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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Complication of the use of a radiofrequency device in arthroscopic shoulder surgery: Second-degree burn of the shoulder girdle.Arthroscopy. 2011; 27: 136-141
- Dermal burns associated with bipolar radiofrequency ablation in the subacromial space.Arthroscopy. 2011; 27: 142-144
- Chondrolysis of the glenohumeral joint following arthroscopic capsular release for adhesive capsulitis: A case report.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 292-294
- Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature.Am J Sports Med. 2004; 32: 509-515
- Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy.Arthroscopy. 2007; 23: 797.e1-797.e5
- Postsurgical glenohumeral arthritis in young adults.Am J Sports Med. 2009; 37: 1784-1791
- An unusual case of chondrolysis of the hip following excision of a torn acetabular labrum.Arch Orthop Trauma Surg. 2010; 130: 65-70
- Thermal chondroplasty of chondromalacic human cartilage: An ex vivo comparison of bipolar and monopolar radiofrequency devices.Am J Sports Med. 2002; 30: 90-97
- Thermal chondroplasty with bipolar and monopolar radiofrequency energy: Effect of treatment time on chondrocyte death and surface contouring.Arthroscopy. 2002; 18: 779-788
- The use of radiofrequency energy during arthroscopic surgery and its effects on intraarticular tissues.Vet Comp Orthop Traumatol. 2006; 19: 65-71
- Effects of thermal energy on chondrocyte viability.Am J Vet Res. 2006; 67: 1708-1712
- Factors influencing intra-articular fluid temperature profiles with radiofrequency ablation.J Bone Joint Surg Am. 2009; 91: 2448-2454
- Effect of radiofrequency energy on glenohumeral fluid temperature during shoulder arthroscopy.J Bone Joint Surg Am. 2009; 91: 429-434
- Effect of simulated shoulder thermal capsulorrhaphy using radiofrequency energy on glenohumeral fluid temperature.Arthroscopy. 2005; 21: 592-596
- Fluid temperatures during radiofrequency use in shoulder arthroscopy: A cadaveric study.J Shoulder Elbow Surg. 2007; 16: 107-111
- Effects of hip joint position and intra-capsular volume on hip joint intra-capsular pressure: A human cadaveric model.J Orthop Surg Res. 2009; 4: 8
- Sequential volume reduction with capsular plications: Relationship between cumulative size of plications and volumetric reduction for multidirectional instability of the shoulder.Am J Sports Med. 2011; 39: 526-531
- The role of flexible radiofrequency energy probes in hip arthroscopy.Tech Orthop. 2005; 20: 37-44
- The labro-acetabular complex.J Bone Joint Surg Am. 2011; 93: 22-27
Article info
Publication history
Published online: January 07, 2013
Accepted:
October 1,
2012
Received:
February 8,
2012
Footnotes
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.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
