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Efficient and safe cement removal is critical in revision arthroplasty. Conventional manual cement removal by hand or power-driven instruments can be time-consuming, require osteotomy, and be associated with complications such as cortical perforation, fracture, or bone loss. Ultrasonic devices offer an alternative method of cement removal by converting mechanical vibrations into thermal energy, liquefying the cement. This facilitates selective cement removal, preserves bone, decreases cortical perforation risk, and eliminates the need for osteotomy. However, potential for thermal injury exists. Ultrasound basic science, mechanism of action, and clinical applications with specific emphasis on methods to limit excessive heat generation are reviewed.