Are There Thermal Risks Associated with Dry Arthroscopy? A Simulated Comparison of Temperatures in Wet versus Dry Wrist Arthroscopy.

Abstract

Dry arthroscopy of the wrist is comparable in safety to wet arthroscopy and is preferred in some cases as it avoids fluid extravasation. However, there is a potential for increased temperatures within the joint and risk of tissue damage. The purpose of this study was to document the maximum temperatures measured in a wrist simulator under dry and wet conditions using different arthroscopes and light sources. A custom designed testing rig with an enclosed space was fabricated with ports to allow for insertion of a temperature probe, arthroscope, and drainage port. Three different arthroscope sizes (2.7, 2.4, and 1.9 mm) and two different light sources (Xenon and light-emitting diode) were tested in wet and dry conditions. Three tested combinations caused the recorded temperature to exceed the temperature threshold. All were using the Xenon light source and with direct contact with the tip of the arthroscope. Light intensity was 100% for the 1.9 mm arthroscope, 60% for the 2.4 mm arthroscope, and 80% for the 2.7 mm arthroscope. Maximum temperatures reached for the arthroscopes were 45.1°C, 55°C, and 50.7°C, respectively. The times to exceed the safe temperature were 620, 380, and 490 seconds, respectively. Generally, the temperatures measured with dry arthroscopy are safe. Larger diameter scopes and Xenon light sources generate more heat. We propose that surgeons should use a light-emitting diode light source at the minimum intensity required, avoid direct contact with tissues and during heat generating procedures, such as burring, and intermittently flush the joint with saline to dissipate heat.