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Ultrasonic bone cement removal efficiency in total joint arthroplasty revision: A computer tomographic-based cadaver
Clemens Roitzsch1, Rudi Apolle2,3,4,5, Christian Jan Baldus6
1University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany.
Summary
Ultrasonic removal of polymethylmethacrylate (PMMA) cement during joint revision surgery is highly effective, removing over 99% of residues. This bone-preserving technique shows promise for managing septic total joint arthroplasty revisions.
Area of Science:
- Orthopedic Surgery
- Biomaterials Engineering
- Medical Imaging
Background:
- Polymethylmethacrylate (PMMA) removal in septic total joint arthroplasty revision carries significant fracture and perforation risks.
- Ultrasonic cement removal is a bone-preserving technique, but its efficacy, especially for small residues, requires further validation.
- Incomplete PMMA removal can lead to biofilm formation, complicating infection eradication.
Purpose of the Study:
- To investigate the efficiency of ultrasonic-based PMMA removal in a human cadaver model.
- To quantify the amount and size of residual PMMA after ultrasonic cement extraction.
Main Methods:
- PMMA cement fixation of femoral components in hip and knee prostheses in cadaver femurs.
- Implant and cement mantle removal using the OSCAR-3-System ultrasonic system.
- Quantitative analysis of PMMA residues using dual-energy and microcomputer tomography (20 µm resolution).
Main Results:
- Ultrasonic removal achieved over 99% PMMA removal.
- Microcomputer tomography identified 734 residues (mean volume 0.40 ± 4.95 mm³), with only 4 exceeding 1 cm in any axis.
- Dual-energy CT (0.75 mm resolution) is suitable for clinical assessment of PMMA residues.
Conclusions:
- Ultrasonic cement removal is a highly effective technique for PMMA extraction during revision arthroplasty.
- Computer tomography can detect sub-millimeter PMMA residues, offering new insights into removal efficiency.
- Further research is needed to determine the clinical impact of residual PMMA on periprosthetic joint infection eradication rates.
