ultrasonic cement removal in revision total hip replacement the acryl-x system
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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Ultrasonic Cement Removal
in Revision Total Hip Replacement
The Acryl-X System
Ohannes Nercessian, MD
Columbia University Medical Center
New York
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Total Hip Replacement
Very Successful
Predictable Outcome
Survivorship Time
Over 300 K In US
Young Active Patient
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Revision
Removal of Old Component
Re-implantation of New Component
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Revision
Failure of Fixation
Failure of Implant
Infection of Periprosthetic Fracture
Dislocation
Technical
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Revision
Complex
Lengthy
Challenging
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Revision/Most Challenging
Cement Removal From Femur
Bone Grafting and Reconstruction
Soft Tissue Balancing
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Current Techniques
Gouging and Chiseling
High Speed
Time Consuming, Unsafe, Cumbersome
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Current Techniques
Perforation
Fracture
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Other Method
Laser
Difficult To Apply
Not Practical
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1990 - 1991
Ohannes Nercessian, M.d.
Philip Hovnanian, Phd
David Wuchinik, Phd
Acryl-X System
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Acryl-X System
Ultrasound Energy
Irrigation
Aspiration
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Acryl-X System
Hand Piece
Ultrasonic Generator
Current Trap/Disposable Tubing
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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
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Hand Piece
Piezoelectric Crystal Attached to the Hollow Connecting Body
Hollow Titanium Tip
Aspiration Line and Cement Trap
Ultrasonic Output Connector
Irrigation Connector
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Piezoelectric Crystal Attached to
the Hollow Connecting Body
Hollow Titanium Tip
Aspiration Line and Cement Trap
Ultrasonic Output Connector
Irrigation Connector
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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
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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
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Irrigation
100 cc/minutes
Pulse Pump
Keeps the Tip Cool
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Safety
High Frequency (Low Power)
Living Cells and Tissue
Little Evidence of Injury
Bone Healing 1950 Germany and Italy
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1969 Polyakov
Alternative to ORIF In Bone Fractures
N - Butyl - Cyano - Acrylate
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Safety
Tissue Necrosis Increases With High Temperature
Nerve Injury
Thrombo-Embolism
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The Use of
Ultrasound Energy Industry
Welding Cutting Plastic
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Medicine
Diagnostic Radiology/ Vascular
Therapeutic
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Therapeutic
Physical Therapy
Dentistry
Ophthalmology
Neurosurgery
Urology
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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
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1992-2008
218 Revisions for Cement Removal
Average Time 25.5 Minutes
Conventional Techniques 72 Minutes
10% Perforation
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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
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