Effect of an ultrasonic device on temperatures generated in bone and on bone-cement structure

Brooks, Andrew T.; Nelson, Carl L.; Stewart, Charles L.; Skinner, Robert A.; Siems, Martin L.

doi:10.1016/s0883-5403(06)80041-0

Cited by 29 publications

(24 citation statements)

References 4 publications

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“…Therefore, the temperature gradient of 2000°C described in the paper by Schwaller [12] is implausible, since on the side of the heat source there would only be gas. In 1993, Brooks et al [24] published more detailed information on the temperatures generated by ultrasonic devices during bone cement extraction. When the ultrasound probe was introduced to the cement-bone interface for 2 s, temperatures of up to 80°C were recorded.…”

Section: Discussionmentioning

confidence: 99%

Thermomechanical method for cement extraction in revision arthroplasty

Ghanem

Köenig

Dehn

et al. 2017

Eur J Orthop Surg Traumatol

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Section: Discussionmentioning

confidence: 99%

Thermomechanical method for cement extraction in revision arthroplasty

Ghanem

Köenig

Dehn

et al. 2017

Eur J Orthop Surg Traumatol

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“…This has the advantage of preserving patient bone stock and preventing bone perforation during revision total hip arthroplasty (Brooks et al, 1993(Brooks et al, , 1995Gardiner et al, 1993;Klapper et al, 1992). A major advantage of the ultrasonic system is the ability to detect the difference between cutting through bone cement and coming into contact with cortical bone (dense bone forming the surface of bones).…”

Section: Bone Cement Removalmentioning

confidence: 99%

“…The absorbed energy alters the structure and mechanical properties of the cement in contact with the surface of the working tool bit, softening it to a gum-like pliable consistency to facilitate accelerated cement removal (Klapper et al, 1992). Microscopic examination of cement demonstrates structural change in the bone cement converting it from a microscopically spherical interlocked material to a homogenous granular substance (Brooks et al, 1993). This process is analogous to insertion of metal screws into plastic parts during ultrasonic assembly (Walter, 1968).…”

Section: Bone Cementmentioning

confidence: 99%

“…In clinical studies, a reduced incidence of thermal damage is reported with the use of ultrasonic instruments in comparison with alternative bone cement-removal techniques (Gardiner et al, 1993;Klapper et al, 1992). In human cadaver bone studies, Caillouette et al and Brooks et al report temperature generation at the bone-cement interface of 39 •C and 80 •C, respectively (Brooks et al, 1993;Caillouette et al, 1991b). This is less than that generated by high speed drills (140 •C) (Matthews and Hirsch, 1972).…”

Section: Protein Denaturation/necrosismentioning

confidence: 99%

“…Sources of thermal injury can potentially be controlled with appropriate surgical technique and appropriate system design. System design should incorporate adequate irrigation (Goldberg et al, 2005;Brooks et al, 1993) or wetting solution (Cooter et al, 2001) and limitation of tissue contact time (Emam and Cuschieri, 2003), as well as reduction in cutting blade velocity, load and p-p tip amplitude (Chan et al, 1986). …”

Section: Protein Denaturation/necrosismentioning

confidence: 99%

See 2 more Smart Citations

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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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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Effect of an ultrasonic device on temperatures generated in bone and on bone-cement structure

Cited by 29 publications

References 4 publications

Thermomechanical method for cement extraction in revision arthroplasty

Thermomechanical method for cement extraction in revision arthroplasty

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

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

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