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Published on: July 15, 2009
Electrocautery Induced Damage of Total Knee Implants
Kirsten C Miller1, Brian R Morrow2, Jameson H Sorrels1
1Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee.
Background:
Pitting damage on implants has been reported and attributed to the use of electrocautery. This study aimed to determine how different total knee arthroplasty bearing surfaces are susceptible to this type of damage and whether surgeons are aware that this damage can occur.
Methods:
A survey was sent to Hip and Knee Society members to determine what percentage of adult reconstructive surgeons use electrocautery after implantation of components. Three bearing surfaces for total knee arthroplasty were selected: cobalt chromium, Oxinium, and zirconium nitride to be damaged by electrocautery with a monopolar (MP) and bipolar (BP) electrocautery with 3 different energy settings. A comparison of surface damage using scanning electron microscopy and elemental differences using energy dispersion spectroscopy was performed. Average roughness (Ra), maximal peak-to-valley height (Rz), kurtosis (Rk), and skewness (Rsk) were recorded for comparison using a profilometer was performed.
Results:
Median Rz and Ra measurements were larger for BP damaged areas compared to MP for all bearing surfaces. The Oxinium surface had the greatest increase in roughness parameters. Survey results indicate that a significant percentage of adult reconstructive surgeons use the electrocautery after implants are in place and are not aware of this type of damage. Backscatter scanning electron microscopy analysis found significant changes for BP damage compared to MP.
Conclusion:
Surface damage caused by electrocautery can have significant effects on the bearing surfaces of implants but further study needs to be performed to determine if this is a clinical issue. Our survey determined that many arthroplasty experts are unaware that this damage can occur.
Insights
Electrosurgery can damage total knee arthroplasty implants, especially bearing surfaces like Oxinium. Many surgeons are unaware of this risk, highlighting a need for increased awareness regarding electrocautery use with 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.
