Basic Science
Electrocautery Induced Damage of Total Knee Implants

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Abstract

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.

Section snippets

Survey on Electrocautery Use During Total Knee Arthroplasty

To better understand if surgeons use EC after implants are placed during primary TKA and THA, a survey was taken of Hip and Knee Society surgeons. The survey was solicited through an email list, and a request with a Survey Monkey link was sent out to members of The Hip and Knee Society. After 102 replies through Survey Monkey were obtained the survey was closed and the results tabulated. Specifically, the survey asked whether surgeons use EC near the primary implants after they have been

Survey

Results from the survey questions from 102 respondents are shown in Figure 3A-C. When responding to “Do you use electrocautery after the implants are inserted,” 44% responded sometimes and 34% responded always. When asked the same question concerning revision surgery, 31% responded sometimes and 7% always. When asked if the surgeon was aware if the EC could damage the surface of the implant, 49% responded no.

Electrocautery-Damaged Specimens

Visual assessment showed a darkened area for the MP damage of the CoCr and ZrN but the

Discussion

This study determined that there may be a large percentage of surgeons who may not realize the damage that can occur to implant bearing surfaces with local use of EC devices. The use of a BP (Aquamantys) vs an MP (Bovie) in this in vitro study found that the BP imparted less damage on all 3 surfaces by topography measures as well as subjective comparisons. The ZrN was damaged the least amount of the 3 surfaces, as determined by Rz and Ra values, while the Oxinium bearing surface saw the largest

Conclusion

The fact that many expert surgeons surveyed were not aware of the damage that can occur when EC devices are used emphasizes the need for these kinds of studies to be reported. Surface topographies, examined by measuring Ra, Rz, Rsk, and Rk roughness parameters for EC-damaged groups from both MP and BP sources on all 3 surfaces, revealed significant changes that may affect both wear patterns and metal ion release over the lifetime of the implant. The authors do stress that these reported

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One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.09.044.

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