Comparison of Carbon Dioxide Laser Modalities for Removal of Polymethylmethacrylate Cement

D. N. Lange; M. C. Rochat; K. E. Bartels; M. E. Payton; R. J. Hoffman; St. A. Schafer; D. Th. Dickey

doi:10.1055/s-0038-1632565

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 1997; 10(01): 27-32
DOI: 10.1055/s-0038-1632565

Original Research

Schattauer GmbH

Comparison of Carbon Dioxide Laser Modalities for Removal of Polymethylmethacrylate Cement

Authors

D. N. Lange

¹From the Oklahoma State University, College of Veterinary Medicine, Boren Veterinary Medical Teaching Hospital, Stillwater, Oklahoma, USA
M. C. Rochat

¹From the Oklahoma State University, College of Veterinary Medicine, Boren Veterinary Medical Teaching Hospital, Stillwater, Oklahoma, USA
K. E. Bartels

¹From the Oklahoma State University, College of Veterinary Medicine, Boren Veterinary Medical Teaching Hospital, Stillwater, Oklahoma, USA
M. E. Payton

¹From the Oklahoma State University, College of Veterinary Medicine, Boren Veterinary Medical Teaching Hospital, Stillwater, Oklahoma, USA
R. J. Hoffman

¹From the Oklahoma State University, College of Veterinary Medicine, Boren Veterinary Medical Teaching Hospital, Stillwater, Oklahoma, USA
St. A. Schafer

¹From the Oklahoma State University, College of Veterinary Medicine, Boren Veterinary Medical Teaching Hospital, Stillwater, Oklahoma, USA
D. Th. Dickey

¹From the Oklahoma State University, College of Veterinary Medicine, Boren Veterinary Medical Teaching Hospital, Stillwater, Oklahoma, USA

Abstract

Summary

Polymethylmethacrylate (PMMA) cement is routinely used in a number of surgical procedures performed on human beings and animals. As the use of PMMA increases in veterinary medicine, the need for its removal during “revision” surgeries also increases. Common indications for removal of PMMA are infection, aseptic loosening, and fracture of the cement. Polymethylmethacrylate cement is often applied in areas of the body where typical mechanical methods of removal are dangerous or impossible. Cement placed near the spinal canal for the treatment of caudal cervical malformation-malarticulation syndrome or deep within the femoral medullary canal for total hip prostheses are examples. The ability to safely and easily remove cement should lower intraoperative complication rates associated with revision surgeries.

The vaporization efficiency for removal of PMMA cement for three carbon dioxide laser modalities (continuous wave only, with Swift-Lase™ attachment, and with Fiberlase™ wave guide) were determined, as well as heat transferred to periosteal surface during PMMA cement vaporization, and gross pathology to the cortical bone at the maximum vaporization efficiency power. Cefazolin sodium was added to half of the samples to determine if the ablation ablation rate of PMMA would be affected. The C02 laser with wave guide was the most efficient modality for vaporization at 25 watts, and produced significantly less heat transfer to the periosteal surface than the heat of polymerization of the PMMA cement. Cefazolin sodium appeared to slightly decrease the vaporization efficiency, and all of the lasers produced gross and histologic lesions to the bone.

Three laser types were compared for their ability to efficiently and safely remove polymethylmethacrylate (PMMA) cement. Vaporization rates were determined. The most efficient wattage for each laser modality was used to compare the heat transferred during PMMA removal as well as the pathology created by application of each laser modality to the cortical bone. The CO₂ laser with wave guide at 25 watts was the most efficient modality for vaporization of PMMA cement, and produced significantly less heat transfer to the periosteal surface than the CO₂ laser and the CO₂ laser with Swift-Lase™.

Keywords

Carbon dioxide laser - polymethylmethacrylate - cortical bone

Full Text

References

REFERENCES
1 Balsas CE, Semi HBO. Spinal fixation in dogs using Steinmann pins and methyl methacrylate. Vet Surg 1984; 13: 203-6.
2 Clayton L, Fuller T, Beckman H. Healing of continuous wave and rapid superposed carbon dioxide laser induced bone defects. J Oral Surg 1978; 36: 932-7.
3 Ellison GW, Seim HB, Clemmons RM. Distracted cervical spinal fusion for management of caudal cervical spondylomyelopathy in large-breed dogs. J Am Vet Med Assoc 1988; 193: 447-53.
4 Gertzbein SD, deDemeter D, Cruickshank B, Kaparsouri A. The effect of laser osteotomy on bone healing. Lasers Surg Med 1981; 1: 361-73.
5 Johnson KA, Goldsmid SE. Methyl methacrylate and polypropylene mesh reconstruction of ventral thoracic wall deficit following sternal liposarcoma resection. V.C.O.T. 1993; 2: 66-9.
6 Levin PD. The effectiveness of various antibiotics in methyl methacrylate. J Bone Joint Surg 1975; 57 B: 234-7.
7 Marks KE, Nelson CL, Lautenschlager EP. Antibiotic-impregnated acrylic bone cement. J Bone Joint Surg 1975; 58 A: 358-64.
8 Massat BJ, Vasseur PB. Clinical and radiographic results of total hip arthroplasty in dogs: 96 cases (1986-1992). J Am Vet Med Assoc 1994; 205: 448-54.
9 Olmstead ML. The canine cemented modular total hip prosthesis. J Am Anim Hosp Assoc 1995; 31: 109-24.
10 Olmstead ML. Total hip replacement. Vet Clin North Am 1987; 17: 943-55.
11 Raif J, Zair E, Levavi H, Nyska A. Swift Lase™ – A new CO₂ laser scanner for reduced tissue carbonization. Lasers Surg Med 1993; 126 (Suppl. 05) 28 (Abstract).
12 Sherk HH, Lane G, Rhodes A. et. al. Carbon dioxide laser removal of polymethylmethacrylate. Clin Orthop Rel Res 1995; 310: 67-71.
13 Small I, Osborn T, Fuller T. et al. Observations of carbon dioxide laser and bone burr in the osteotomy of the rabbit tibia. J Oral Surg 1979; 37: 159-66.
14 Steel RGD, Torrie JH. Principles and Procedures of Statistics: A Biometrical Approach. 2nd ed.. New York: McGraw-Hill; 1980: 236
15 Stubbs WP, Lewis DD, Miller GJ. et. al. A biomechanical evaluation and assessment of the accuracy of reduction for two methods of acetabular osteotomy fixation in dogs. Presented at the ACVS annual meeting; October 1995. Chicago.