A new Journal of Arthroplasty study of more than 200 unilateral cemented total knee arthroplasty (TKA) cases found that using CO2 bone preparation (CarboJet from Kinamed, Inc., in Camarillo, California) cuts pain and opioid use in tourniquetless cases.
New Study: Using CO2 Bone Prep in TKA Cuts Pain, Opioid Use
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#opioids#totalkneereplacementSecondary#carbojet
The study, “Tourniquetless Total Knee Arthroplasty With Modern Perioperative Protocols Decreases Pain and Opioid Consumption in Women,” appears in the November 2018 edition of the Journal of Arthroplasty.
According to study co-author Michael Meneghini, M.D., associate professor of Clinical Orthopedic Surgery at Indiana University School of Medicine, using CO2 bone preparation in no-tourniquet, female TKA patients resulted in less post-operative pain and fewer opioids as compared to female patients in the tourniquet group.
The researchers enrolled 203 patients who underwent primary unilateral cemented TKAs. The patients were divided into two groups, each using identical perioperative pain and blood loss protocols. One group did not receive tourniquet but were treated with a CO2 bone preparation and the other group was treated with a tourniquet.
According to the manufacturer, the CO2 system (CarboJet from Kinamed) employed medical grade compressed carbon dioxide gas to deep clean the bone bed and remove lipids/fatty marrow elements, blood, and saline prior to the application of bone cement.
Dr. Meneghini explained the results to OTW, “In this era of opioid addiction, identifying practical methods to decrease pain and narcotic use after total knee replacement should be a goal of all surgeons and caregivers. We were pleased to discover such a dramatic decrease in inpatient opioid consumption and pain by eliminating tourniquet-induced limb ischemia.”
“I consider the CarboJet bone preparation system an essential tool in these cases because it is effective at removing lipids, saline, and blood from the bone bed. Proper cleaning of the bone bed is especially important in tourniquetless knee arthroplasty for achieving a good, long-lasting cement bond.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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