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Saturday, February 24, 1996

Says ultrasonic tools useful for revision surgery

Revision total hip arthroplasty poses many technical challenges among which is cement removal. It often involves increased operative time, blood loss, as well as increased rates of bone perforation and fracture. Ultrasonically driven tools (UDTs) have already been used for plaque removal in dentistry and for removal of cataracts and are now being used in revision arthroplasty. That is the subject of Poster B23, "Use of Ultrasonic Tools in Cemented Femoral Revision Surgery," authored by Thomas C. Kim, MD; William A McGann, MD; and Richard B. Welch, MD.

Studies on ultrasonically driven tools indicate no adverse thermal effects and no significant cortical destruction. Furthermore, fume emission during cement removal has been demonstrated to be safe. A UDT was used in 21 revision hip operations performed by a single surgical team from March 1992 to April 1995.

In this series, the UDT was utilized on the femoral side in revision cases where cement was adjacent to regions of fragile femoral bone stock, for removal of distal cement plugs, and for reshaping an old cement mantle when the bone-cement interface was intact. Overall, the UDT was utilized in five cases for cement removal (in conjunction with manual tools), in eight cases for distal cement plug removal and in eleven cases to "enlarge" an intact cement mantle.

The UDT was found to be successful in each case - cement removal was facilitated without fracture, distal cement plugs were removed without the use of cortical windows and in an average of three minutes, and femoral prostheses of modern design were able to be recemented into an "enlarged" old cement mantle which had been shaped by the ultrasonic tools.

In this series, the UDT was found to be an effective tool to aid the surgeon in the performance of revision arthroplasties. It facilitates cement removal especially in regions where fracture is of concern. UDT reduces operative time by removing cement and distal plugs in an expedient fashion. It often permits revision surgery without the use of trochanteric osteotomy and may further facilitate revision femoral surgery by allowing the reimplementation of a new prosthesis without the need for complete cement removal through the technique of shaping and enlarging an intact old cement mantle.

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