Effect of Radiofrequency Use on Hip Arthroscopy Irrigation Fluid Temperature

doi:10.1016/j.arthro.2012.10.001

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 29, Issue 2, February 2013, Pages 336-342

https://doi.org/10.1016/j.arthro.2012.10.001 Get rights and content

Purpose

The purpose of this study was to determine operating parameters for joint fluid lavage using radiofrequency (RF) in maintaining intra-articular temperatures ≤50°C in the hip joint and to then quantify the influence of flow rate on maintaining safe intra-articular temperatures.

Methods

Fiberoptic intra-articular thermometers at radial distance intervals of 1, 2, 5, and 10 mm, spanning cross-sectional areas of 3.14, 12.56, 78.5, and 314.1 mm², respectively, from the RF probe were used in 3 human hip cadaveric specimens at room temperature, with 9 trials per variable, using a 3-portal technique with a capsule release. Using a new Dyonics RF System continuously at the superior capsulolabral junction for 90 seconds, continuous temperatures were recorded at 50 mm Hg inflow and variable outflow intervals: no flow and 5, 15, and 30 seconds. Lavages were 1 second in duration on suction. Statistical comparison was through multivariate regression analysis and a logistic model.

Results

Temperatures reached ≥50°C at 5-mm radial distance from the probe in all but the 5-second pulse lavage group. Elevated temperatures were reached within 1 to 2 seconds locally (1- to 2-mm radial distance) and at a radial distance of 5 mm in the 15-, 30-, and 0-second lavage groups. Logistic regression revealed a reduction in the odds that temperatures ≥50°C will occur as flow frequency increases every 30 (odds ratio = 0.68, P = .086); 15 (odds ratio = −1.22, P = .0067); and 5 (odds ratio = −4.26, P < .0001) seconds.

Conclusions

Increasing-interval pulsed irrigation is effective in maintaining intra-articular temperature profiles below 50°C during use of continuous RF ablation. Five-second-interval pulsed lavage is the longest flow interval identified during which fluid 5 mm radially from the RF device never reached temperatures >50°C.

Clinical Relevance

Clinical guidelines for using the RF ablation include: meticulous technique, intermittent use, good inflow and outflow, and pulsed lavage at frequent intervals.

Section snippets

Methods

A controlled laboratory study design was employed using 3 fresh human cadaver hip specimens at room temperature (22°C), with saline irrigation, also at room temperature, under traction. Each variable was tested 9 times (3 trials per specimen). Continuous RF at the capsulolabral junction was used under direct visualization for periods of 90 seconds at varying pulsed lavage interval rates. Fiberoptic intra-articular thermometers with probes at interval radial distances (1, 2, 5, and 10 mm) from

Determining Safe Temperature Profiles

Temperatures never reached ≥50°C at 5-mm or longer distances in the 5-second pulse lavage group (Fig 3); however, elevated temperatures were reached within 1 to 2 seconds locally (1- to 2-mm radial distance) and at a radial distance of 5 mm in the 15-second, 30-second and no-pulsed-lavage groups. Table 1 lists the times taken to achieve intra-articular temperatures >50°C at both near (1 and 2 mm) and far (5 and 10 mm) sites for each flow rate variable; the maximum joint temperature both near

Discussion

The purpose of this study was to determine the joint fluid lavage intervals during simultaneous RF ablation that effectively maintained intra-articular temperatures ≤50°C in the hip joint. In addition, we sought to quantify the influence of pulsed lavage interval rate on intra-articular temperatures, using lavage rates and radial distances from the temperature probe tip as variables. Five-second-interval pulsed lavage is the longest flow interval identified during which fluid 5-mm radially from

Conclusions

Increasing interval pulsed irrigation is effective in maintaining intra-articular temperature profiles below 50°C with the use of continuous RF ablation. Five-second interval pulsed lavage is the longest flow interval identified during which fluid 5 mm radially from the RF device never reaches temperatures above 50°C. Guidelines for using RF devices should include: meticulous technique, intermittent use, good inflow and outflow, and pulsed lavage at frequent intervals.

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Preoperative Paralabral Cysts Predict More Significant Chondral Damage but Not 2-Year Functional Outcomes Following Arthroscopic Labral Repair
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To investigate whether paralabral cysts identified incidentally on preoperative magnetic resonance imaging (MRI/MRA) predict 2-year functional outcomes after arthroscopic acetabular labral repair.
Prospectively collected data for patients undergoing primary hip arthroscopy by a single surgeon from 2014 to 2020 were retrospectively reviewed. Included patients were ≥18 years and completed baseline patient-reported outcome measures (PROMs) with additional follow-up at 3, 6, 12, and 24 months. Exclusion criteria were labral debridement, hip dysplasia, advanced hip osteoarthritis (Tönnis >1), or previous ipsilateral hip surgery. Patients were stratified based on the presence of paralabral cysts identified on MRI/MRA. Primary outcomes were International Hip Outcome Tool (iHOT-33) and modified Harris Hip Score (mHHS). Secondary outcomes included other PROMs and the visual analog pain scale. Outcomes were compared between cohorts using linear mixed-effects models and Fisher’s exact tests. Sensitivity analyses accounted for preoperative PROMs, nonlinear improvement trajectories, and relevant baseline characteristics.
Of the 182 included hips (47.8% female; mean ± standard deviation age, 36.9 ± 11.4), 30 (16.4%) had paralabral cysts. During the 2-year study period, there were no significant differences between patients with and without paralabral cysts in terms of iHOT-33 scores (weighted difference = 1.60; 95% confidence interval [CI], −5.09, 8.28; P = .64), mHHS scores (weighted difference = 0.56; 95% CI, −4.16, 5.28; P = .82), or any secondary outcomes (except for HOS–Sports Subscale at 3 months [mean difference = −11.85; 95% CI, −22.85, −0.84; P = .035]). Furthermore, there were no significant differences in clinically meaningful outcomes (P > .05 for all), revision rates (P = 1.00), or conversion to total hip arthroplasty between cohorts (P = 1.00). These results held across all sensitivity analyses.
Although preoperative paralabral cysts were associated with worse cam impingement and more severe chondral damage observed intraoperatively, they did not predict 2-year functional outcomes or clinically meaningful improvements, suggesting that incidentally discovered paralabral cysts are not a contraindication for arthroscopic labral repair.
Level III, retrospective cohort study.
Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture Capsulotomy
2019, Arthroscopy Techniques
Citation Excerpt :
First, it is important to keep the irrigation at a constant temperature using a high outflow rate. If the lavage temperature is allowed to rise it can cause chondral injury, with temperatures above 50˚C causing chondrolysis.18 Second, when a nodular lesion is identified with an obvious stalk, it is important to ablate the blood supply to that lesion.
Pigmented villonodular synovitis (PVNS) is a monoarticular, benign tumor arising from the synovium. Although classically treated with open synovectomy, arthroscopic treatment has demonstrated good clinical outcomes. The arthroscopic management of hip PVNS has been described as technically challenging due to difficulty obtaining the appropriate exposure. The purpose of this technical report is to describe a novel technique that allows for sound excision of PVNS during hip arthroscopy using a puncture capsulotomy. Full visualization throughout the central and peripheral compartments is key to achieving meticulous surgical excision and ablation, with careful attention to the medial and lateral synovial folds and gutters. It is important to avoid chondral injury by using a high outflow rate of irrigation to maintain a constant temperature, to ablate the blood supply of nodular lesions, and to not use a shaver as this may disseminate tumor cells. Multifactorial advancements in hip arthroscopy have permitted adequate visualization and exposure of PVNS lesions, making them amenable to arthroscopic synovectomy. Puncture capsulotomy does not require capsular closure, preserves the iliofemoral ligament, and minimizes exposure of extra-articular structures to the hip joint environment. Recurrence rates are lower in arthroscopic management compared with open management, at 7.7% and 17.8%, respectively.
Effects on the Distal Radioulnar Joint of Ablation of Triangular Fibrocartilage Complex Tears With Radiofrequency Energy
2016, Journal of Hand Surgery
This cadaver study investigated the temperature profile in the wrist joint and distal radioulnar joint (DRUJ) during radiofrequency energy (RFE) application for triangular fibrocartilage complex resection.
An arthroscopic partial resection of the triangular fibrocartilage complex using monopolar and bipolar RFE was simulated in 14 cadaver limbs. The temperature was recorded simultaneously in the DRUJ and at 6 other anatomic locations of the wrist during RFE application.
The mean temperature in the DRUJ was 43.3 ± 8.2°C for the bipolar system in the ablation mode (60 W) and 30.4 ± 3.4°C for the monopolar system in the cut mode (20 W) after 30 seconds. The highest measured temperature in the DRUJ was 54.3°C for the bipolar system and 68.1°C for the monopolar system.
The application of RFE for debridement or resection of the triangular fibrocartilage complex in a clinical setting can induce peak temperatures that might cause damage to the cartilage of the DRUJ. Bipolar systems produce higher mean temperatures than monopolar devices.
RFE application increases the mean temperature in the DRUJ after 30 seconds to a level that may jeopardize cartilage tissue.
Chondrolysis after hip arthroscopy
2015, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
The authors speculated that the heat generated at that time may have been responsible for the subsequent chondrolysis. McCormick et al.13 recommended meticulous technique, intermittent use of electrocautery, good inflow and outflow, and pulsed lavage at frequent intervals to maintain intra-articular temperature at less than 50°C. In our patient, we used a conventional electrosurgical device to perform capsulotomy, so we know there were effects not only in target tissue but also in surrounding tissues.
We report the case of a 58-year-old woman who presented with left hip pain and was diagnosed with femoroacetabular impingement. She underwent hip arthroscopy to repair a degenerative labral tear, as well as radiofrequency debridement and microfracture of the exposed chondral defect, and femoral osteoplasty. Two months after hip arthroscopy, hip pain and limping began. Hip radiography showed a concentric decrease of joint space and no signs of joint incongruity or osteophytosis. Revision surgery 4 months after hip arthroscopy showed that the cartilage of the femoral head was soft and separated from the subchondral bone.
Association Between Chondrolabral Junction Breakdown and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up
2024, American Journal of Sports Medicine
Intra-articular temperature monitoring during radiofrequency ablation in ex-vivo bovine hip joints via Fiber Bragg grating sensors
2023, BMC Musculoskeletal Disorders

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: The authors report the following conflict of interest or source of funding in relation to this article: Smith & Nephew Endoscopy, Andover, MA. Grant provided for research expenses. The study was carried out at the Smith & Nephew Endoscopy Lab in Andover, MA.

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Original ArticleEffect of Radiofrequency Use on Hip Arthroscopy Irrigation Fluid Temperature

Purpose

Methods

Results

Conclusions

Clinical Relevance

Section snippets

Methods

Determining Safe Temperature Profiles

Discussion

Conclusions

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

Chondrolysis of the glenohumeral joint following arthroscopic capsular release for adhesive capsulitis: A case report

Knee Surg Sports Traumatol Arthrosc

Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature

Am J Sports Med

Postsurgical glenohumeral arthritis in young adults

Am J Sports Med

Original Article
Effect of Radiofrequency Use on Hip Arthroscopy Irrigation Fluid Temperature