatile saline lavage does not clear all the cement debris. It is more effective at washing out cement particles larger than 100 microns. We also suggest ways to decrease the generation of cement debris during the implantation process.