Factors influencing intra-articular fluid temperature profiles with radiofrequency ablation

Radiofrequency ablation devices are being used increasingly in arthroscopic surgery. However, there are concerns that excessive temperatures may damage the articular cartilage. The purpose of this study was to investigate the temperature profiles that occur within the glenohumeral space with the use of one commercially available radiofrequency ablation probe.

Ten fresh-frozen human cadaver shoulder specimens were used. Intra-articular temperatures were measured at different time intervals over a two-minute period at a distance of 1, 3, 5, and 10 mm away from the probe. The radiofrequency probe was activated throughout the range of machine power settings, and irrigation fluid flow was varied (no flow, a flow at 60 mm Hg without suction, and a flow at 60 mm Hg with suction).

Temperatures deleterious to articular cartilage chondrocytes (i.e., those in excess of 50 degrees C) were seen with an increased duration of application, a decreased distance between the thermometer and the probe, and a decreased irrigation fluid flow rate. The highest recorded irrigation fluid temperature reached >80 degrees C after two minutes in a no-flow setting. The flow rate was found to be the most significant predictor of intra-articular temperature profiles. The various machine power settings had no apparent influence on temperature, meaning that higher probe settings are not necessarily associated with higher temperature profiles.

These results demonstrate the importance of the management of the irrigation fluid flow rate across the joint during arthroscopic procedures that involve radiofrequency ablation. Even short intervals of limited flow could lead to supraphysiological temperature profiles and potentially to cartilage damage.