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Research Papers

# Physical Simulation Environment for Arthroscopic Joint Irrigation

[+] Author and Article Information
Gabriëlle J. M. Tuijthof

Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlandsg.j.tuijthof@amc.uva.nl

Paul M. Heeman

Department of Medical Technological Development (MTO), Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlandsp.heeman@amc.uva.nl

C. Niek Van Dijk

Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlandsc.n.vandijk@amc.uva.nl

Leendert Blankevoort

Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlandsl.blankevoort@amc.uva.nl

J. Med. Devices 3(2), 021001 (May 27, 2009) (6 pages) doi:10.1115/1.3131729 History: Received July 09, 2008; Revised March 05, 2009; Published May 27, 2009

## Abstract

Good arthroscopic view is important to perform arthroscopic operations (minimally invasive surgery in joints) safely and fast. To obtain this, the joint is irrigated. However, optimal irrigation settings are not described. To study the complex clinical practice of irrigation, a physical simulation environment was developed that incorporates the main characteristics for performing arthroscopy. Its irrigation capacities were validated with patient data. The physical simulation environment consists of a specially designed knee phantom, all normally used arthroscopic equipment, and registration devices for two video streams, pressures, and flows. The physical embodiment of the knee phantom matches that of human knee joints during arthroscopic operations by the presence of important anatomic structures in sizes comparable to human knee joints, the presence of access portals, and the ability to stress the joint. The hydrostatic and hydrodynamic behavior of the knee phantom was validated with pressure and flow measurements documented during arthroscopic knee operations. Surgeons confirmed that the knee phantom imitated human knee joints sufficiently. The hydrostatic parameters of the knee phantom could be tuned within the range of the human knee joints (restriction: $0.0266–29.3 N s2/m8$ versus $0.0143–1.22×1018 N s2/m8$ and capacitance: $6.89 m5/N$ versus $7.50×10−9 m5/N$). The hydrodynamic properties of the knee phantom were acceptably comparable to those of the human knee joints. The physical simulation environment enables realistic and conditioned experimental studies to optimize joint irrigation. The foundation has been laid for evaluation of other surgical instruments and of training of surgical skills.

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## Figures

Figure 1

(a) Prototype of the knee phantom, (b) arthroscopic view showing a probe (routinely used instrument to inspect the joints arthroscopically), and (c) overview from underneath the transparent tibial surface showing the location of the probe in the knee phantom.

Figure 2

Interface of the VISIONDAQ player showing two recorded images and four data signals. Left: The view form underneath the tibial surface. Right: The arthroscopic view. Bottom: Four colored data signals; the upper and lower signal indicate the flow, and the two signals in the middle indicate the pressure. The two digital video streams and the four data signals can be saved separately for further processing. Additional functions enable scrolling and zooming on the recorded signals.

Figure 3

Schematic drawing of the irrigation setting in the operating room and simulation environment. The sheath is modeled as a restriction, and the knee joint or phantom as a restriction placed in a parallel circuit with a capacitance. In inflow tubing has negligible characteristics. The pressure and flow were measured at the indicated locations both in the operating room and the simulation environment.

Figure 4

The solid circles represent the mean pressure and flow as measured at the locations shown in Fig. 3. The plus signs indicate the standard deviations. The light colored circles indicate data of the 17 patients and the dark circles those of 10 conditions of the knee phantom. The lines are the regression lines for each condition. Their slopes determine the value of the combined restriction of the sheath and knee phantom. The steepest line is the condition with a triple stack of rubber rings of ∅1 mm and the initial phantom volume of 95 ml, and the flattest line is the condition with a single rubber ring of ∅3 mm and a volume of 80 ml.

Figure 5

Fourier spectra of stressing performed on human knee joints (see legend) and the knee phantom (see legend). The mean and upper and lower boundary Fourier spectra of 16 knee joints are drawn. Hydrodynamic changes due to stressing of the knee phantom were determined for four different cross-sectional areas of the anterolateral portal: single (phantom 1 mm), double (phantom 2×1 mm), triple (phantom 3×1 mm) stacks of rubber rings of ∅1 mm, and a single rubber ring of ∅2 mm (phantom 2 mm).

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