Use of an Irrigation Pump System in Arthroscopic Procedures

Abstract

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.].

What should we be careful of ankle arthroscopy?

“…An automated pump or gravity flow system has the benefits of a tamponade effect on bleeding, an intraarticular irrigation effect, and a decreasing need for tourniquet use. 39,42 However, since the pump system can generate higher flow rates and pressures, more marked damage can occur. 39,43 Intraarticular fluid pressure increase via the pump system combined with the distraction force during arthroscopy should not be overlooked, even when arthroscopic procedures are performed without tourniquet inflation.…”

Does desflurane need more irrigating-pump pressure for the visibility in arthroscopic shoulder surgery than sevoflurane?

“…In shoulder surgery, arthroscopic procedures are popular and widely used because they enable a smaller incision, less tissue injury, a wider surgical field, less postoperative pain and potentially faster recovery [ 1 , 2 ]. To achieve successful surgery with an arthroscope, a mechanical fluid-irrigation system (irrigation pump, as below) is used to produce adequate joints distension and wash out blood and cell debris from the joint space [ 3 ].…”

Comparison of Cytotoxic Effects of Intra-Articular Use of Tranexamic Acid versus Epinephrine on Rat Cartilage

“…The role of arthroscopic procedures in the diagnosis and treatment of a wide variety of joint disorders is evolving. Among the many factors that determine the success of surgery and patient outcomes, adequate visualization is known to be essential to perform these procedures effectively and efficiently [ 1 , 2 ]. Numerous devices and surgical techniques have been developed for this purpose [ 2 , 3 ].…”

“…Among the many factors that determine the success of surgery and patient outcomes, adequate visualization is known to be essential to perform these procedures effectively and efficiently [ 1 , 2 ]. Numerous devices and surgical techniques have been developed for this purpose [ 2 , 3 ]. Epinephrine is a potent vasoconstrictor, frequently added to the irrigation fluid to reduce intra-articular bleeding, and thereby maintaining adequate visualization during the operation [ 4 , 5 ].…”