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Han Y, Cai C, Lv Q, Song Y, Zhang Q. Effect of process parameters on the temperature changes during robotic bone drilling. Proc Inst Mech Eng H 2022; 236:1129-1138. [DOI: 10.1177/09544119221106825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In medical surgery, bone drilling is an inevitable procedure. The thermal necrosis in the drilling process can affect post-operative recovery. In this study, the method of drill bit precooling is proposed in bone drilling with robot assisted system. The influence of process parameters on the drilling temperature were investigated and analyzed. The results showed that the method of drill bit precooling could reduce the drilling temperature. The drill bit starting temperature and the feed rate were more important parameters on the drilling temperature compared with rotational speed and cooling length of the drill bit. The quadratic regression model obtained from response surface experiments can predicted the drilling temperature correctly under the range of process parameters in this study. The optimal parameter combination is rotational speed = 1610 rpm, feed rate = 0.5 mm/s, the starting temperature of drill bit = 8°C, and the cooling length = 34.8 mm. The results provide an effective method to reduce thermal necrosis of bone cells in drilling.
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Affiliation(s)
- Ying Han
- Key Laboratory of Efficient and Clean Machinery Manufacturing of Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan, China
- National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan, China
| | - Chenxu Cai
- Key Laboratory of Efficient and Clean Machinery Manufacturing of Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan, China
- National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan, China
| | - Qinjing Lv
- Key Laboratory of Efficient and Clean Machinery Manufacturing of Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan, China
- National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan, China
| | - Yixuan Song
- Key Laboratory of Efficient and Clean Machinery Manufacturing of Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan, China
- National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan, China
| | - Qinhe Zhang
- Key Laboratory of Efficient and Clean Machinery Manufacturing of Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan, China
- National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan, China
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Bruketa T, Augustin G, Staroveški T, Klaić M, Brezak D, Capak H, Dobrić I. Distribution of coolant during drilling with open type internally cooled medical steel drill. Injury 2021; 52 Suppl 5:S32-S37. [PMID: 32958340 DOI: 10.1016/j.injury.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/16/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Internally cooled bone drills with an open system, conduct coolant directly to the point of contact of cutting surface of the drill and the bone and lower the temperature at the drilling site. During bone drilling with internally cooled drills of open type, there is a possibility that coolant enters the intramedullary canal and has an adverse effect on intramedullary pressure. In this research, the intramedullary distribution of the coolant during and after drilling was analyzed. MATERIALS AND METHODS Specially constructed open type internally cooled medical steel drills were used. Experimental studies were conducted on the porcine femoral bone diaphysis. Coolant (saline) was mixed with water-soluble contrast agent and x-ray images of the distribution of coolant during and after drilling were taken with different regimes of drilling (drill rotational speed from 1300 rpm to 5000 rpm, and coolant flow rate from 0,6 l/min to 1,35 l/min). RESULTS An x-ray images showed that coolant did not spread from the borehole and has not spread intramedullary with any combination of coolant flow and drill rotation regimes. CONCLUSION Coolant does not disperse into the intramedullary canal outside of the borehole in given flow ranges (0,6-1,35 l/min) and drill rotational speed regimes (1300-5000 rpm). Open type internally cooled can safely be used for bone drilling.
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Affiliation(s)
- Tomislav Bruketa
- Department of Surgery, University Hospital Centre Zagreb and School of Medicine University of Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb and School of Medicine University of Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
| | - Tomislav Staroveški
- Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000, Zagreb.
| | - Miho Klaić
- Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000, Zagreb.
| | - Danko Brezak
- Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000, Zagreb.
| | - Hrvoje Capak
- Department of Radiology, Ultrasound Diagnostic and Physical Therapy, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia.
| | - Ivan Dobrić
- Department of Surgery, University Hospital Centre Zagreb and School of Medicine University of Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
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Surgical Drill Bit Design and Thermomechanical Damage in Bone Drilling: A Review. Ann Biomed Eng 2020; 49:29-56. [PMID: 32860111 DOI: 10.1007/s10439-020-02600-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022]
Abstract
As drilling generates substantial bone thermomechanical damage due to inappropriate cutting tool selection, researchers have proposed various approaches to mitigate this problem. Among these, improving the drill bit design is one of the most feasible and economical solutions. The theory and applications in drill design have been progressing, and research has been published in various fields. However, pieces of information on drill design are dispersed, and no comprehensive review paper focusing on this topic. Systemizing this information is crucial and, therefore, the impetus of this review. Here, we review not only the state-of-the-art in drill bit designs-advances in surgical drill bit design-but also the influences of each drill bit geometries on bone damage. Also, this work provides future directions for this topic and guidelines for designing an improved surgical drill bit. The information in this paper would be useful as a one-stop document for clinicians, engineers, and researchers who require information related to the tool design in bone drilling surgery.
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Jamil M, Rafique S, Khan AM, Hegab H, Mia M, Gupta MK, Song Q. Comprehensive analysis on orthopedic drilling: A state-of-the-art review. Proc Inst Mech Eng H 2020; 234:537-561. [DOI: 10.1177/0954411920911283] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bone drilling is a well-known internal fixation procedure to drill a hole, fixing the bone fragments to reduce the susceptibility of permanent paralysis. The success of bone drilling is evaluated based on the extent of osteonecrosis in terms of heat generation, tissue damage, quality of hole, and drilling forces. The appropriate control of cutting conditions, drill geometric parameters, and bone-specific parameters offer bone drilling a viable solution through conventional and non-conventional drilling techniques. The majority of the published research work considers only limited parameters and tries to optimize the drilling parameters and performance measures. However, bone drilling involves numerous conventional and non-conventional drilling parameters and technologies. In order to develop a better understanding of all the studied parameters and performance measures, there is a dire need to develop a framework. The key objective of this review study is to establish a hierarchy of the framework by collecting almost all the parameters studied until now and addressed the relationship between parameters and performance measures to diminish the controversies in the published literature. Therefore, this framework is novel in nature, organizing all the parameters, performance measures, logical comparisons, and limitations of studies. This holistic review can help medical surgeons and design engineers to understand the complicated relationship among parameters and performance measures associated with this state-of-art technologies. Also, modeling, simulations, and optimization techniques are included to explore the application of such techniques in recent advancements in orthopedic drilling.
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Affiliation(s)
- Muhammad Jamil
- Department of Mechanical Manufacture and Automation, College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
- Department of Industrial Engineering, University of Engineering and Technology Taxila, Taxila, Pakistan
| | - Saima Rafique
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Aqib Mashood Khan
- Department of Mechanical Manufacture and Automation, College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
- Department of Industrial Engineering, University of Engineering and Technology Taxila, Taxila, Pakistan
| | - Hussien Hegab
- Department of Mechanical Design and Production Engineering, Cairo University, Giza, Egypt
| | - Mozammel Mia
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Munish Kumar Gupta
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture, Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan, China
| | - Qinghua Song
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture, Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan, China
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Luo Y, Chen L, Shih AJ. Hollow Notched K-Wires for Bone Drilling With Through-Tool Cooling. J Orthop Res 2019; 37:2297-2306. [PMID: 31332811 DOI: 10.1002/jor.24419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/02/2019] [Indexed: 02/04/2023]
Abstract
Kirschner wire (K-wire) is a common tool in clinical orthopedic surgery for bone fracture fixation. A significant amount of heat is generated in bone drilling using K-wires, causing bone thermal necrosis and osteonecrosis. To minimize the temperature rise, a hollow notched K-wire in a modified surgical hand drill with through-tool cooling was developed to study the bone temperature, debris evacuation, and material removal rate. The hollow notched K-wire was fabricated by grinding and micro-milling on a stainless steel tube. Bone drilling tests were conducted to evaluate its performance against the solid K-wires. Results showed that compared with solid K-wires, hollow notched K-wire drilling without cooling reduced the peak bone temperature rise, thrust force, and torque by 42%, 59%, and 62% correspondingly. The through-tool compressed air reduced the peak bone temperature rise by 48% with the forced air convection and better debris evacuation. The through-tool water cooling decreased the bone temperature by only 26% due to accumulation and blockage of bone debris in the groove and channel. This study demonstrated the benefit of using the hollow notched K-wire with through-tool compressed air to prevent the bone thermal necrosis. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2297-2306, 2019.
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Affiliation(s)
- Yuanqiang Luo
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan.,Department of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan, China
| | - Lei Chen
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
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Jamil M, Khan AM, Mia M, Iqbal A, Gupta MK, Sen B. Evaluating the effect of micro-lubrication in orthopedic drilling. Proc Inst Mech Eng H 2019; 233:1024-1041. [PMID: 31347443 DOI: 10.1177/0954411919865389] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Achievement of low temperature, thrust force, and clean operating zone under with/without irrigation-assisted drilling is still a challenge in orthopedic surgery owing to substantial bone-tissue damage that extends the healing time. In order to mitigate the above challenges, a new micro-lubrication technique-a low-pressure cold mist impinged on the tool-bone joint interface and penetrating well into the bone surface to improve the cooling/lubrication efficiency-has been proposed in bone drilling. In this study, the aims are to characterize the effect of micro-cooling/lubrication on temperature and thrust force at different levels of cutting speed, feed rate, drill diameter, and coolant flow rate. For that purpose, a fresh calf bone was drilled through commercially available drill tool on three-axis mini-machine. The response surface methodology was applied to get the design of experiments, and the analysis of variance at p-values < 0.5 was used. Moreover, the empirical models were developed to examine the simultaneous effect of all the parameters on performance measures. The employed cooling-lubrication technology has shown a percentage reduction in temperature ranging from 34.3% to 48.3%, and 26.8%-35.9% under irrigation with respect to without-irrigation mode. For cutting force, these reductions are 13%-47.6% and 14.5%-44.2%, respectively. Furthermore, analysis of variance has highlighted the cutting speed and feed rate as the two most prominent parameters for temperature and thrust force under all the drilling modes. Relatively high-pressure cold mist in micro-lubrication has offered a lower temperature, thrust force, and clean operating zone under micro-lubrication mode than with/without-irrigation modes. Henceforth, the micro-lubrication technique has been found as a suitable cooling technique for drilling of bone in the viewpoint of temperature and thrust force.
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Affiliation(s)
- Muhammad Jamil
- Mechanical, Manufacturing and Automation, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,Industrial Manufacturing, University of Engineering and Technology Taxila, Taxila, Pakistan
| | - Aqib Mashood Khan
- Mechanical, Manufacturing and Automation, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,Industrial Manufacturing, University of Engineering and Technology Taxila, Taxila, Pakistan
| | - Mozammel Mia
- Mechanical and Production Engineering, Ahsanullah University of Science and Technology, Dhaka, Bangladesh
| | - Asif Iqbal
- Faculty of Integrated Technologies, Universiti Brunei Darussalam, Gadong, Brunei
| | - Munish Kumar Gupta
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture, Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan, China
| | - Binayak Sen
- Production Engineering, National Institute of Technology, Agartala, India
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Domitran Z, Brezak D, Staroveski T, Klaic M, Bruketa T. Experimental and finite element analysis of surgical drill bits with and without irrigation channel - A case study approach. Med Eng Phys 2018; 62:29-35. [PMID: 30337053 DOI: 10.1016/j.medengphy.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 09/24/2018] [Accepted: 10/07/2018] [Indexed: 10/28/2022]
Abstract
The aim of this study was to perform a finite element and experimental comparative analysis of the mechanical characteristics of surgical drill bits used in bone and joint surgery applications with and without an irrigation channel. Internally cooled drills are very efficient in maintaining the drilling temperature below the critical level. However, a cooling channel could potentially have a negative influence on the drill structure, particularly in the flutes zone. A commercially available type of surgical drill bit without irrigation channel and a modified variant with the built-in channel were simultaneously loaded with torque, axial and bending forces with magnitudes similar to and higher than those utilized in clinical practice. When loaded under the same conditions, both types of drills showed very similar mechanical properties in the sense of the average von Mises stress in chosen sections and the deflections after plastic deformation. The highest stress was observed in the bending zone which was located at the beginning of the flutes section of the drill. All analysed drills suffered only from plastic deformation without any breakage despite the fact that they were loaded with forces higher than those expected in normal operational conditions.
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Affiliation(s)
- Zoran Domitran
- Department of Design, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, I. Lucica 5, HR-10000 Zagreb, Croatia
| | - Danko Brezak
- Department of Robotics and Production Systems Automation, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lucica 5, HR-10000 Zagreb, Croatia.
| | - Tomislav Staroveski
- Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, I. Lucica 5, HR-10000 Zagreb, Croatia
| | - Miho Klaic
- Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, I. Lucica 5, HR-10000 Zagreb, Croatia
| | - Tomislav Bruketa
- University Hospital Centre Zagreb, Kispaticeva 12, HR-10000 Zagreb, Croatia
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Brand S, Bauer M, Petri M, Schrader J, Maier HJ, Krettek C, Hassel T. Impact of intraprosthetic drilling on the strength of the femoral stem in periprosthetic fractures: A finite element investigation. Proc Inst Mech Eng H 2016; 230:675-81. [PMID: 27272200 DOI: 10.1177/0954411916647078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/05/2016] [Indexed: 11/15/2022]
Abstract
Treatment of periprosthetic femur fractures after total hip arthroplasty remains a major challenge in orthopedic surgery. Recently, a novel surgical technique using intraprosthetic screw fixation has been suggested. The purpose of this study was to evaluate the influence of drilling the femoral hip stem on integrity and strength of the implant. The hypothesis was that intraprosthetic drilling and screw fixation would not cause the load limit of the prosthesis to be exceeded and that deformation would remain within the elastic limit. A sawbone model with a conventional straight hip stem was used and a Vancouver C periprosthetic fracture was created. The fracture was fixed with a nine-hole less invasive stabilization system plate with two screws drilled and inserted through the femoral hip stem. Three different finite element models were created using ANSYS software. The models increased in complexity including joint forces and stress risers from three different dimensions. A variation of drilling positions was analyzed. Due to the complexity of the physiological conditions in the human femur, the most complex finite element model provided the most realistic results. Overall, significant changes in the stresses to the prosthesis caused by the drilling procedure were observed. While the stresses at the site of the bore hole decreased, the load increased in the surrounding stem material. This effect is more pronounced and further the holes were apart, and it was found that increasing the number of holes could counteract this. The maximum load was still found to be in the area of the prosthesis neck. No stresses above the load limit of titanium alloy were detected. All deformations of the prosthesis stem remained in the elastic range. These results may indicate a potential role for intraprosthetic screw fixation in the future treatment of periprosthetic femur fractures.
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Affiliation(s)
- Stephan Brand
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Michael Bauer
- Institute of Materials Science, Leibniz University of Hannover, Hannover, Germany
| | - Maximilian Petri
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Julian Schrader
- Institute of Materials Science, Leibniz University of Hannover, Hannover, Germany
| | - Hans J Maier
- Institute of Materials Science, Leibniz University of Hannover, Hannover, Germany
| | | | - Thomas Hassel
- Institute of Materials Science, Leibniz University of Hannover, Hannover, Germany
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Brand S, Ettinger M, Omar M, Hawi N, Krettek C, Petri M. Concepts and Potential Future Developments for Treatment of Periprosthetic Proximal Femoral Fractures. Open Orthop J 2015; 9:405-11. [PMID: 26401164 PMCID: PMC4578140 DOI: 10.2174/1874325001509010405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/08/2015] [Accepted: 07/22/2015] [Indexed: 11/22/2022] Open
Abstract
Periprosthetic proximal femoral fractures are a major challenge for the orthopaedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Transprosthetic drilling of screws through the hip stem as the most solid and reliable part in the patient might represent a promising future approach, with auspicious results in recent biomechanical studies.
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Affiliation(s)
| | - Max Ettinger
- Orthopaedic Department, Hannover Medical School, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Germany
| | - Nael Hawi
- Trauma Department, Hannover Medical School, Germany
| | | | - Maximilian Petri
- Trauma Department, Hannover Medical School, Germany ; Steadman Philippon Research Institute, Vail, CO, USA
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Brand S, Klotz J, Hassel T, Petri M, Ettinger M, Bach FW, Krettek C, Gösling T. Intraprosthetic screw fixation increases primary fixation stability in periprosthetic fractures of the femur—A biomechanical study. Med Eng Phys 2014; 36:239-43. [DOI: 10.1016/j.medengphy.2013.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 07/17/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
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Different thermal conductivity in drilling of cemented compared with cementless hip prostheses in the treatment of periprosthetic fractures of the proximal femur: an experimental biomechanical analysis. INTERNATIONAL ORTHOPAEDICS 2013; 37:1885-9. [PMID: 23775453 DOI: 10.1007/s00264-013-1964-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the different temperature levels whilst drilling cemented and cementless hip prostheses implanted in bovine femora, and to evaluate the insulating function of the cement layer. METHODS Standard hip prostheses were implanted in bovine donor diaphyses, with or without a cement layer. Drilling was then performed using high-performance-cutting drills with a reinforced core, a drilling diameter of 5.5 mm and cooling channels through the tip of the drill for constantly applied internal cooling solution. An open type cooling model was used in this setup. Temperature was continuously measured by seven thermocouples placed around the borehole. Thermographic scans were also performed during drilling. RESULTS At the cemented implant surface, the temperature never surpassed 24.7 °C when constantly applied internal cooling was used. Without the insulating cement layer (i.e. during drilling of the cementless bone-prosthesis construct), the temperature increased to 47 °C. CONCLUSION Constantly applied internal cooling can avoid structural bone and soft tissue damage during drilling procedures. With a cement layer, the temperatures only increased to non-damaging levels. The results could be useful in the treatment of periprosthetic fractures with intraprosthetic implant fixation.
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