Skip to main content

Advertisement

SpringerLink
Log in

Electrocautery in arthroscopic surgery: intra-articular fluid temperatures above 43 °C cause potential tissue damage

  • Experimental Study
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The use of electrocautery during arthroscopy may heat intra-articular saline and subsequently damage intra- and extra-articular tissue. Newer electrocautery devices have the ability to measure the outflow fluid temperature and switch off before reaching a certain threshold; however, the scientific evidence establishing these temperature thresholds’ potential for inadvertent damage is lacking. The aim of this study was to analyse current available literature on temperature thresholds for tissue damage after exposure to heated fluid and provide a recommendation for the maximum temperature of intra-articular fluid to prevent tissue damage.

Methods

In February 2018, a systematic literature review was performed using the MEDLINE/PubMed and Embase databases. Inclusion was limited to studies investigating temperature thresholds for thermal damage to at least one of the tissues of interest: skin, bone, cartilage, soft tissues, and nerves. Studies not reporting specific temperature thresholds for thermal damage were excluded.

Results

Twenty articles were selected for the final evaluation and data extraction. Varying temperature thresholds, based on the lowest reported temperature causing tissue damage, were found for the different tissues of interest: 44 °C for dermal tissues, between 47 and 50 °C for bony tissues, 50 °C for cartilage, between 43 and 55 °C for soft tissues, and 43 °C for nerves.

Conclusion

Based on the current literature, a temperature threshold for intra-articular fluid of 43 °C during an arthroscopic procedure is recommended to prevent tissue damage. Higher temperatures may cause damage to surrounding intra- and extra-articular tissues. The threshold for irreversible damage is likely to be higher. In clinical practise, one should be aware of possible heating of intra-articular fluid when using electrocautery and related risk of tissue damage.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

EMG:

Electromyogram

References

  1. Andrews CJ, Kimble R, Kempf M, Cuttle L (2017) Evidence-based injury prediction data for the water temperature and duration of exposure for clinically relevant deep dermal scald injuries. Wound Repair Regen 25(5):792–804

    Article  Google Scholar 

  2. Berman AT, Spence Reid J, Yanicko DR, Sih GC, Zimmerman MR (1984) Thermally induced bone necrosis in rabbits. Relation to implant failure in humans. Clin Orthop Relat Res 186:284–292

    Google Scholar 

  3. Carlander J, Koch C, Brudin L, Nordborg C, Gimm O, Johansson K (2012) Heat production, nerve function, and morphology following nerve close dissection with surgical instruments. World J Surg 36(6):1361–1367

    Article  Google Scholar 

  4. Chu CR, Kaplan LD, Fu FH, Crossett LS, Studer RK (2004) Recovery of articular cartilage metabolism following thermal stress is facilitated by IGF-1 and JNK Inhibitor. Am J Sports Med 32(1):191–196

    Article  Google Scholar 

  5. Coffey RJ, Kalin R, Olsen JM (2014) Magnetic resonance imaging conditionally safe neurostimulation leads: investigation of the maximum safe lead tip temperature. Neurosurgery 74(2):215–225

    Article  Google Scholar 

  6. Eriksson AR, Albrektsson T (1983) Temperature threshold levels for heat-induced bone tissue injury: A vital-microscopic study in the rabbit. J Prosthet Dent 50(1):101–107

    Article  CAS  Google Scholar 

  7. Good CR, Shindle MK, Kelly BT, Wanich T, Warren RF (2007) Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy. Arthroscopy 23(7):797e.1-5

    Article  Google Scholar 

  8. Greenhalgh DG, Lawless MB, Chew BB, Crone WA, Fein ME, Palmeiri TL (2004) Temperature threshold for burn injury: an oximeter safety study. J Burn Care Rehabil 25(5):411–415

    Article  Google Scholar 

  9. Greis PE, Burks RT, Schickendantz MS, Sandmeier R (2001) Axillary nerve injury after thermal capsular shrinkage of the shoulder. J Shoulder Elbow Surg 10(3):231–235

    Article  CAS  Google Scholar 

  10. Gryler EC, Greis PE, Burks RT, West J (2001) Axillary nerve temperatures during radiofrequency capsulorrhaphy of the shoulder. Arthroscopy 17(6):567–572

    Article  CAS  Google Scholar 

  11. Hecht P, Hayashi K, Cooley AJ, Lu Y, Fanton GS, Thabit G III, Markel MD (1998) The thermal effect of monopolar radiofrequency energy in the properties of joint capsule. An in vivo histologic study using a sheep model. Am J Sports Med 26(6):808–814

    Article  CAS  Google Scholar 

  12. Higgins PD, Adams WM, Dubielzig RR (1988) Thermal dosimetry of normal porcine tissue. Radiat Res 114(2):225–230

    Article  CAS  Google Scholar 

  13. Hindle AK, Brody F, Hopkins V, Rosales G, Gonzalez F, Schwartz A (2009) Thermal injury secondary to laparoscopic fibre-optic cables. Surg Endosc 23(8):1720–1723

    Article  Google Scholar 

  14. Kaplan LD, Chu CR, Bradley JP, Fu FH, Struder RK (2003) Recovery of chondrocyte metabolic activity after thermal exposure. Am J Sports Med 31(3):392–398

    Article  Google Scholar 

  15. Kaplan LD, Ionescu D, Ernsthausen JM, Bradley JP, Fu FH, Farkas DL (2004) Temperature requirements for altering the morphology of osteoarthritic and nonarthritic articular cartilage: in vitro thermal alteration of articular cartilage. Am J Sports Med 32(3):688–692

    Article  Google Scholar 

  16. Konno S, Olmarker K, Byröd G, Nordborg C, Strömqvist B, Rydevik B (1994) The European spine society AcroMed prize 1994. Acute thermal nerve root injury. Eur Spine J 3(6):299–302

    Article  CAS  Google Scholar 

  17. Kouk SN, Zoric B, Steston WB (2011) Complication of the use of a radiofrequency device in arthroscopic shoulder surgery: second-degree burn of the shoulder girdle. Arthroscopy 27(1):136–141

    Article  Google Scholar 

  18. Kurata K, Matsushita J, Furuno A, Fujino J, Takamatsu H (2017) Assessment of thermal damage in total knee arthroplasty using an osteocyte injury model. J Orthop Res 35(12):2799–2807

    Article  CAS  Google Scholar 

  19. Lin YC, Dionigi G, Randolph GW, Lu IC, Chang PY, Tsai SY, Kim HY, Lee HY, Tufano RP, Sun H, Liu X, Chiang FY, Wu CW (2015) Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model. Laryngoscope 125(8):E283–E290

    Article  Google Scholar 

  20. Lopez MJ, Hayashi K, Fanton GS, Thabit G III, Markel MD (1998) The effect of radiofrequency energy on the ultrastructure of joint capsular collagen. Arthroscopy 14(5):495–501

    Article  CAS  Google Scholar 

  21. Maiotti M, Massoni C, Tarantino U (2005) The use of arthroscopic thermal shrinkage to treat chronic lateral ankle instability in young athletes. Arthroscopy 21(6):751–757

    Article  Google Scholar 

  22. Martinez AA, Meshorer A, Meyer JL, Hahn GM, Fajardo LF, Prionas SD (1983) Thermal sensitivity and thermotolerance in normal porcine tissues. Can Res 43:2072–2075

    CAS  Google Scholar 

  23. Medvecky MJ, Ong BC, Rokito AS, Sherman OH (2001) Thermal capsular shrinkage: basic science and clinical applications. Arthroscopy 17(6):624–635

    Article  CAS  Google Scholar 

  24. Miniaci A, Codsi MJ (2006) Thermal capsulorrhaphy for the treatment of shoulder instability. Am J Sports Med 34(8):1356–1363

    Article  Google Scholar 

  25. Mir MR (2017) Electrocautery. https://emedicine.medscape.com/article/2111163-overview. Accessed 24 Jan 2017

  26. Monafo WW, Eliasson SG (1987) Sciatic nerve function following hindlimb thermal injury. J Surg Res 43(4):344–350

    Article  CAS  Google Scholar 

  27. Moritz AR, Henriques FC (1947) Studies of thermal injury II. The relative importance of time and surface temperature in the causation of cutaneous burns. Am J Pathol 23(5):695–720

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Mundiger GS, Rozen SM, Carson B, Greenberg RS, Redett RJ (2007) Case report: full-thickness forehead burn over indwelling titanium hardware resulting from an aberrant intraoperative electrocautery circuit. Eplasty 20(8):e1

    Google Scholar 

  29. Podhajsky RJ, Sekiguchi Y, Kikuchi S, Myers RR (2005) The histologic effects of pulsed and continuous radiofrequency lesions at 42 °C to rat dorsal root ganglion and sciatic nerve. Spine 30(9):1008–1013

    Article  Google Scholar 

  30. Suzuki T, Hirayama T, Aihara K, Hirohata Y (1991) Experimental studies of moderate temperature burns. Burns 17(6):443–451

    Article  CAS  Google Scholar 

  31. Talati RK, Dein EJ, Huri G, McFarland EG (2015) Cutaneous burn caused by radiofrequency ablation probe during shoulder arthroscopy. Am J Orthop (Belle Mead NJ) 44(2):E58–E60

    Google Scholar 

  32. Troxell CR, Morgan CD, Rajan S, Leitman EH, Bartolozzi AR (2011) Dermal burns associated with bipolar radiofrequency ablation in the subacromial space. Arthroscopy 27(1):142–144

    Article  Google Scholar 

  33. Tseng H, Lin SE, Chang YL, Chen MH, Hung SH (2016) Determining the critical effective temperature and heat dispersal pattern in monopolar radiofrequency ablation using temperature-time integration. Exp Ther Med 11(3):763–768

    Article  Google Scholar 

  34. Voss JR, Lu Y, Edwards RB III, Bogdanske JJ, Markel MD (2006) Effects of thermal energy on chondrocyte viability. Am J Vet Res 67(10):1708–1712

    Article  Google Scholar 

  35. Vuurberg G, de Vries JS, Krips R, Blankevoort L, Fievez AWFM, van Dijk CN (2017) Arthroscopic capsular shrinkage for treatment of chronic lateral ankle instability. Foot Ankle Int 38(10):1078–1084

    Article  Google Scholar 

Download references

Acknowledgements

We thank Bert Berenschot, medical librarian in the Onze Lieve Vrouwe Gasthuis Amsterdam, who helped in performing the searches and in retrieving the selected articles. We thank John Watson and Amir Kamali, medical writers at Smith & Nephew, for reading and when necessary correcting the manuscript in correct language.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, St Maartenskliniek, Nijmegen, The Netherlands

    J. H. G. Derriks

  2. Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Location AMC, Amsterdam, The Netherlands

    N. F. J. Hilgersom

  3. Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centres, Location VUMC, Amsterdam, The Netherlands

    E. Middelkoop

  4. Association of Dutch Burn Centers, Beverwijk, The Netherlands

    E. Middelkoop

  5. Department of Orthopaedic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden

    K. Samuelsson

  6. Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    M. P. J. van den Bekerom

Authors
  1. J. H. G. Derriks
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. F. J. Hilgersom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Middelkoop
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Samuelsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. P. J. van den Bekerom
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JD performed the search, retrieved, analysed, and interpreted the data and drafted the manuscript. NH analysed and interpreted the data and critically revised the manuscript. EM critically revised the manuscript. KS critically revised the manuscript. MB contributed in conception and design of the manuscript and critically revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to J. H. G. Derriks.

Ethics declarations

Funding

No funding was received for this study.

Conflict of interests

The authors declare that they have no competing interests.

Ethics approval

No IRB-approval is required for this type of study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix 1

Appendix 1

Search strategy

MEDLINE/Pubmed

((heat[ti] OR warmth[ti] OR temperature*[ti] OR thermal[ti] OR “hot temperature”[Majr])

AND

(maximum[tiab] OR tolerance[tiab] OR limit[tiab] OR threshold*[tiab] OR cutoff[tiab] OR safe*[tiab])

AND

(“burns”[MeSH] OR burn*[tiab] OR injur*[tiab] OR “wounds and injuries”[MeSH] OR damage*[tiab] OR desiccat*[tiab] OR degrad*[tiab] OR denaturat*[tiab])

AND

(tissue[tiab] OR “tissues”[MeSH] OR skin[tiab] OR “skin”[MeSH] OR cartilag*[tiab] OR articular surface[tiab] OR bone*[tiab] OR “bone and bones”[MeSH] OR ligament*[tiab] OR “ligaments”[MeSH] OR muscular*[tiab] OR muscle*[tiab] OR “muscles”[MeSH] OR nerve*[tiab] OR “peripheral nerves”[Mesh] OR osseous[tiab]))

EMBASE

(heat or warmth or temperature* or thermal).m_titl.

AND

(maximum or tolerance or limit or threshold* or cutoff or safe*).mp.

AND

(burn* or injur* or damage* or desiccat* or degrad* or denaturat*).mp.

AND

(tissue or skin or cartilag* or articular surface or bone* or ligament* or muscular* or muscle* or nerve* or osseous).mp.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Derriks, J.H.G., Hilgersom, N.F.J., Middelkoop, E. et al. Electrocautery in arthroscopic surgery: intra-articular fluid temperatures above 43 °C cause potential tissue damage. Knee Surg Sports Traumatol Arthrosc 28, 2270–2278 (2020). https://doi.org/10.1007/s00167-019-05574-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-019-05574-4

Keywords

Search

Navigation