The Journal of Bone and Joint Surgery (American). 2009;91:2448-2454.
doi:10.2106/JBJS.H.01552
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Factors Influencing Intra-Articular Fluid Temperature Profiles with Radiofrequency Ablation

Bojan B. Zoric, MD1, Nils Horn2, Sepp Braun, MD3 and Peter J. Millett, MD, MSC2

1 Stetson Powell Orthopedics and Sports Medicine, 191 South Buena Vista Street, Suite 470, Burbank, CA 91505
2 Clinical Research, Steadman Hawkins Research Foundation, 181 West Meadow Drive, Suite 1000, Vail, CO 81657. E-mail address for P.J. Millett: drmillett{at}steadman-hawkins.com
3 Department for Orthopaedics and Traumatology, University of Freiburg, Hugstetter Strasse 55, Freiburg 79106, Germany

Investigation performed at the Steadman Hawkins Research Foundation, Vail, Colorado

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from ArthroCare. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Radiofrequency ablation devices are being used increasingly in arthroscopic surgery. However, there are concerns that excessive temperatures may damage the articular cartilage. The purpose of this study was to investigate the temperature profiles that occur within the glenohumeral space with the use of one commercially available radiofrequency ablation probe.

Methods: Ten fresh-frozen human cadaver shoulder specimens were used. Intra-articular temperatures were measured at different time intervals over a two-minute period at a distance of 1, 3, 5, and 10 mm away from the probe. The radiofrequency probe was activated throughout the range of machine power settings, and irrigation fluid flow was varied (no flow, a flow at 60 mm Hg without suction, and a flow at 60 mm Hg with suction).

Results: Temperatures deleterious to articular cartilage chondrocytes (i.e., those in excess of 50°C) were seen with an increased duration of application, a decreased distance between the thermometer and the probe, and a decreased irrigation fluid flow rate. The highest recorded irrigation fluid temperature reached >80°C after two minutes in a no-flow setting. The flow rate was found to be the most significant predictor of intra-articular temperature profiles. The various machine power settings had no apparent influence on temperature, meaning that higher probe settings are not necessarily associated with higher temperature profiles.

Conclusions and Clinical Relevance: These results demonstrate the importance of the management of the irrigation fluid flow rate across the joint during arthroscopic procedures that involve radiofrequency ablation. Even short intervals of limited flow could lead to supraphysiological temperature profiles and potentially to cartilage damage.


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