Mechanical loosening of implants is in the majority accompanied with a periprosthetic interface membrane, which has to be removed during revision surgery. The same is true if a minimal invasive (percutaneous) refixation of a loose implant is done. We describe the requirements for a waterjet applicator for interface tissue removal for this percutaneous hip refixation technique. The technical requirements were either obtained from a literature review, a theoretical analysis, or by experimental setup. Based on the requirements, a waterjet applicator is designed which is basically a flexible tube (outer diameter 3 mm) with two channels. One channel for the water supply (diameter 0.9 mm) and one for suction to evacuate water and morcellated interface tissue from the periprosthetic cavity. The applicator has a rigid tip (length 6 mm), which directs the water flow to create two waterjets (diameter 0.2 mm), both focused into the suction channel. The functionality of this new applicator is demonstrated by testing a prototype of the applicator tip in an in vitro experimental setup. This testing has shown that the designed applicator for interface tissue removal will eliminate the risk of water pressure buildup; the ejected water was immediately evacuated from the periprosthetic cavity. Blocking of the suction opening was prevented because the jets cut through interface tissue that gets in front of the suction channel. Although further development of the water applicator is necessary, the presented design of the applicator is suitable for interface tissue removal in a minimally invasive hip refixation procedure.
Issue Section:
Research Papers
Topics:
Biological tissues,
Design,
Ducts,
Engineering prototypes,
Jets,
Suction,
Water,
Testing,
Dimensions,
Water supply,
Pressure,
Cavities,
Instrumentation
References
1.
Strehle
, J.
, DelNotaro
, C.
, Orler
, R.
, and Isler
, B.
, 2000
, “The Outcome of Revision Hip Arthroplasty in Patients Older Than Age 80 Years—Complications and Social Outcome of Different Risk Groups
,” J. Arthroplasty
, 15
(6
), pp. 690
–697
.2.
Sundfeldt
, M.
, Carlsson
, L.
, Johansson
, C.
, Johansson
, C.
, Thomsen
, P.
, Thomsen
, P.
, and Gretzer
, C.
, 2006
, “Aseptic Loosening, Not Only a Question of Wear: A Review of Different Theories
,” Acta Orthop.
, 77
(2
), pp. 177
–197
.3.
Labek
, G.
, Thaler
, M.
, Janda
, W.
, Agreiter
, M.
, and Stockl
, B.
, 2011
, “Revision Rates After Total Joint Replacement: Cumulative Results From Worldwide Joint Register Datasets
,” J. Bone Jt. Surg.
, 93
, pp. 293
–297
. 4.
Kurtz
, S.
, Ong
, K.
, Lau
, E.
, Mowat
, F.
, and Halpern
, M.
, 2007
, “Projections of Primary and Revision Hip and Knee Arthroplasty in the United States From 2005 to 2030
,” J. Bone Jt. Surg. Am.
, 89A
(4), pp. 780
–785
.https://insights.ovid.com/pubmed?pmid=174038005.
Badarudeen
, S.
, Shu
, A. C.
, Ong
, K. L.
, Baykal
, D.
, Lau
, E.
, and Malkani
, A. L.
, 2017
, “Complications After Revision Total Hip Arthroplasty in the Medicare Population
,” J. Arthroplasty
, 32
(6
), pp. 1954
–1958
.6.
Andreykiv
, A.
, Janssen
, D.
, Nelissen
, R.
, and Valstar
, E. R.
, 2012
, “On Stabilization of Loosened Hip Stems Via Cement Injection Into Osteolytic Cavities
,” Clin. Biomech.
, 27
(8
), pp. 807
–812
.7.
Malan
, D. F.
, Valstar
, E. R.
, and Nelissen
, R.
, 2014
, “Percutaneous Bone Cement Refixation of Aseptically Loose Hip Prostheses: The Effect of Interface Tissue Removal on Injected Cement Volumes
,” Skeletal Radiol.
, 43
(11
), pp. 1537
–1542
.8.
de Poorter
, J. J.
, Obermann
, W. R.
, Huizinga
, T. W. J.
, and Nelissen
, R.
, 2006
, “Arthrography in Loosened Hip Prostheses. Assessment of Possibilities for Intra-Articular Therapy
,” Jt. Bone Spine
, 73
(6
), pp. 684
–690
.9.
de Poorter
, J. J.
, Hoeben
, R. C.
, Hogendoorn
, S.
, Mautner
, V.
, Ellis
, J.
, Obermann
, W. R.
, Huizinga
, T. W. J.
, and Nelissen
, R.
, 2008
, “Gene Therapy and Cement Injection for Restabilization of Loosened Hip Prostheses
,” Human Gene Ther.
, 19
(1
), pp. 83
–95
.10.
de Poorter
, J. J.
, 2010
, “Gene Therapy and Cement Injection for the Treatment of Hip Prosthesis Loosening in Elderly Patients
,” Ph.D. dissertation, Leiden University, Leiden, The Netherlands.11.
de Poorter
, J. J.
, Hoeben
, R. C.
, Obermann
, W. R.
, Huizinga
, T. W. J.
, and Nelissen
, R.
, 2008
, “Gene Therapy for the Treatment of Hip Prosthesis Loosening: Adverse Events in a Phase 1 Clinical Study
,” Human Gene Ther.
, 19
(10
), pp. 1029
–1038
.12.
Kraaij
, G.
, Malan
, D. F.
, van der Heide
, H. J. L.
, Dankelman
, J.
, Nelissen
, R. G. H. H.
, and Valstar
, E. R.
, 2012
, “Comparison of Ho:YAG Laser and Coblation for Interface Tissue Removal in Minimally Invasive Hip Refixation Procedures
,” Medical Eng. Phys.
, 34
, pp. 370
–377
. 13.
Kraaij
, G.
, Tuijthof
, G. J. M.
, Dankelman
, J.
, Nelissen
, R. G. H. H.
, and Valstar
, E. R.
, 2015
, “Waterjet Cutting of Periprosthetic Interface Tissue in Loosened Hip Prostheses: An In Vitro Feasibility Study
,” Med. Eng. Phys.
, 37
, pp. 245
–250
.14.
Schmolke
, S.
, Pude
, F.
, Kirsch
, L.
, Honl
, M.
, Schwieger
, K.
, and Kromer
, S.
, 2004
, “Temperature Measurements During Abrasive Water Jet Osteotomy
,” Biomed. Tech.
, 49
(1–2
), pp. 18
–21
.15.
Honl
, M.
, Rentzsch
, R.
, Muller
, G.
, Brandt
, C.
, Bluhm
, A.
, Hille
, E.
, Louis
, H.
, and Morlock
, M.
, 2000
, “The Use of Water-Jetting Technology in Prostheses Revision Surgery-First Results of Parameter Studies on Bone and Bone Cement
,” J. Biomed. Mater. Res., Part B
, 53
(6
), pp. 781
–790
.16.
Hloch
, S.
, Valicek
, J.
, and Kozak
, D.
, 2011
, “Preliminary Results of Experimental Cutting of Porcine Bones by Abrasive Waterjet
,” Tech. Gazette
, 18
, pp. 467
–470
.https://www.researchgate.net/profile/Sergej_Hloch/publication/232729760_Preliminary_results_of_experimental_cutting_of_porcine_bones_by_abrasive_waterjet/links/0fcfd5092c7760c0af000000.pdf17.
Honl
, M.
, Rentzsch
, R.
, Schwieger
, K.
, Carrero
, V.
, Dierk
, O.
, Dries
, S.
, Louis
, H.
, Pude
, F.
, Bishop
, N.
, Hille
, E.
, and Morlock
, M.
, 2003
, “The Water Jet as a New Tool for Endoprosthesis Revision Surgery—An In Vitro Study on Human Bone and Bone Cement
,” Bio-Med. Mater. Eng.
, 13
, pp. 317
–325
.https://content.iospress.com/articles/bio-medical-materials-and-engineering/bme26518.
Schwieger
, K.
, Carrero
, V.
, Rentzsch
, R.
, Becker
, A.
, Bishop
, N.
, Hille
, E.
, Louis
, H.
, Morlock
, M.
, and Honl
, M.
, 2004
, “Abrasive Water Jet Cutting as a New Procedure for Cutting Cancellous Bone–In Vitro Testing in Comparison With the Oscillating Saw
,” J. Biomed. Mater. Res., Part B
, 71
, pp. 223
–228
.https://onlinelibrary.wiley.com/doi/abs/10.1002/jbm.b.1007819.
Breusch
, S. J.
, and Malchau
, H.
, 2005
, The Well Cemented Total Hip Arthroplasty—Theory and Practice
, Springer-Verlag
, Berlin, Heidelberg
.20.
Pitto
, R. P.
, Koessler
, M.
, and Kuehle
, J. W.
, 1999
, “Comparison of Fixation of the Femoral Component Without Cement and Fixation With Use of a Bone-Vacuum Cementing Technique for the Prevention of Fat Embolism During Total Hip Arthroplasty—A Prospective, Randomized Clinical Trial
,” J. Bone Jt. Surg. Am.
, 81A
, pp. 831
–843
.https://insights.ovid.com/pubmed?pmid=1039154821.
Breusch
, S. J.
, Norman
, T. L.
, Schneider
, U.
, Reitzel
, T.
, Blaha
, J. D.
, and Lukoschek
, M.
, 2000
, “Lavage Technique in Total Hip Arthroplasty—Jet Lavage Produces Better Cement Penetration Than Syringe Lavage in the Proximal Femur
,” J. Arthroplasty
, 15
(7
), pp. 921
–927
.22.
Jansson
, V.
, 1994
, “The Cement-Canal Prosthesis—A New Cementation Technique Studied in Cadaver Femora
,” Acta Orthop. Scand.
, 65
(2
), pp. 221
–224
.23.
Juliusson
, R.
, Arve
, J.
, and Ryd
, L.
, 1994
, “Cementation Pressure in Arthroplasty—In-Vitro Study of Cement Penetration Into Femoral Heads
,” Acta Orthop. Scand.
, 65
(2
), pp. 131
–134
.24.
Schmidutz
, F.
, Dull
, T.
, Voges
, O.
, Grupp
, T.
, Muller
, P.
, and Jansson
, V.
, 2012
, “Secondary Cement Injection Technique Reduces Pulmonary Embolism in Total Hip Arthroplasty
,” Int. Orthop.
, 36
(8
), pp. 1575
–1581
.25.
Cristofolini
, L.
, Erani
, P.
, Grupp
, T.
, Jansson
, V.
, and Viceconti
, M.
, 2007
, “In Vitro Long-Term Fatigue Endurance of the Secondary ‘Cement Injection Stem’ Hip Prosthesis
,” Artif. Organs
, 31
(6
), pp. 441
–451
.26.
Maleike
, D.
, Nolden
, M.
, Meinzer
, H. P.
, and Wolf
, I.
, 2009
, “Interactive Segmentation Framework of the Medical Imaging Interaction Toolkit
,” Comput. Methods Programs Biomed.
, 96
(1
), pp. 72
–83
.27.
Kroh
, M.
, Hall
, R.
, Udomsawaengsup
, S.
, Smith
, A.
, Yerian
, L.
, and Chand
, B.
, 2008
, “Endoscopic Water Jets Used to Ablate Barrett's Esophagus: Preliminary Results of a New Technique
,” Surg. Endoscopy Other Interven. Tech.
, 22
(11
), pp. 2498
–2502
.28.
White
, F. M.
, 1998
, Fluid Mechanics
, McGraw-Hill Higher Education
, New York.Copyright © 2019 by ASME
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