Radiofrequency Probe Application and it’s effects on Irrigation Fluid Temperature in the Wrist Joint
Electrosurgical Radiofrequency (RF) devices have increased in popularity, and the development of small joint RF probes has extended its use to the wrist joint.
The issue has been raised over the unintentional increases in irrigation fluid temperature in the wrist joint when using RF application, resulting in thermal tissue damage.
8 cadaveric forearms were used on for arthroscopic surgery. Ablation and coagulation cycles using RF probes were performed at certain locations within the joint, for 60 seconds, with two minutes between each cycle. This procedure was performed on both the radial and ulnar sides of the wrist. Temperatures were recorded using fiberoptic phosphorescent sensors; (radial, ulnar, inflow and outflow tubes). This study measured joint fluid temperature with and without outflow.
Results of this study showed a significant difference between wrists, with and without outflow when examining maximum ablation temperatures. Increased maximum and average ablation temperatures without outflow were seen in all 8 cadaveric forearms. Maximum joint temperatures greater than 60 degrees centigrade were only observed in no-outflow conditions.
According to this study, when performing RF ablation during wrist arthroscopy, an outlet portal reduces the joint fluid temperature. Without the use of an outlet portal, desirable temperatures can be exceeded when using ablation, and could potentially damage tissues.
Mike Hayton routinely uses an extra outflow portal when using RF probes in wrist arthroscopy.
D.G. Sotereanos, N.A. Darlis, Z.T. Kokkalis, G. Zanaros, G.T.Altman, M.C. Miller
Journal of Hand Surgery 2009, Department of Orthopaedic Surgery, Pittsburgh.