1. Ultrasonic Cement Removal in Revision Total Hip Replacement The Acryl-X System Ohannes Nercessian, MD Columbia University Medical Center New York

2. Total Hip Replacement Very Successful Predictable Outcome Survivorship Time Over 300 K In US Young Active Patient

3. Revision Removal of Old Component Re-implantation of New Component

4. Revision Failure of Fixation Failure of Implant Infection of Periprosthetic Fracture Dislocation Technical

5. Revision Complex Lengthy Challenging

6. Revision/Most Challenging Cement Removal From Femur Bone Grafting and Reconstruction Soft Tissue Balancing

7. Current Techniques Gouging and Chiseling High Speed Time Consuming, Unsafe, Cumbersome

8. Current Techniques Perforation Fracture

9. Other Method Laser Difficult To Apply Not Practical

10. 1990 - 1991 Ohannes Nercessian, M.d. Philip Hovnanian, Phd David Wuchinik, Phd Acryl-X System

11. Ultrasound Energy Irrigation Aspiration

12. Acryl-X System Hand Piece Ultrasonic Generator Current Trap/Disposable Tubing

13. Acryl-X System How it Works When Applied to Cement Fractional Temperature Rise Soften the Cement Softened Cement Enters Hollow Tube Suctioned Out Irrigation Keeps the Tip Cool

14. Hand Piece Piezoelectric Crystal Attached to the Hollow Connecting Body Hollow Titanium Tip Aspiration Line and Cement Trap Ultrasonic Output Connector Irrigation Connector

15. Piezoelectric Crystal Attached to the Hollow Connecting Body Hollow Titanium Tip Aspiration Line and Cement Trap Ultrasonic Output Connector Irrigation Connector

16. When the Foot Petal is Pressed Irrigation Ultrasonic Current From the Generator Vibration 20k/Hz Tip Vibrates The Friction Softens the Cement Soften Core is Aspirated

17. Ultrasonic Generator Current Line Converts to 20k/Hz Power Drive the Hand Piece Crystal Vibrations Adjust Control Knob Adjust the Power Level Delivers to the Piezoelectric Crystal in the Hand Piece Determines the Force of the Titanium Tip Vibration The Frequency Does Not Change Only the Stroke on the Tip 0-10

18. Irrigation 100 cc/minutes Pulse Pump Keeps the Tip Cool

19. Safety High Frequency (Low Power) Living Cells and Tissue Little Evidence of Injury Bone Healing 1950 Germany and Italy

20. 1969 Polyakov Alternative to ORIF In Bone Fractures N - Butyl - Cyano - Acrylate

21. Safety Tissue Necrosis Increases With High Temperature Nerve Injury Thrombo-Embolism

22. The Use of Ultrasound Energy Industry Welding Cutting Plastic

23. Medicine Diagnostic Radiology/ Vascular Therapeutic

24. Physical Therapy Dentistry Ophthalmology Neurosurgery Urology

25. 1967 Quinetron U/S Chisel Bone Harvesting 1981 (URSK-7N) Cement Removal from Bone - Temperature ≥ 150 Degrees Celsius Cameron et al U/S Removal of Porous Implant From Bone

26. 1992-2008 218 Revisions for Cement Removal Average Time 25.5 Minutes Conventional Techniques 72 Minutes 10% Perforation

27. Advantages Easy to Use Effective and Efficient Reduce Cement Removal Time Reduces Overall Operating Time Reduces Femoral Perforation/Fracture No Significant Thermal Injury Decreases the Level of Anxiety and Frustration