Fatigue strength reduction of Ti-6Al-4V titanium alloy after contact with high-frequency cauterising instruments.

Contact of implants with high-frequency cauterising instruments has serious implications for patient safety. Studies have reported a possible direct connection of fatigue failure of Ti-6Al-4V implants with electrocautery contact. Such contacts were observed at the polished neck of titanium hip stems, which are subjected to high-tension loads. Evidence of electrocautery contact has also been found on a retrieved spinal fixator with a rough surface; however, no fatigue failure related to electrocautery contact has been reported thus far. The influence of the heat-affected zone caused by flashover on the mechanical behaviour of the Ti-6Al-4V titanium alloy is not yet fully understood. Then, the aim of this study was to investigate whether the polished areas of Ti-6Al-4V implants are especially susceptible to fatigue failure after electrocautery contact. Flashovers caused by electrocautery contact were induced on titanium specimens with different surface roughnesses. These specimens were subjected to cyclic loading in a four-point-bending test setup, which represented the stress resulting from physiological loading activities (~861 MPa). In this test setup, electrocautery contact was found to reduce the fatigue strength of the titanium alloy significantly-by up to 96%-as revealed from the median value of the cycles to failure. Cycles to failure showed a dependence on the flashover duration, with a flashover for 40 ms leading to fatigue fracture. Despite the lower fatigue strength of a rough polished surface in the undamaged state, it is less prone to the damaging effect of flashover than a smooth polished surface.