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Biomechanical Evaluation of Powered Acetabular Extraction Tool Reduces Force, Time, and Surgeon Burden Compared to
Dimitri J Mabarak1, Shujaa T Khan1, Khaled A Elmenawi1
1Cleveland Clinic Foundation, Department of Orthopaedic Surgery, Cleveland, OH, USA.
Background:
Removing acetabular implants is time- and labor-intensive, prompting the development of powered and manual extraction systems. Comparative data on force requirements, ergonomics, and operative time remain limited. We compared a powered vs a manual system in novice and expert surgeons using an in vitro model.
Methods:
Composite foam blocks implanted with a 54-mm hemispherical acetabular shell emulated a well-fixed cementless construct and were mounted on a force sensor. Three board-certified, fellowship-trained orthopaedic surgeons and 3 residents each performed 3 trials with a powered extractor and a manual extractor. Participants wore triaxial accelerometers on the back and both hands and an in-line force sensor. Outcomes were peak acceleration (proxy for vibration), peak applied force, and time to extraction.
Results:
Relative to the powered device, the manual device was associated with higher back acceleration (estimate 0.55; 95% confidence interval [CI]: 0.49-0.61; P < .001), greater applied force (5.75; 95% CI: 4.04-7.47; P < .001), and longer time to component removal (61.31 s; 95% CI: 48.04-74.58; P < .001). Surgeon experience did not affect force (estimate -1.03; P = .696) or time (estimate -1.03; P = .696).
Conclusions:
The powered acetabular extraction tool reduced vibration exposure, applied force, and extraction time compared with a manual device across both novice and expert operators. In a field with substantial work-related musculoskeletal injury and growing emphasis on surgeon well-being, powered extraction may improve efficiency while helping preserve surgeon health and career longevity. These data provide objective support for selecting powered systems when available and justify further study in cadaveric and clinical settings to confirm external validity.
