Minimal femoral cortical thickness necessary to prevent perforation by ultrasonic tools in joint revision surgery

Brooks, Andrew T.; Nelson, Carl L.; Hofmann, Otto E.

doi:10.1016/s0883-5403(05)80185-8

Cited by 16 publications

(7 citation statements)

References 4 publications

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“…However, there are few studies on UCR, and to our knowledge none on its efficacy. 14,15,17 Thus, the current study aimed to investigate the efficiency of UCR in TJA revision.…”

Section: Discussionmentioning

confidence: 99%

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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“…However, there are few studies on UCR, and to our knowledge none on its efficacy. 14,15,17 Thus, the current study aimed to investigate the efficiency of UCR in TJA revision.…”

Section: Discussionmentioning

confidence: 99%

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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“…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%

“…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. In general, risk of cortical perforation for any cement extraction instrument increases as the thickness of femoral cortex decreases.…”

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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“…Cement removal can be performed with ultrasonic tools (16, 17), high speed burrs, osteotomes, reamers, trochanteric osteotomy, controlled femoral perforation (18), endoscopically (19) and by computer assisted fluoroscopic navigation (20). These techniques are either costly, onerous or challenging, and associated with the risk of femoral perforation (21–22–23) and periprosthetic fracture (23, 24).…”

Section: Introductionmentioning

confidence: 99%

Stem compatibility for cement-in-cement femoral revision: an in vitro study

et al. 2014

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Cement-in-cement femoral component revision is a useful and commonly practised technique. Onerous and hazardous re-shaping of the original cement mantle is required if the new stem does not seat easily. Furthermore, without removing the entirety of the original cement mantle, the freedom to alter anteversion or leg length is difficult to predict preoperatively. We present data from in vitro experiments testing the compatibility of the top cemented stems according to UK registry figures (NJR 2013). This data augments preoperative planning by indicating which revision stems require minimal or no cement reshaping when being inserted into another stem's mantle. We also present the maximum shortening and anteversion that can be achieved without reshaping the original cement mantle.

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Minimal femoral cortical thickness necessary to prevent perforation by ultrasonic tools in joint revision surgery

Cited by 16 publications

References 4 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

Stem compatibility for cement-in-cement femoral revision: an in vitro study

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