Accuracy of pressure and flow capacities of four arthroscopic fluid management systems

Muellner, Thomas; Menth-Chiari, Wolfgang A.; Reihsner, R.; Eberhardsteiner, Josef; Engebretsen, Lars

doi:10.1053/jars.2001.25340

Cited by 33 publications

(18 citation statements)

References 18 publications

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“…Pedowitz demonstrated that metallic micro debris is liberated by common arthroscopic instruments, and may induce intra-articular damage if their concentrations reach clinically significant levels [23]. In order to ensure good visualization, which is one of the key importance in arthroscopic surgery [24], arthroscopic surgery is usually performed with pressurized saline. The liquid pressure can enlarge the available joint space, and the liquid flow not only flushes out the joint-free tissue such as synovial or cartilage debris but also avoids thermal damage inside the joint [25,26].…”

Section: Discussionmentioning

confidence: 99%

Assessment of arthroscopic shavers: a comparison test of resection performance and quality

Peng

Zhao

et al. 2020

J Orthop Surg Res

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Background: Arthroscopic shavers play an indispensable role in arthroscopic debridement. They have exquisite structures and similar designs. The purpose of this study was to establish a reproducible testing protocol to compare the resection performance and the quality (tensile strength, torsional strength, and corrosion resistance) of different arthroscopic shavers with comparable designs. We hypothesized that there could be little difference in resection performance and quality between these shavers. Methods: Incisor Plus Blade (IPB; Smith & Nephew, Andover, MA) and Double Serrated Plus Blade (DSPB; BJKMC, Shanghai, China) were selected for resection performance and quality test. For resection performance testing, the resection torque, which is the minimum torque required to cut off silicone blocks with the same cross-sectional area, was measured to evaluate the resection performance of shaver blades when the other factors remain the same. For quality testing, tensile and torsion tests of the shavers' joint part were performed, and ultimate failure load and maximum torque were measured and compared. The corrosion resistance of these blades was assessed by the boiling water test based on the ISO13402. Results: No significant difference existed in the resection torque between the shaver blades of IPB and DSPB (P = 0.54). To the failure load of shavers' joint parts, IPB was significantly higher than DSPB, both in the outer and inner blades (P < 0.0001). The maximum torque of the joint part had no significant difference between IPB and DSPB (for inner blades P = 0.60 and outer blades P = 0.94). The failure load (for both IPB and DSPB P < 0.0001) and maximum torque (for IPB P = 0.0475 and DSPB P = 0.015) of the inner blades were higher than those of the outer blades. No blemishes were observed on the surface of the blades after corrosion resistance tests. Conclusions: This study provided some new methods to evaluate the resection performance and quality of different shavers. The resection performance, the torsional strength of the joint part, and the corrosion resistance of IPB and DSPB may show comparable properties, whereas the tensile strength of the shavers' joint part showed some level of difference.

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Section: Discussionmentioning

confidence: 99%

Assessment of arthroscopic shavers: a comparison test of resection performance and quality

Peng

Zhao

et al. 2020

J Orthop Surg Res

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“…Several studies have been performed to compare irrigation systems, but none actually deals with the ease of control of the systems [1,5,13]. As we have derived a model, this helps in indicating limitations of both pumps.…”

Section: Discussionmentioning

confidence: 99%

Behavior of arthroscopic irrigation systems

Tuijthof

Dusée

Herder

et al. 2005

Knee Surg Sports Traumatol Arthrosc

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In the literature, no consensus exists about optimal irrigation of joints during arthroscopic operations. The goal of this paper is to study the behavior of irrigation systems resulting in the proposal of guidelines for optimal irrigation. To this end, optimal irrigation is defined as the steady state of irrigation of a joint in which a sufficient positive intra-articular pressure and a sufficient flow are maintained. A model of the complete irrigation system was created to schematically elucidate the behavior of pump systems. Additionally, clinical experiments were performed during arthroscopic knee operations in which the pressure at different locations and the irrigation flow were measured. The combination of model prediction and clinical results could well be used to derive guidelines, since the clinical results, which showed considerable variation, were used to verify the model, and the model could be used to explain the typical trends. The main findings are twofold the set pressure is always higher than the intra-articular pressure, and the scope-sheath combination has a significant influence on irrigation control, because of its large restriction. Based on the results, we advice to increase the set pressure during active suction, and to include the sheath-scope combination in the control loop.

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“…[5][6][7] Pump systems used for arthroscopic surgery have evolved over the years to provide improved visualization. 8 Gravity flow systems were used first and are still commonly used, followed by automated pump systems. Gravity flow systems simply use gravity to control inflow by positioning a bag of fluid higher than the joint to provide enough pressure for insufflation.…”

Section: Historymentioning

confidence: 99%

“…21,22 Despite known possible complications related to high pressure, many commercial devices allow pressure values far above 100 mm Hg. 8 Complications rate of 1% have been described in the literature, with complications including fluid extravasation (intraperitoneal and extraperitoneal accumulation), synovial pouch rupture (distension of compartments of the leg and thigh), and compartment syndrome. 13 There are reported cases for termination of knee arthroscopy due to distention of the anterior and posterior compartment of the leg and thigh, and compartment syndrome with no palpable pulses of posterior tibial or dorsalis pedis arteries requiring fasciotomies.…”

Section: Complicationsmentioning

confidence: 99%

Use of an Irrigation Pump System in Arthroscopic Procedures

Hsiao¹,

Kusnezov²,

Sieg³

et al. 2016

Orthopedics

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Since its inception, arthroscopic surgery has become widely adopted among orthopedic surgeons. It is therefore important to have an understanding of the basic principles of arthroscopy. Compared with open techniques, arthroscopic procedures are associated with smaller incisions, less structural damage, improved intra-articular visualization, less pain in the immediate postoperative period, and faster recovery for patients. Pump systems used for arthroscopic surgery have evolved over the years to provide improved intraoperative visualization. Gravity flow systems were described first and are still commonly used today. More recently, automated pump systems with pressure or dual pressure and volume control have been developed. The advantages of automated irrigation systems over gravity irrigation include a more consistent flow, a greater degree of joint distention, improved visualization especially with motorized instrumentation, decreased need for tourniquet use, a tamponade effect on bleeding, and decreased operative time. Disadvantages include the need for additional equipment with increased cost and maintenance, the initial learning curve for the surgical team, and increased risk of extra-articular fluid dissection and associated complications such as compartment syndrome. As image quality and pump systems improve, so does the list of indications including diagnostic and treatment modalities to address intra-articular pathology of the knee, shoulder, hip, wrist, elbow, and ankle joints. This article reviews the current literature and presents the history of arthroscopy, basic science of pressure and flow, types of irrigation pumps and their functions, settings, applications, and complications. [Orthopedics. 2016; 39(3):e474-e478.].

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Accuracy of pressure and flow capacities of four arthroscopic fluid management systems

Cited by 33 publications

References 18 publications

Assessment of arthroscopic shavers: a comparison test of resection performance and quality

Assessment of arthroscopic shavers: a comparison test of resection performance and quality

Behavior of arthroscopic irrigation systems

Use of an Irrigation Pump System in Arthroscopic Procedures

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