Revision arthroplasty facilitated by ultrasonic tool cement removal

Callaghan, John J.; Elder, Steven H.; Stranne, Steven K.; Fulghum, Chris F.; Seaber, Anthony V.; Myers, Barry S.

doi:10.1016/s0883-5403(06)80070-7

Cited by 18 publications

(6 citation statements)

References 13 publications

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“…15 Callaghan et al demonstrated in an in vivo study that UCR has no disadvantageous effects on whole bone strength compared to manual cement removal. 32 Other histological studies showed no significant cortical bone damage. 33 Besides removing cement from the femoral canal, ultrasound was reported to extract a massive intrapelvic cement deposit 34 safely.…”

Section: Discussionmentioning

confidence: 94%

Ultrasonic bone cement removal efficiency in total joint arthroplasty revision: A computer tomographic‐based cadaver study

Roitzsch

Apolle

Baldus

et al. 2022

Journal Orthopaedic Research

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Polymethylmethacrylate (PMMA) removal during septic total joint arthroplasty revision is associated with a high fracture and perforation risk. Ultrasonic cement removal is considered a bone‐preserving technique. Currently, there is still a lack of sound data on efficacy as it is difficult to detect smaller residues with reasonable technical effort. However, incomplete removal is associated with the risk of biofilm coverage of the residue. Therefore, the study aimed to investigate the efficiency of ultrasonic‐based PMMA removal in a human cadaver model. The femoral components of a total hip and a total knee prosthesis were implanted in two cadaver femoral canals by 3rd generation cement fixation technique. Implants were then removed. Cement mantle extraction was performed with the OSCAR‐3‐System ultrasonic system (Orthofix®). Quantitative analysis of cement residues was carried out with dual‐energy and microcomputer tomography. With a 20 µm resolution, in vitro microcomputer tomography visualized tiniest PMMA residues. For clinical use, dual‐energy computer tomography tissue decomposition with 0.75 mm resolution is suitable. With ultrasound, more than 99% of PMMA was removed. Seven hundred thirty‐four residues with a mean volume of 0.40 ± 4.95 mm3 were identified with only 4 exceeding 1 cm in length in at least one axis. Ultrasonic cement removal of PMMA was almost complete and can therefore be considered a highly effective technique. For the first time, PMMA residues in the sub‐millimetre range were detected by computer tomography. Clinical implications of the small remaining PMMA fraction on the eradication rate of periprosthetic joint infection warrants further investigations.

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Section: Discussionmentioning

confidence: 94%

Ultrasonic bone cement removal efficiency in total joint arthroplasty revision: A computer tomographic‐based cadaver study

Roitzsch

Apolle

Baldus

et al. 2022

Journal Orthopaedic Research

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“…However, vessel perforation had been reported in an earlier study by Siegel et al (1988). They found that perforation is avoidable with pulsed wave energy, keeping power below 50W and duration less than 30 s. In whole bone strength studies using an ex vivo canine model and torsion testing, Callaghan et al (1992) found no decrease in ultimate torque, maximum angle and energy capacity after ultrasonic bone cement removal. In another study, Brooks et al (1995) assessed the average load generated across cortical bone by ultrasonic tools while removing cement.…”

Section: Global Biomechanical Propertiesmentioning

confidence: 99%

High-power low-frequency ultrasound: A review of tissue dissection and ablation in medicine and surgery

OʼDaly

Morris

Gavin³

et al. 2008

Journal of Materials Processing Technology

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Ab s t r a c t High-power low-frequency ultrasound in the range 20-60 kHz has wide ranging clinical applications in surgical and medical instruments for biological tissue cutting, ablation or fragmentation, and removal. Despite widespread clinical application and common device operating characteristics, there is an incomplete understanding of the mechanism of tissue failure, removal and damage. The relative contribution of cavitation, direct mechanical impact and thermal effects to each process for specific tissue types remains unclear. Different and distinct mechanisms and rates of tissue removal are observed for interaction with soft and hard tissue types. Device operating parameters known to affect the interaction include frequency, peak-peak tip amplitude, suction and application time. To date, there has been little analysis of the effect of variations in, and interactions of, these parameters on tissue removal and damage for individual biological tissue types. Potential controllable damage mechanisms occurring in tissues include alteration in global biomechanical properties, histomorphological changes, protein denaturation and tissue necrosis. This paper presents a critical review of the literature on the clinical application, mechanism of tissue interaction, removal and residual tissue damage. It describes known mechanisms for distinct tissue types.

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“…Another method of cement removal not discussed here is with ultrasonically driven cement removal instruments. [3][4][5][6] They are used to assist with the removal of poylmethylmethacrylate (PMMA) bone cement during arthroplasty revision. The potential advantages of using the hand tools versus the ultrasonic instrumentation is the avoidance of cell death at the endosteal bone surface, hazardous fumes from the melting of the PMMA bone cement, and soft tissue damage from heat or friction burns.…”

confidence: 99%

Clinical Tip: Extraction of a difficult to remove intramedullary antibiotic rod in the ankle

Belczyk¹

2008

FAOJ

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Revision arthroplasty facilitated by ultrasonic tool cement removal

Cited by 18 publications

References 13 publications

Ultrasonic bone cement removal efficiency in total joint arthroplasty revision: A computer tomographic‐based cadaver study

Ultrasonic bone cement removal efficiency in total joint arthroplasty revision: A computer tomographic‐based cadaver study

High-power low-frequency ultrasound: A review of tissue dissection and ablation in medicine and surgery

Clinical Tip: Extraction of a difficult to remove intramedullary antibiotic rod in the ankle

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