Effect of commonly used lavage solutions on the polymerization of bone cement

Orthop Traumatol Surg Res. 2022 Dec;108(8):103243. doi: 10.1016/j.otsr.2022.103243. Epub 2022 Feb 11.


Introduction: Little is known about the impact irrigation solutions have on the material properties of cement used in hip and knee arthroplasty. We sought to compare the effect of three commonly used lavage solutions on cement polymerization.

Methods: Ten groups were used for cure and mechanical testing: two cement controls, and eight cement groups mixed with test solutions. Test solutions included a commercially available benzalkonium chloride/citric acid solution (BCS), chlorhexidine gluconate (0.05%) (CHG), povidone-iodine 0.35%, and normal saline added at cement mixing onset. Cement dough-time, set-time, and compression testing were performed following The American Society for Testing and Materials guidelines.

Results: Povidone-iodine had shorter dough-time (1min 34sec, sd 1min 5sec) versus controls (1min 56sec, sd 1min 35sec), p=0.0419. Cement exposed to all lavage samples had significantly reduced set-time. Compressive strength was reduced for all surgical lavages (p<0.001). Pairwise testing revealed that all lavage treatments reduced offset strength versus controls (p<0.001).

Conclusion: Bone cement exposed to lavage solutions during the cement mixing-phase showed accelerated set-times and decreased compressive strength. If bone is not dry, and cement has not finished mixing at the time of application, cement curing time may be shortened. Additionally, bone cement should reach dough phase prior to pre-closure surgical lavage.

Level of evidence: III; case control study.

Keywords: Infection prevention; Irrigation solutions; Prosthetic joint infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone Cements*
  • Case-Control Studies
  • Humans
  • Polymerization
  • Povidone-Iodine
  • Therapeutic Irrigation*


  • Bone Cements
  • Povidone-Iodine
  • chlorhexidine gluconate