Using a Reamer-Irrigator-Aspirator Reduces Femoral Intramedullary Pressure During Simulated Total Knee Arthroplasty

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Title: Using a Reamer-Irrigator-Aspirator Reduces Femoral Intramedullary Pressure During Simulated Total Knee Arthroplasty
Creators: Falk, James
Advisor: Siston, Robert
Issue Date: 2008-06
Abstract: Total knee arthroplasty is a common procedure to relieve pain and improve mobility of individuals with osteoarthritis of the knee. During the procedure, an alignment rod is forced down the canal of the femur to guide in the cuts of the femur for proper fitting of the prosthetic implant. However, 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 rise 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 below 200 mmHg, a threshold for fat embolism in a sheet model. A simulated TKA was performed 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 mmHg. Clinical studies would be required to confirm any reduction in complications using the reamer/irrigator/aspirator system.
Embargo: No embargo
Series/Report no.: The Ohio State University. Department of Mechanical Engineering Honors Theses; 2008
Keywords: Reamer-Irrigator-Aspirator
Total Knee Arthroplasty
Femoral Intramedullary Pressure
Fat Embolism
Sponsors: Synthes (West Chester, PA)
Description: The Research was presented at the annual ORS Conference March 2nd-March 5th 2008
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