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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
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