Behavior of arthroscopic irrigation systems

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.