Heat-Related Complications from Radiofrequency and Electrocautery Devices Used in Arthroscopic Surgery: A Systematic Review

Carola F van Eck; Tim A C van Meel; Michel P J van den Bekerom; Jacco A C Zijl; Bauke Kooistra

doi:10.1016/j.asmr.2020.12.002

Heat-Related Complications from Radiofrequency and Electrocautery Devices Used in Arthroscopic Surgery: A Systematic Review

Arthrosc Sports Med Rehabil. 2021 Feb 23;3(2):e605-e613. doi: 10.1016/j.asmr.2020.12.002. eCollection 2021 Apr.

Authors

Carola F van Eck¹, Tim A C van Meel², Michel P J van den Bekerom³, Jacco A C Zijl⁴, Bauke Kooistra³

Affiliations

¹ Department of Orthopaedic Surgery/Orthopaedic Engineering & Sports Medicine Laboratory, University of Pittsburgh, Pittsburgh, PA.
² Department of General Surgery, Amphia Ziekenhuis, Breda, the Netherlands.
³ Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis Amsterdam, the Netherlands.
⁴ Department of Orthopaedic Surgery, St. Antonius Ziekenhuis, Utrecht, the Netherlands.

Abstract

Purpose: To investigate the occurrence of heat-related complications from radiofrequency and electrocautery devices in patients undergoing arthroscopic surgery.

Methods: A systematic review was performed using the PubMed/Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reporting complications after arthroscopy using electrosurgery devices were included. Only English- and Dutch-language articles were included. Basic science/nonclinical studies/human cadaveric studies and animal studies were excluded. Article selection was performed by 2 separate reviewers. Interobserver agreement of the selection procedure was determined by Cohen's kappa. All included articles were critically appraised using an adapted version of the ROBINS-I tool.

Results: Twenty-five studies were included in this systematic review. A total of 309 cases of heat-related complications were identified. Chondrolysis was present in 45 cases and dermal burns in 15 cases. Axillary nerve injuries were reported in 197 cases of arthroscopic adhesive capsulitis release. However, it was unclear whether these injuries were directly related to the overheating of the arthroscopic fluid. No one specific risk factor for thermal complications was identified, but related factors included the leakage of the arthroscopy fluid, use of a thermal device continuously for a long period of time, proximity of the thermal device to the tissue, intra-articular local anesthetic injection or the use of intra-articular pain pumps, and certain surgical procedures, such as thermal capsulorrhaphy, capsular release, and synovectomy.

Conclusions: The most common heat-related complications in arthroscopy are dermal burns and chondrolysis. Risk factors include leakage of arthroscopy fluid, use of a thermal device, intra-articular anesthetics/pain pumps, and performing specific surgical procedures.

Level of evidence: Systematic review of level III-IV studies.

Publication types

Review