Electrocautery Induced Damage of Total Knee Implants

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Surgical Technology

Background:

• Pitting damage on total knee arthroplasty (TKA) implants has been linked to electrocautery use.
• The susceptibility of different TKA bearing surfaces to electrocautery-induced damage is not well understood.
• Surgeon awareness regarding electrocautery risks to implants is uncertain.

Purpose of the Study:

• To assess the susceptibility of various TKA bearing surfaces to electrocautery damage.
• To evaluate surgeon awareness of electrocautery-induced implant damage.
• To compare damage from monopolar and bipolar electrocautery on different implant materials.

Main Methods:

• A survey of Hip and Knee Society members assessed electrocautery use post-implantation.
• Cobalt chromium, Oxinium, and zirconium nitride TKA surfaces were damaged using monopolar and bipolar electrocautery at varying energy levels.
• Surface analysis included scanning electron microscopy, energy-dispersive spectroscopy, and profilometry (measuring Ra, Rz, Rk, Rsk).

Main Results:

• Bipolar electrocautery caused greater increases in roughness (Rz, Ra) than monopolar across all bearing surfaces.
• Oxinium exhibited the most significant increase in roughness parameters after damage.
• Survey data revealed a substantial percentage of surgeons use electrocautery post-implantation without awareness of potential damage; backscatter SEM confirmed significant changes with bipolar damage.

Conclusions:

• Electrocautery can cause significant surface alterations to TKA bearing surfaces.
• The clinical implications of this surface damage require further investigation.
• A notable portion of arthroplasty specialists are unaware of electrocautery's potential to damage implants.