ultrasonic cement removal in revision total hip replacement the acryl-x system

Ultrasonic Cement Removal

in Revision Total Hip Replacement

The Acryl-X System

Ohannes Nercessian, MD

Columbia University Medical Center

New York

Total Hip Replacement

Very Successful

Predictable Outcome

Survivorship Time

Over 300 K In US

Young Active Patient

Revision

Removal of Old Component

Re-implantation of New Component

Revision

Failure of Fixation

Failure of Implant

Infection of Periprosthetic Fracture

Dislocation

Technical

Revision

Complex

Lengthy

Challenging

Revision/Most Challenging

Cement Removal From Femur

Bone Grafting and Reconstruction

Soft Tissue Balancing

Current Techniques

Gouging and Chiseling

High Speed

Time Consuming, Unsafe, Cumbersome

Current Techniques

Perforation

Fracture

Other Method

Laser

Difficult To Apply

Not Practical

1990 - 1991

Ohannes Nercessian, M.d.

Philip Hovnanian, Phd

David Wuchinik, Phd

Acryl-X System

Acryl-X System

Ultrasound Energy

Irrigation

Aspiration

Acryl-X System

Hand Piece

Ultrasonic Generator

Current Trap/Disposable Tubing

Acryl-X SystemHow it Works When Applied to Cement

Fractional Temperature Rise

Soften the Cement

Softened Cement Enters Hollow Tube

Suctioned Out

Irrigation Keeps the Tip Cool

Hand Piece

Piezoelectric Crystal Attached to the Hollow Connecting Body

Hollow Titanium Tip

Aspiration Line and Cement Trap

Ultrasonic Output Connector

Irrigation Connector

Piezoelectric Crystal Attached to

the Hollow Connecting Body

Hollow Titanium Tip

Aspiration Line and Cement Trap

Ultrasonic Output Connector

Irrigation Connector

When the Foot Petal is Pressed

Irrigation

Ultrasonic Current From the Generator Vibration 20k/Hz

Tip Vibrates

The Friction Softens the Cement

Soften Core is Aspirated

Ultrasonic Generator

Current Line Converts to 20k/Hz Power Drive the Hand Piece Crystal

Vibrations Adjust Control Knob Adjust the Power Level Delivers to the Piezoelectric Crystal

in the Hand Piece

Determines the Force of the Titanium Tip Vibration

The Frequency Does Not Change Only the Stroke on the Tip 0-10

Irrigation

100 cc/minutes

Pulse Pump

Keeps the Tip Cool

Safety

High Frequency (Low Power)

Living Cells and Tissue

Little Evidence of Injury

Bone Healing 1950 Germany and Italy

1969 Polyakov

Alternative to ORIF In Bone Fractures

N - Butyl - Cyano - Acrylate

Safety

Tissue Necrosis Increases With High Temperature

Nerve Injury

Thrombo-Embolism

The Use of

Ultrasound Energy Industry

Welding Cutting Plastic

Medicine

Diagnostic Radiology/ Vascular

Therapeutic

Therapeutic

Physical Therapy

Dentistry

Ophthalmology

Neurosurgery

Urology

1967 Quinetron U/S Chisel Bone Harvesting

1981 (URSK-7N) Cement Removal from Bone - Temperature

≥ 150 Degrees Celsius

Cameron et al U/S Removal

of Porous Implant From Bone

1992-2008

218 Revisions for Cement Removal

Average Time 25.5 Minutes

Conventional Techniques 72 Minutes

10% Perforation

Advantages

Easy to Use

Effective and Efficient

Reduce Cement Removal Time

Reduces Overall Operating Time

Reduces Femoral Perforation/Fracture

No Significant Thermal Injury

Decreases the Level of Anxiety and Frustration