New Study Shows Use of Kinamed’s CarboJet® System Yields Increased Bone Cement Penetration in Total Knee Arthroplasty, Even When No Tourniquet Is Used
August 7, 2019
Camarillo, California – A new clinical study published in the Journal of Arthroplasty demonstrates that use of the CarboJet CO2 Bone Preparation System from Kinamed Incorporated yields increased bone cement penetration in total knee arthroplasty (TKA), even during tourniquetless surgery in which a thigh tourniquet was not used to control bleeding at any time during the procedure.
As stated in the study, “Tourniquetless TKA is experiencing resurgence in popularity due to potential pain control benefits. Furthermore, optimal cement technique and implant fixation remain paramount to long-term cemented TKA success, as aseptic loosening continues to be a leading cause of revision.” The study notes that aseptic loosening remains one of the primary causes for early and late revisions, with up to 28.7% of all revisions being due to aseptic loosening.
The study authors also note that “Increasing the amount of cement into the tibial and femoral bone (cement penetration) has been shown to provide a stronger bone-cement interface which leads to increased stability and long-term survivorship of the implants.” Achieving appropriate penetration and inter-digitation of bone cement is therefore important for ensuring the overall success of TKA.
This new study, performed by R. Michael Meneghini M.D. and colleagues at the Indiana University School of Medicine, compared cement penetration in three groups of TKA patients: (1) tourniquet without CO2 gas bone preparation, (2) no tourniquet with CO2 gas bone preparation, and (3) tourniquet with CO2 gas bone preparation. The results show that when sterile compressed CO2 gas is used for bone preparation, cement penetration is actually increased in not only the tourniquet (group 3) but also in the no-tourniquet group (group 2), as compared to the tourniquet group in which CO2 gas was not used (group 1).
An earlier study conducted by Dr. Meneghini and colleagues compared TKA groups with and without use of the thigh tourniquet and demonstrated that female patients in the no-tourniquet group experienced significantly less post-operative pain and consumed fewer opioids as compared to female patients in the tourniquet group. Their work has important implications given the scope of the opioid crisis and the very large number of knee replacements being performed in the United States.
About Kinamed
Kinamed is a leading developer, manufacturer, and distributor of innovative specialty orthopedic, neurosurgical, and cardiothoracic medical devices. In addition to the CarboJet system, Kinamed’s other orthopedic products include: the SuperCable® Iso-Elastic Polymer Cerclage system: a revolutionary cabling system that eliminates problems associated with traditional metal cables; and the KineMatch® Patello-Femoral Replacement: a patient–specific (custom) unicompartmental joint replacement implant. Since the company’s founding, Kinamed has manufactured and sold over 2.5 million surgical implants.
For additional information on Kinamed, Inc., please visit www.Kinamed.com.
Dr. Meneghini is a consultant for Kinamed.
CarboJet® Employed in Study Showing Tourniquetless Total Knee Arthroplasty Decreases Pain and Opioid Consumption in Women
Given the opioid crisis in America, surgical protocols that minimize opioid consumption are highly sought after. A recently published study shows that elimination of the tourniquet during TKA may be one such protocol.
CAMARILLO, CALIF. (PRWEB) DECEMBER 11, 2018
A new clinical study published in the Journal of Arthroplasty comparing total knee replacement (TKR) surgery with and without use of the traditional thigh tourniquet demonstrated that female patients in the no-tourniquet group experienced significantly less post-operative pain and consumed fewer opioids as compared to female patients in the tourniquet group.
In 2017, there were approximately 50,000 opioid drug overdose deaths in the United States. Although opioids are effective at reducing pain after surgery, patients receiving prescription opioids are at risk for developing an opioid use disorder. Therefore, development of surgical protocols that reduce post-operative pain and the need for opioid medication are of critical importance and are highly sought after.
Maintaining appropriate penetration and inter-digitation of bone cement is extremely important for ensuring long-term success of TKR, because aseptic implant loosening has been identified as a leading failure mode in the modern TKA procedure. When performing knee arthroplasty without a tourniquet, achieving an optimal “cement technique” can be a challenge because of the additional fluid debris present in the bone and at the implant-interfaces. The CarboJet® CO2 Bone Preparation system employed in this study addresses this challenge by using medical-grade compressed carbon dioxide gas to remove lipids/fatty marrow elements, blood, and saline from the bone surface prior to the application of bone cement. The lead author of this study, R. Michael Meneghini, MD, Associate Professor of Clinical Orthopedic Surgery at Indiana University School of Medicine, chose to employ the CarboJet system to manage these blood and lipid debris and optimize cement penetration for his patients.
With nearly 800,000 procedures performed in the United States each year, knee replacement surgery is one of the most widely accepted and effective treatments for relieving the pain and disability associated with degenerative osteoarthritis. Because of the sheer number of knee replacements being performed, approaches that can reduce opioid consumption as demonstrated in this study are noteworthy.
About Kinamed
Kinamed is a leading developer, manufacturer, and distributor of innovative specialty orthopedic, neurosurgical, and cardiothoracicmedical devices. In addition to the CarboJet system, Kinamed’s other orthopedic products include: the SuperCable® Iso-Elastic Polymer Cerclage system: a revolutionary cabling system that eliminates problems associated with traditional metal cables; and the KineMatch® Patello-Femoral Replacement: a patient–specific (custom) unicompartmental joint replacement implant. Since the company’s founding, Kinamed has manufactured and sold over 2.5 million surgical implants.
For additional information on Kinamed, Inc., please visit www.Kinamed.com. The full press release can be viewed here.
Dr. Meneghini is a consultant for Kinamed.
CarboJet Effective at Removing Immunogenic Marrow Elements from Osteochondral Allografts
Naples, Italy (September 2016) – A new study looking at the effects of different bone cleaning techniques on the removal of immunogenic marrow elements from osteochondral allografts was presented at the 13th World Congress of the International Cartilage Repair Society (ICRS) by Brian Cole, MD, MBA, and Adam Yanke MD of Rush University Medical Center in Chicago, Illinois. The study compared three treatment arms: A; no lavage, B, saline lavage only; C saline lavage with CarboJet. The results showed that the third arm was significantly more effective at removing marrow debris from osteochondral allografts than saline lavage alone, especially in the deepest portion of the allograft plug.
Technique Using Isoelastic Tension Band for Treatment of Olecranon Fractures
Excerpts
The particular property profile of the isoelastic tension band gives the cable intrinsic elastic and pliable qualities. In addition, unlike stainless steel, the band maintains a uniform, continuous compression force across a fracture site.
The pliability of the band allows the surgeon to create multiple loops of cable without the wire failure side effects related to kinking, which is common with the metal construct.
Abstract
The isoelastic ultrahigh-molecular-weight polyethylene tension band may be considered an alternative to stainless steel wire for tension band fixation of olecranon fractures.
In this article, we present our technique using this isoelastic tension band and describe the outcomes of 7 patients who underwent open reduction and internal fixation of closed, displaced olecranon fractures with minimal or no articular surface comminution. We reviewed medical records and performed physical examinations and functional assessments.
Anatomical reduction was maintained in all elbows through union. Physical examination measurements indicated nominal side-to-side differences in motion and strength. Mean Broberg and Morrey elbow score was good (92/100), and mean (SD) Disabilities of the Arm, Shoulder, and Hand score was 12.6 (17.2). One patient had a minor degree of hardware irritation at longest follow-up but did not request hardware removal. One patient underwent implant removal for a symptomatic implant 5 years after surgery.
This easily reproducible technique yields excellent physical and functional outcomes.
Click here to view complete article and view a video demonstrating the technique.
Click here to view the article pdf.
The Role of CarboJet in the Reduction of Aseptic Loosening
Recent evidence from a large multicenter study shows that aseptic loosening has become the single largest cause of failure of modern primary knee arthroplasties requiring revision. Earlier studies, conducted in the 1990s, had shown polyethylene wear to be the leading cause of failure. The more current study found that 28.0% of all knee failures were due to aseptic loosening, comprising the single most common failure mode. In the case of unicompartmental knees, 60.6% of failures were due to aseptic loosening. A significant portion of the aseptic loosening failures were early failures, with 32.9% of these failures classified as never successful, suggesting failure of initial fixation.
These findings suggest that meticulous attention to cement technique and proper preparation of the bone bed prior to cementation may improve implant longevity and quality outcomes. There is also considerable evidence suggesting that increased cement penetration depth into the bone bed improves cement mantle toughness and reduces cement-bone interface stresses. Of particular note, a recent tibial component retrieval study showed that there is a time dependent resorption of interlocking trabecular bone away from the cement mantle. This progressive loss of cement interdigitation with time in service suggests that it is important to ensure maximum cement penetration and interdigitation at implantation…
Upcoming Events
Kinamed is proud to support the following meetings. Please visit us at our display if you will be in attendance.
- CCJR Spring 2015 Meeting, May 17-20, 2015, Las Vegas, NV
- Malaysian Orthopaedic Association 45th Annual General/Scientific Meeting, May 22-24, 2015, Kuala Lumpur, Malaysia
- EFORT 16th Congress, May 27-29, 2015, Prague, Czech Republic, 1st floor Booth 31. Download pdf flyer here.
- ICJR South/RLO, May 28-30, 2015, Charleston, SC
- ICJR 3rd Annual West Meeting, June 4-13, 2015, Napa, CA
- AAOS/AAHKS Fundamentals of Hip and Knee Arthroplasty for Orthopaedic Residents (East), June 5-7, 2015, Baltimore, MD
- AAOS/AAHKS Total Hip Arthroplasty: From Primary to Revision, June 25-26, Rosemont, IL
- Congress of Neurological Surgeons 2015 Annual Meeting, September 26-30, New Orleans, LA
- American Association of Hip & Knee Surgeons (AAHKS) Annual Meeting, November 5-8, Dallas, TX
- CCJR Winter 2015 Meeting, December 9-12, Orlando, FL
Kinamed Supports Orthopeadic Research
Kinamed was named as a 2014 “Corporate Associate” of the Orthopaedic Research and Education Foundation (OREF), whose mission is “Improving lives by supporting excellence in orthopaedic research.” Kinamed, a longtime supporter of OREF, recognizes the importance of this mission.
Kinamed CEO on Importance of Orthopaedic Research
Mr. Clyde Pratt, Chief Executive Officer of Kinamed, shares why he believes it is important to support OREF and its mission of advancing the field of orthopaedic research.
Surgical Techniques of Olecranon Fractures
Another study demonstrating the clinical benefits of SuperCables was recently published: Rosenwasser (2014) Surgical Techniques of Olecranon Fractures. J Hand Surg Am 39(8): 1606-14. The article can be accessed via PubMed here
Abstract: Olecranon fractures are common upper extremity injuries. The vast majority are treated with operative fixation. Many treatment techniques have been described including tension band and plating. This review covers the most commonly used fixation techniques in detail, including pearls and pitfalls with case examples of both successful treatments and potential complications.
The authors note that proper tensioning a figure-of-8 wire is technically challenging and it is difficult to both teach and learn because of a tendency to either undertwist or overdo it and break the wire . Plus, any kink in the figure-of-8 passage will decrease the equalization of tension in the construct despite 2 twisting points. The authors state that they are now using SuperCable because its locking mechanism can be easily positioned laterally where it will be least prominent, the isoelastic nature of the material has a more uniform tension, and the nylon is softer than traditional wire and seems to be better tolerated by patients along the posterior border of the ulna. They further state that they prefer K-wire and tension cables instead of traditional 18-gauge wire for transverse fractures. Finally, they state that the need for secondary surgery for hard-ware removal after SuperCable fixation is less often than with twisted wire fixation.
Kinamed’s KineMatch Partial Knee Technology
Camarillo, Ca. – In the competitive medical device field, Camarillo-based Kinamed Inc. continues to thrive by making unique, highly differentiated products, such as a partial knee replacement that is custom-manufactured for each patient.