Ultrasound gel minimizes third body debris with partial hardware removal in joint arthroplasty

Abstract

Hundreds of thousands of revision surgeries for hip, knee, and shoulder joint arthroplasties are now performed worldwide annually. Partial removal of hardware during some types of revision surgeries may create significant amounts of third body metal, polymer, or bone cement debris. Retained debris may lead to a variety of negative health effects including damage to the joint replacement. We describe a novel technique for the better containment and easier removal of third body debris during partial hardware removal. We demonstrate hardware removal on a hip joint model in the presence and absence of water-soluble gel to depict the reduction in metal debris volume and area of spread.

Keywords: Debris; Hardware removal; Revision; Technique; Ultrasound gel.

Figure 1

Photograph of an experimental jig using a Sawbones (Pacific Research Laboratories, Vashon Island, WA) hemipelvis with a pelvic reconstruction plate (SynthesDepuy, West Chester, PA) applied to a posterior wall fragment. Ultrasound gel has been placed on the intraarticular cobalt-chromium screw that will be removed by high-speed burr.

Figure 2

Photograph of the partial removal of a cobalt-chromium screw with a high-speed burr in the experimental model, without any protection to minimize debris spread.

Figure 3

Photograph of experimental jig after partial removal of retained hardware with a high-speed burr without (a) and with (b) ultrasound gel applied over the hardware during removal.

Figure 4

Radiograph of experimental jig after partial removal of retained hardware with a high-speed burr without (a) and with (b) ultrasound gel applied over the hardware during removal. Note how the debris from the removal is distributed throughout the model acetabulum when no protection is used (a); but is collected in the gel so it can be easily removed by suction (b).