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Guo H, Pan N, Yang B, Ma M, Wu D, Li C, Zhu R, Wang M, Zhu Y, Zhang Y, Wang J. Clinical outcomes of guider-assisted osteotomy compared to conventional pendulum-saw osteotomy in open wedge high tibial osteotomy: a propensity score-matched cohort study. J Orthop Surg Res 2024; 19:432. [PMID: 39054455 PMCID: PMC11271211 DOI: 10.1186/s13018-024-04909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE We developed a novel guider-assisted osteotomy (GAO) procedure to improve the safety of open wedge high tibial osteotomy (OWHTO) and aimed to compare its efficacy and complications with the conventional pendulum-saw osteotomy (PSO). METHODS This is a retrospective cohort study of patients undergoing either GAO or PSO procedure in the OWHTO to treat varus knee osteoarthritis, who had a minimum of 2 years of follow-up. Patients were propensity score matched (PSM) in a 1:1 ratio based on demographic and clinical data with a caliper width of 0.02. The outcomes assessed involved the hospital for special surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and the Intraoperative and postoperative complications. RESULTS 199 patients were included in each group after PSM. The mean duration of follow-up was 38.3 ± 8.9 months. The GAO group had a shorter operation duration (104.5 ± 35.7 vs. 112.1 ± 36.0 min, p = 0.027) and fewer times of intraoperative fluoroscopy (4.2 ± 1.4 vs. 6.0 ± 1.4, p < 0.001). At the last follow-up, clinical scores for knee achieved significant improvements in both GAO and PSO groups: HSS (67.5 ± 10.5 vs. 90.2 ± 7.0, p < 0.001; 69.4 ± 8.2 vs. 91.7 ± 6.8, p < 0.001) and WOMAC (65.7 ± 11.6 vs. 25.2 ± 10.4, p < 0.001; 63.3 ± 12.2 vs. 23.8 ± 9.5, p < 0.001). However, no significant difference was observed between groups for any measures (p > 0.05). In addition, the intraoperative complications (0.5% vs. 3.5%, p = 0.068) and the postoperative bone delayed union and nonunion (1.0% vs. 4.5%, p = 0.032) were marginally or significantly reduced in the GAO versus PSO group. CONCLUSION GAO demonstrates improvements in intraoperative radiation exposure and complications, with comparable short-term efficacy to PSO, and could be considered a viable alternative in clinical practice.
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Affiliation(s)
- Haichuan Guo
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, P.R. China
| | - Naihao Pan
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, P.R. China
| | - Bin Yang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, P.R. China
| | - Meixin Ma
- College of Letters and Science, University of California, Berkeley, CA, 94720, USA
| | - Dongwei Wu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, P.R. China
| | - Chengsi Li
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, P.R. China
| | - Ruoxuan Zhu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, P.R. China
| | - Maolin Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, P.R. China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China.
- Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, P.R. China.
| | - Yingze Zhang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China.
- Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, P.R. China.
| | - Juan Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China.
- Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, P.R. China.
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Walle M, Yeritsyan D, Abbasian M, Oftadeh R, Müller R, Nazarian A. A graph model to describe the network connectivity of trabecular plates and rods. Front Bioeng Biotechnol 2024; 12:1384280. [PMID: 38770275 PMCID: PMC11103010 DOI: 10.3389/fbioe.2024.1384280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction: The trabecular network is perceived as a collection of interconnected plate- (P) and rod-like (R) elements. Previous research has highlighted how these elements and their connectivity influence the mechanical properties of bone, yet further work is required to elucidate better the deeply interconnected nature of the trabecular network with distinct element formations conducting forces per their mechanical boundary conditions. Within this network, forces act through elements: a rod or plate with force applied to one end will transmit this force to a component connected to the other end, defining the boundary conditions for the loading of each element. To that end, this study has two aims: First, to investigate the connectivity of individually segmented elements of trabecular bone with respect to their local boundary conditions as defined by the surrounding trabecular network and linking them directly to the bone's overall mechanical response during loading using a mathematical graph model of the plate and rod (PR) Network. Second, we use this model to quantify side artifacts, a known artifact when testing an excised specimen of trabecular bone, where vertical trabeculae lose their load-bearing capacity due to a loss of connectivity, ultimately resulting in a change of the trabecular network topology. Resuts: Connected elements derived from our model predicted apparent elastic modulus by fitting a linear regression (R 2 = 0.81). In comparison, prediction using conventional bone volume fraction results in a lower accuracy (R 2 = 0.72), demonstrating the ability of the PR Network to estimate compressive elastic modulus independent of specimen size or loading boundary condition. Discussion: PR Network models are a novel approach to describing connectivity within the trabecular network and incorporating mechanical boundary conditions within the morphological analysis, thus enabling the study of intrinsic material properties of trabecular bone. Ultimately, PR Network models may be an early predictor or provide further insights into osteo-degenerative diseases.
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Affiliation(s)
- Matthias Walle
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Ramin Oftadeh
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Ralph Müller
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
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Mosher ZA, Bolognesi MP, Malkani AL, Meneghini RM, Oni JK, Fricka KB. Cementless Total Knee Arthroplasty: A Resurgence - Who, When, Where, and How? J Arthroplasty 2024:S0883-5403(24)00198-0. [PMID: 38458333 DOI: 10.1016/j.arth.2024.02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is one of the most common procedures in orthopaedics, but there is still debate over the optimal fixation method for long-term durability: cement versus cementless bone ingrowth. Recent improvements in implant materials and technology have offered the possibility of cementless TKA to change clinical practice with durable, stable biological fixation of the implants, improved operative efficiency, and optimal long-term results, particularly in younger and more active patients. METHODS This symposium evaluated the history of cementless TKA, the recent resurgence, and appropriate patient selection, as well as the historical and modern-generation outcomes of each implant (tibia, femur, and patella). Additionally, surgical technique pearls to assist in reliable, reproducible outcomes were detailed. RESULTS Historically, cemented fixation has been the gold standard for TKA. However, cementless fixation is increasing in prevalence in the United States and globally, with equivalent or improved results demonstrated in appropriately selected patients. CONCLUSION Cementless TKA provides durable biologic fixation and successful long-term results with improved operating room efficiency. Cementless TKA may be broadly utilized in appropriately selected patients, with intraoperative care taken to perform meticulous bone cuts to promote appropriate bony contact and biologic fixation.
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Affiliation(s)
- Zachary A Mosher
- Anderson Orthopaedic Research Institute (AORI), Alexandria, VA, USA; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA, USA
| | | | - Arthur L Malkani
- University of Louisville Department of Orthopaedic Surgery, Louisville, KY, USA
| | - R Michael Meneghini
- Indiana Joint Replacement Institute, Indianapolis, IN, USA; Indiana University Department of Orthopaedic Surgery, Indianapolis, IN, USA
| | - Julius K Oni
- The Johns Hopkins University Department of Orthopaedic Surgery, Baltimore, MD, USA
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute (AORI), Alexandria, VA, USA; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA, USA.
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Polizzotti G, Lamberti A, Mancino F, Baldini A. New Horizons of Cementless Total Knee Arthroplasty. J Clin Med 2023; 13:233. [PMID: 38202240 PMCID: PMC10780266 DOI: 10.3390/jcm13010233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Considering the increasing number of young and active patients needing TKA, orthopedic surgeons are looking for a long-lasting and physiological bond for the prosthetic implant. Multiple advantages have been associated with cementless fixation including higher preservation of the native bone stock, avoidance of cement debris with subsequent potential third-body wear, and the achievement of a natural bond and osseointegration between the implant and the bone that will provide a durable and stable fixation. DISCUSSION Innovations in technology and design have helped modern cementless TKA implants to improve dramatically. Better coefficient of friction and reduced Young's modulus mismatch between the implant and host bone have been related to the use of porous metal surfaces. Moreover, biologically active coatings have been used on modern implants such as periapatite and hydroxyapatite. These factors have increased the potential for ingrowth by reducing micromotion and increasing osteoconductive properties. New materials with better biocompatibility, porosity, and roughness have been introduced to increase implant stability. CONCLUSIONS Innovations in technology and design have helped modern cementless TKA implants improve primary stability in both the femur and tibia. This means that short-term follow-up are comparable to cemented. These positive prognostic factors may lead to a future in which cementless fixation may be considered the gold-standard technique in young and active patients.
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Affiliation(s)
- Giuseppe Polizzotti
- Istituto Chirurgico Ortopedico Traumatologico (ICOT), Sapienza University of Rome, 00185 Rome, Italy
| | | | - Fabio Mancino
- University College London Hospital, London NW1 2BU, UK
- The Princess Grace Hospital, London W1U 5NY, UK
| | - Andrea Baldini
- Istituto Fiorentino di Cura e Assistenza, 50139 Florence, Italy
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Zawadzki P, Talar R, Grochalski K, Dąbrowski M. The Influence of Osteon Orientation on Surface Topography Parameters after Machining of Cortical Bone Tissue. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4293. [PMID: 37374480 DOI: 10.3390/ma16124293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
Mechanical processing of cortical bone tissue is one of the most common surgical procedures. A critical issue accompanying this processing is the condition of the surface layer, which can stimulate tissue growth and serve as a drug carrier. A comparison of the surface condition before and after orthogonal and abrasive processing was conducted to validate the influence of bone tissue's processing mechanism and orthotropic properties on the surface topography. A cutting tool with a defined geometry and a custom-made abrasive tool was used. The bone samples were cut in three directions, depending on the orientation of the osteons. The cutting forces, acoustic emission, and surface topography were measured. The level of isotropy and the topography of the grooves showed statistical differences relative to the anisotropy directions. After orthogonal processing, the surface topography parameter Ra was determined from 1.38 ± 0.17 μm to 2.82 ± 0.32. In the case of abrasive processing, no correlation was found between the orientation of osteons and topographical properties. The average groove density for abrasive machining was below 1004 ± 0.7, and for orthogonal, it was above 1156 ± 58. Due to the positive properties of the developed bone surface, it is advisable to cut in the transverse direction and parallel to the axis of the osteons.
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Affiliation(s)
- Paweł Zawadzki
- Faculty of Mechanical Engineering, Poznan University of Technology, Maria Sklodowska-Curie Square 5, 60-965 Poznan, Poland
| | - Rafał Talar
- Faculty of Mechanical Engineering, Poznan University of Technology, Maria Sklodowska-Curie Square 5, 60-965 Poznan, Poland
| | - Karol Grochalski
- Faculty of Mechanical Engineering, Poznan University of Technology, Maria Sklodowska-Curie Square 5, 60-965 Poznan, Poland
| | - Mikołaj Dąbrowski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, 61-545 Poznan, Poland
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Füssenich W, Seeber GH, van Raaij TM, van Lingen CP, Zuurmond RG, Stevens M, Somford MP. Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study. Foot Ankle Int 2023; 44:508-515. [PMID: 36959744 PMCID: PMC10248293 DOI: 10.1177/10711007231160754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion. METHODS A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion. RESULTS Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index. CONCLUSION Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Affiliation(s)
- Wout Füssenich
- Department of Orthopaedic Surgery,
University of Groningen, University Medical Center Groningen, Groningen, the
Netherlands
| | - Gesine H. Seeber
- Department of Orthopaedic Surgery,
University of Groningen, University Medical Center Groningen, Groningen, the
Netherlands
- University Hospital for Orthopaedics
and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg,
Germany
| | - Tom M. van Raaij
- Department of Orthopaedic Surgery,
Martini Hospital, Groningen, the Netherlands
| | | | | | - Martin Stevens
- Department of Orthopaedic Surgery,
University of Groningen, University Medical Center Groningen, Groningen, the
Netherlands
| | - Matthijs P. Somford
- Department of Orthopaedic Surgery,
Rijnstate Hospital, Arnhem, the Netherlands
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Alam K, Qamar SZ, Iqbal M, Piya S, Al-Kindi M, Qureshi A, Al-Ghaithi A, Al-Sumri B, Silberschmidt VV. Effect of drill quality on biological damage in bone drilling. Sci Rep 2023; 13:6234. [PMID: 37069203 PMCID: PMC10110507 DOI: 10.1038/s41598-023-33381-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/12/2023] [Indexed: 04/19/2023] Open
Abstract
Bone drilling is a universal procedure in orthopaedics for fracture fixation, installing implants, or reconstructive surgery. Surgical drills are subjected to wear caused by their repeated use, thermal fatigue, irrigation with saline solution, and sterilization process. Wear of the cutting edges of a drill bit (worn drill) is detrimental for bone tissues and can seriously affect its performance. The aim of this study is to move closer to minimally invasive surgical procedures in bones by investigating the effect of wear of surgical drill bits on their performance. The surface quality of the drill was found to influence the bone temperature, the axial force, the torque and the extent of biological damage around the drilling region. Worn drill produced heat above the threshold level related to thermal necrosis at a depth equal to the wall thickness of an adult human bone. Statistical analysis showed that a sharp drill bit, in combination with a medium drilling speed and drilling at shallow depth, was favourable for safe drilling in bone. This study also suggests the further research on establishing a relationship between surface integrity of a surgical drill bit and irreversible damage that it can induce in delicate tissues of bone using different drill sizes as well as drilling parameters and conditions.
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Affiliation(s)
- Khurshid Alam
- Department of Mechanical and Industrial Engineering, College of Engineering, Sultan Qaboos University, P.O. Box 33, Al-Khoud, 123, Sultanate of Oman.
| | - Sayyad Zahid Qamar
- Department of Mechanical and Industrial Engineering, College of Engineering, Sultan Qaboos University, P.O. Box 33, Al-Khoud, 123, Sultanate of Oman
| | - Muhammad Iqbal
- Creative Engineering & Management Services, Saddar Road, Peshawar, Pakistan
| | - Sujan Piya
- Department of Industrial Engineering and Engineering Management, College of Engineering, University of Sharjah, Sharjah, UAE
| | - Mahmood Al-Kindi
- Department of Mechanical and Industrial Engineering, College of Engineering, Sultan Qaboos University, P.O. Box 33, Al-Khoud, 123, Sultanate of Oman
| | - Asim Qureshi
- Department of Pathology, Sultan Qaboos University, Al-Khoud, 123, Sultanate of Oman
| | - Ahmed Al-Ghaithi
- Department of Surgery, Sultan Qaboos University Hospital, Al-Khoud, 123, Sultanate of Oman
| | - Badar Al-Sumri
- Histopathology Laboratory, Sultan Qaboos University Hospital, Al-Khoud, 123, Sultanate of Oman
| | - Vadim V Silberschmidt
- School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, UK
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Akhbar MFA. Thermomechanical damage in cortical bone caused by margins of surgical drill bit: A finite element analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 231:107361. [PMID: 36736133 DOI: 10.1016/j.cmpb.2023.107361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Conventional surgical drill bits suffer from several drawbacks, including extreme heat generation, breakage, jam, and undesired breakthrough. Understanding the impacts of drill margin on bone damage can provide insights that lay the foundation for improvement in the existing surgical drill bit. However, research on drill margins in bone drilling is lacking. This work assesses the influences of margin height and width on thermomechanical damage in bone drilling. METHODS Thermomechanical damage-maximum bone temperature, osteonecrosis diameter, osteonecrosis depth, maximum thrust force, and torque-were calculated using the finite element method under various margin heights (0.05-0.25 mm) and widths (0.02-0.26 mm). The simulation results were validated with experimental tests and previous research data. RESULTS The effect of margin height in increasing the maximum bone temperature, osteonecrosis diameter, and depth were at least 19.1%, 41.9%, and 59.6%, respectively. The thrust force and torque are highly sensitive to margin height. A higher margin height (0.21-0.25 mm) reduced the thrust force by 54.0% but increased drilling torque by 142.2%. The bone temperature, osteonecrosis diameter, and depth were 16.5%, 56.5%, and 81.4% lower, respectively, with increasing margin width. The minimum thrust force (11.1 N) and torque (41.9 Nmm) were produced with the highest margin width (0.26 mm). The margin height of 0.05-0.13 mm and a margin width of 0.22-0.26 produced the highest sum of weightage. CONCLUSIONS A surgical drill bit with a margin height of 0.05-0.13 mm and a margin width of 0.22-0.26 mm can produce minimum thermomechanical damage in cortical bone drilling. The insights regarding the suitable ranges for margin height and width from this study could be adopted in future research devoted to optimizing the margin of the existing surgical drill bit.
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Affiliation(s)
- Mohd Faizal Ali Akhbar
- Department of Naval Architecture and Maritime Technology, Faculty of Ocean Engineering Technology and Informatics (FTKKI), Universiti Malaysia Terengganu (UMT), 21030, Kuala Nerus, Terengganu, Malaysia.
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Sigilião Celles CA, Ferreira I, Valente MDLDC, Dos Reis AC. Osseointegration in relation to drilling speed in the preparation of dental implants sites: A systematic review. J Prosthet Dent 2023:S0022-3913(23)00138-5. [PMID: 37019748 DOI: 10.1016/j.prosdent.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 04/05/2023]
Abstract
STATEMENT OF PROBLEM The drilling speed used for preparing dental implants may affect bone-implant contact (BIC), implant stability quotient (ISQ), and bone area fraction occupancy (BAFO). Different rotational speeds and the presence or absence of irrigation during site preparation have been investigated, but an established protocol for achieving the best osseointegration results is lacking. PURPOSE The purpose of this systematic review was to investigate the influence of drill rotational speed on bone drilling for dental implant placement and its relationship with osseointegration. MATERIAL AND METHODS This review included the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and was registered in the international prospective register of systematic reviews (PROSPERO) database. Electronic searches were performed in the MEDLINE (PubMed), Scopus, Science Direct, and Embase databases. The risk of bias was analyzed by using the systematic review center for laboratory animal experimentation (SYRCLE). RESULTS A total of 1282 articles were found, and after removing duplicates and applying the eligibility criteria to in vivo articles on animals that addressed drilling speed and its relationship to osseointegration, 8 articles were selected for analysis. Of these, 5 articles showed no statistical differences, and 3 others showed significantly better osseointegration results by analyzing the parameters of BIC, BAFO, ISQs, and pull-out forces (PoFs). In all selected articles, high-speed drilling was performed with irrigation. CONCLUSIONS Although drilling speed seems to affect bone perforation, no definitive protocol was found in the literature consulted. The results vary depending on the combination of different factors, including bone type, irrigation, and drilling speed.
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Affiliation(s)
- Cícero Andrade Sigilião Celles
- Post-graduate student, Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Izabela Ferreira
- Post-graduate student, Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Mariana da Lima da Costa Valente
- Collaborating Professor, Post-doctoral fellow, Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Andréa Cândido Dos Reis
- Professor, Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
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10
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Bone cutting efficiency and heat generation using a traditional fluted Burr and a novel fluteless resurfacing tool. Clin Biomech (Bristol, Avon) 2023; 102:105898. [PMID: 36764102 DOI: 10.1016/j.clinbiomech.2023.105898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Powered instrumentation is often used for bone preparation and/or removal in many orthopaedic procedures but does risk thermogenesis. This study compares biomechanical properties of a fluted burr and a novel fluteless resurfacing tool. METHODS Twenty cadaveric metatarsals were tested with four predetermined cutting forces to evaluate heat generation and cutting rate for the fluted burr and fluteless resurfacing tool over 40 s or until a depth of 4 mm was reached. Cutting rate was calculated from displacement transducer data. Heat generation was measured by thermocouples placed in the bone adjacent to the burring site. Assuming a body temperature of 37 °C, a 10 °C increase in heat was used as the threshold of inducing osteonecrosis. FINDINGS At 1.0 N and 1.7 N, the thermal osteonecrosis threshold was reached at comparable times between burrs, while the bone removed by the resurfacing tool was on average five times greater than fluted burr at 1.0 N and over twice as great at 1.7 N. Statistical analysis of these common cutting forces showed the resurfacing tool had significantly higher cutting rates (P < 0.01). As a result, the fluted burr produced higher temperatures for the same amount of bone removal (P < 0.01). INTERPRETATION In a cadaveric study, the fluteless resurfacing tool demonstrated higher bone cutting rates and lower heat generation for the same amount of bone removed than a traditional fluted burr.
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Zawadzki P, Talar R, Patalas A, Legutko S. Influence of Machining Parameters on Cutting and Chip-Formation Process during Cortical Bone Orthogonal Machining. MATERIALS (BASEL, SWITZERLAND) 2022; 15:ma15186414. [PMID: 36143728 PMCID: PMC9502497 DOI: 10.3390/ma15186414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 05/08/2023]
Abstract
Cortical bone machining is commonly used in craniofacial surgery. The shaping of bone surfaces requires a precise determination of the process’s complexity due to the cutting tool’s defined or undefined geometry. Therefore, research was carried out to assess the impact of the rake angle (γ), clearance angle and depth of cut (d) on the cortical bone machining process. Analysis was carried out based on the orthogonal cutting in three directions. The cutting tool shape was simplified, and the cutting forces and the chip-formation process were monitored. The highest values of the resultant cutting force and shear force were recorded for γ < 0. The specific cutting force decreases with the increase of d. Cutting in the transverse direction is characterized by the highest values of resultant cutting force and shear force. The coefficient of friction depends primarily on the d and takes a constant value or increases with the increase of γ. The tests showed that the chips are formed in the entire range of d ≥ 0.5 µm and create regular shapes for d ≥ 10 µm. The research novelty confirms that even negative cutting angles guarantee controlled cutting and can find wider application in surgical procedures.
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12
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Lin W, Yang F. Computational analysis of cutting parameters based on gradient Voronoi model of cancellous bone. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:11657-11674. [PMID: 36124607 DOI: 10.3934/mbe.2022542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Bone cutting is a complicated surgical operation. It is very important to establish a kind of gradient porous bone model in vitro which is close to human bone for the research of bone cutting. Due to the existing bone cutting researches are based on solid bone model, which is quite different from human bone tissue structure. Therefore, Voronoi method was used to establish a gradient porous bone model similar to real bone tissue to simulate the process of bone drilling in this paper. High temperature and large cutting force during bone drilling can cause serious damage to bone tissue. Urgent research on bone drilling parameters is necessary to reduce cutting temperature and cutting force. The finite element analysis (FEA) of Voronoi bone models with different gradients is carried out, and a Voronoi model which is similar to real bone tissue is obtained and verified by combining the cutting experiment of pig bone. Then orthogonal experiments are designed to optimize the cutting parameters of Voronoi bone model. The range method is used to analyze the influence weights of cutting speed, feed speed and tip angle on cutting temperature and cutting force, and the least square method was used to predict the cutting temperature and cutting force, respectively. The gradient porous bone model constructed by Voronoi method was studied in detail in this paper. This study can provide theoretical guidance for clinical bone drilling surgery, and the prediction model of bone drilling has practical significance.
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Affiliation(s)
- Wei Lin
- School of Mechanical and Vehicle Engineering, Changchun University, Changchun 130012, China
| | - Fengshuang Yang
- School of Mechanical and Vehicle Engineering, Changchun University, Changchun 130012, China
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13
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Liu S, Wu D, Zhao J, Yang T, Sun J, Gong K. Novel crescent drill design and mechanistic force modeling for thrust force reduction in bone drilling. Med Eng Phys 2022; 103:103795. [PMID: 35500995 DOI: 10.1016/j.medengphy.2022.103795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
Bone drilling tends to cause mechanical damages and thermal necrosis in the vicinity of the drilled hole, which can deteriorate the surgery quality and patients' recovery. Understanding the cutting forces generation mechanism is crucial in controlling thrust force and bone temperature for optimum tool design. In this study, a novel crescent drill bit featuring an improved positive rake angle distribution was designed to reduce the thrust force and temperature elevation. On this basis, a mechanistic model for predicting thrust force and torque was proposed for drill bits with different geometries (twist drill and crescent drill). The proposed model was established in the polar coordinate system to precisely calculate the curvilinear integral of the crescent cutting edges. Drilling experiments were carried out using two types of drill bit under different cutting conditions and results showed that our proposed model agrees well with the experimental data. The experimental results also demonstrated that our tool design can significantly reduce the thrust force and reduce the bone temperature below the thermal threshold without coolant, providing a clinical option for coolant free drilling.
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Affiliation(s)
- Sinan Liu
- School of Control and Mechanical Engineering, Tianjin Chengjian University, Tianjin 300384, China
| | - Di Wu
- School of Control and Mechanical Engineering, Tianjin Chengjian University, Tianjin 300384, China
| | - Jian Zhao
- School of Control and Mechanical Engineering, Tianjin Chengjian University, Tianjin 300384, China.
| | - Tao Yang
- School of Mechanical Engineering, Tiangong University, Tianjin 300387, China
| | - Jie Sun
- Tianjin Hospital, Tianjin 300211, China
| | - Kun Gong
- School of Control and Mechanical Engineering, Tianjin Chengjian University, Tianjin 300384, China
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14
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Bahat O, Yin X, Holst S, Zabalegui I, Berroeta E, Pérez J, Wöhrle P, Sörgel N, Brunski J, Helms JA. An Osteotomy Tool That Preserves Bone Viability: Evaluation in Preclinical and Clinical Settings. J Clin Med 2022; 11:jcm11092536. [PMID: 35566662 PMCID: PMC9103213 DOI: 10.3390/jcm11092536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/20/2022] Open
Abstract
The main objectives of this work were to assess the efficiency, ease-of-use, and general performance of a novel osseoshaping tool based on first-user clinical experiences and to compare these observations with preclinical data generated in rodents using a miniaturized version of the instrument. All patients selected for the surgery presented challenging clinical conditions in terms of the quality and/or quantity of the available bone. The presented data were collected during the implant placement of 15 implants in 7 patients, and included implant recipient site (bone quality and quantity) and ridge evaluation, intra-operative handling of the novel instrument, and the evaluation of subsequent implant insertion. The instrument was easy to handle and was applied without any complications during the surgical procedure. Its use obviated the need for multiple drills and enabled adequate insertion torque in all cases. This biologically driven innovation in implant site preparation shows improvements in preserving vital anatomical and cellular structures as well as simplifying the surgical protocol with excellent ease-of-use and handling properties.
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Affiliation(s)
- Oded Bahat
- Private Practice, Beverly Hills, CA 90210, USA
- Correspondence:
| | - Xing Yin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA; (X.Y.); (J.B.); (J.A.H.)
| | - Stefan Holst
- Nobel Biocare Services AG, 8058 Zurich, Switzerland;
| | | | | | | | | | | | - John Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA; (X.Y.); (J.B.); (J.A.H.)
| | - Jill A. Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA; (X.Y.); (J.B.); (J.A.H.)
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15
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Aerosol morphology and particle size distribution in orthopaedic bone machining: a laboratory worst-case contamination simulation. Is high-speed bone machining potentially harmful by pollution and quality schemes and what measures could be taken for prevention? INTERNATIONAL ORTHOPAEDICS 2022; 46:1647-1655. [PMID: 35435476 PMCID: PMC9013979 DOI: 10.1007/s00264-022-05398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
Abstract
Aim of the study High-speed bone machining devices with irrigation fluid were used in surgery to spread aerosols and toss tissue particles of varying morphology into the operating room. Based on measurements taken on a phantom object, the shape, size, and spatial contamination distribution of such particles were assessed. Method Cadaveric femoral heads were continuously machined with a spherical bur, manually held at a fixed attack angle. The irrigation fluid used during bone machining was enriched with bacteria to act as a tracer to quantify the spatial contamination. A vertical board equipped with snippets served as a phantom object to assess contamination load and morphology of airborne particles. Results Eight-nine percent of the particles had a non-circular cross section. The detected particle size ranged across six orders of magnitude, from 0.006 to 4 mm2 with a median particle size of 0.125 mm2. The CFU counts observed after the standard machining time ranged from 7 to 240, with a median of 2 CFUs. The highest median contamination was seen at the upper right corner of the phantom. Discussion The experiments show that contaminating particles of a wide variety of shapes and sizes are part of the aerosol created by high-speed burring. While protection of personnel and equipment is always important, surgical helmets should be worn, especially at contamination hotspots, and gloves should be replaced at the end of machining. Sensitive instruments and measuring devices—such as optical sensors—should also be protected effectively, as the optical measurement may be obstructed by aerosol particles.
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16
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Hong CH, Park JS, Jang BW, Jang H, Kim CH. Subtrochanteric Insufficiency Fracture Occurring 5 Years after Surgery at the Steinmann Pin Insertion Site for Fracture Reduction. Medicina (B Aires) 2022; 58:medicina58030404. [PMID: 35334582 PMCID: PMC8949153 DOI: 10.3390/medicina58030404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives: Steinmann pins are commonly used in orthopedics, with a low rate of complications. However, thermal osteonecrosis may occur when a pin is inserted using a drill. There have been no reports on late-onset fractures at the Steinmann pin insertion site. Materials and Methods: A 32-year-old man who underwent surgery for a femoral shaft fracture 5 years ago complained of proximal thigh pain 1 month after the removal of the internal device. On physical examination, the patient showed a limping gait due to pain, and tenderness was observed on the lateral aspect of the proximal thigh. Magnetic resonance imaging was performed because the symptoms did not improve, despite conservative treatment. A new fracture line was observed in the lateral cortical bone of the proximal femur. It was found that a fracture occurred at the site where the Steinmann pin was inserted for a closed reduction at the time of the first operation. The patient was instructed to limit weight bearing and to use crutches while walking. Parathyroid hormone was additionally administered to promote bone formation. Results: Six months after diagnosis, a complete union was achieved at the subtrochanteric fracture site, and the patient’s pain subsided. Conclusions: A fracture that occurs as a late onset at the provisional Steinmann pin insertion site is an extremely rare complication; however, orthopedic surgeons must consider this possibility and make more efforts to lower the occurrence of thermal damage. In addition, if the patient complains of pain in the region where the pin was inserted after surgery, surgeons should spare no effort to determine whether a new fracture has occurred.
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Affiliation(s)
- Chang-Hwa Hong
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Chungcheongnam-do, Korea; (C.-H.H.); (J.-S.P.); (H.J.)
| | - Jong-Seok Park
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Chungcheongnam-do, Korea; (C.-H.H.); (J.-S.P.); (H.J.)
| | - Byung-Woong Jang
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Gumi, 179, 1 Gongdan-ro, Gumi 39371, Gyeongsangbuk-do, Korea;
| | - Heejun Jang
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Chungcheongnam-do, Korea; (C.-H.H.); (J.-S.P.); (H.J.)
| | - Chang-Hyun Kim
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Chungcheongnam-do, Korea; (C.-H.H.); (J.-S.P.); (H.J.)
- Correspondence:
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17
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Zawadzki P. Proposal for a Novel Abrasive Machining Method for Preparing the Surface of Periarticular Tissue during Orthopedic Surgery on Hip Joints. J Funct Biomater 2021; 12:50. [PMID: 34564199 PMCID: PMC8482268 DOI: 10.3390/jfb12030050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 01/21/2023] Open
Abstract
Drilling, cutting, and milling are the most common methods used in orthopedic surgery. However, popular machining methods do not obtain the complex shape of the periarticular tissue surfaces, increasing operation time and patient recovery. This paper reports an attempt to research a novel design of a machining process for surgical procedures. A device using abrasion machining based on mechanical erosion was proposed. Machining uses an undefined geometry of the cutting grains to cut tissue in any direction during oscillatory tool movement. This new concept is based on a cylindrical abrasive device made of brown fused alumina and silicon carbide grains deposited with an epoxy resin binder on the surface of a polyamide shaft. The best results in terms of machining efficiency were obtained for grains of the BFA80 type. Cutting experiments with different values in terms of cutting speed, granulation of the abrasive grains, pressure forces, and machining scope showed that the proposed concept, by developing the shape of the device, allows for penetration of the tissue structure. The research shows the possibility of using the proposed method during periarticular tissue machining.
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Affiliation(s)
- Paweł Zawadzki
- Faculty of Mechanical Engineering, Poznan University of Technology, Maria Sklodowska-Curie Square, 60-965 Poznan, Poland
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18
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Bai W, Pan P, Shu L, Yang Y, Zhang J, Xu J, Sugita N. Design of a self-centring drill bit for orthopaedic surgery: A systematic comparison of the drilling performance. J Mech Behav Biomed Mater 2021; 123:104727. [PMID: 34492615 DOI: 10.1016/j.jmbbm.2021.104727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Bone drilling is an indispensable and demanding operation among many orthopaedic operations. A dedicated drill bit that can achieve low-trauma and self-centring drilling is in urgent need. In this study, a three-step orthopaedic low-traumatic drill bit design was proposed. In order to evaluate the drilling performance of the proposed drill, comprehensive comparison tests were carried out with various commercial medical drills in terms of skiving force, thrust force, temperature rise, and surface quality. The experimental results show that the proposed three-step drill design with the optimal point angle, a small chisel edge, transition arc and web thinning can obtain lower and more stable thrust force, slighter bending force, smaller temperature rise, and higher hole quality compared with the commercial drill bits. The proposed drill shows satisfactory drilling performance and has great application potential in clinical surgery.
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Affiliation(s)
- Wei Bai
- State Key Lab of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China; Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen, 518000, China
| | - Pengfei Pan
- State Key Lab of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Liming Shu
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138656, Japan.
| | - Yuhang Yang
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL, 33124, United States
| | - Jianguo Zhang
- State Key Lab of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China; Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen, 518000, China
| | - Jianfeng Xu
- State Key Lab of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China.
| | - Naohiko Sugita
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138656, Japan
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19
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Füssenich W, Brusse-Keizer MGJ, Somford MP. Severe Hallux Valgus Angle Attended With High Incidence of Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Follow-Up Study. J Foot Ankle Surg 2021; 59:993-996. [PMID: 32690233 DOI: 10.1053/j.jfas.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 02/03/2023]
Abstract
The incidence of nonunion after first metatarsophalangeal joint (MTP-1) arthrodesis was found to be high in our clinic. By raising awareness for the problem, making a uniform surgical treatment protocol, banning the commonly used convex-concave reamers, and promoting solely the use of hand instruments to prepare the joint for arthrodesis, we tried to decrease the numbers of nonunion. This prospective cohort study included all patients who underwent MTP-1 fusion between January 2018 and March 2019. Patients were treated according to a standardized protocol, using hand instruments to prepare the joint for fusion. Anthropometric and therapy-related data were collected and compared with an earlier 2015-2016 cohort that was retrospectively assessed. Furthermore, the frequency of nonunion between convex-concave reamers and hand instruments was compared. A total of 53 patients underwent MTP-1 fusion surgery. The incidence of nonunion was 3.8%, significantly lower than the 24.1% in 2015 to 2016 (p = .002). Multivariate regression analysis showed a 7.11 times higher risk of nonunion in 2015 to 2016 compared with 2018 to 2019 (95% confidence interval [CI] 1.55 to 32.55) (p = .012). Furthermore, an increase of 10° in HVA showed a 1.52 risk of occurrence of nonunion (95% CI 1.07 to 2.17) (p = .021). The use of convex/concave reamers was univariately associated with a 3.61 times higher risk of nonunion (95% CI 1.14 to 11.43) (p = .029); however, after correction for preoperative HVA, the preparation method was no longer associated with the occurrence of nonunion (p = .108). Patients suffering from severe hallux valgus had nonunion in 32.1% of cases. Incidence of nonunion after MTP-1 arthrodesis was significantly reduced by raising awareness and by standardizing the treatment protocol. There was no significant difference in nonunion frequency between the methods of joint surface preparation. Severe hallux valgus is prone to nonunion, and more research into this indication for MTP-1 fusion and outcome is needed.
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Affiliation(s)
- Wout Füssenich
- Resident, Department of Orthopedic Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Matthijs P Somford
- Foot and Ankle Surgeon, Department of Orthopedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
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20
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Putzer D, Coraça-Huber D, Huber C, Boschert H, Thaler M, Nogler M. The spatial distribution of aerosols in high-speed bone burring with external irrigation. J Microbiol Methods 2021; 184:106205. [PMID: 33774109 DOI: 10.1016/j.mimet.2021.106205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022]
Abstract
It is well-known that the use of high-speed burring devices with irrigation used in bone surgery produces aerosols, and can toss tissue particles into space. The aim of this study was to assess the spatial vertical contamination in the sterile operation field while using a high-speed cutting device at various locations. A fresh porcine knee was resected for 10 min with a high-speed burring device. To determine the spatial contamination distribution bacteria were used as a tracer. In this novel method for detecting environmental contamination droplets of the contaminated irrigation solution were collected on vertically mounted Petri dishes and the number of colony-forming units was counted. Contamination of varying intensity was observed throughout the room. The highest contamination was found perpendicular to the bur rotation axis in a distance 0.5 m from the bur, at a height of 1.4 m. Around this spot, colony-forming units count isotropically drops to less than 100 CFUs at an area of 0.5 m in diameter. The contamination decreases with increasing distance to the bur head and a main direction of contamination was identified. Placing critical sterile objects in the highly contaminated space during and after bone resection procedures should be avoided whenever possible.
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Affiliation(s)
- David Putzer
- Medical University of Innsbruck, Department of Orthopaedic and Traumatology - Experimental Orthopaedics, Sonnenburgstrasse 16, 6020 Innsbruck, Austria.
| | - Débora Coraça-Huber
- Medical University of Innsbruck, Department of Orthopaedic and Traumatology - Experimental Orthopaedics, Sonnenburgstrasse 16, 6020 Innsbruck, Austria
| | - Cora Huber
- Stryker Leibinger GmbH & Co. KG, Bötzinger Strasse 41, 79111 Freiburg, Germany
| | - Harald Boschert
- Stryker Leibinger GmbH & Co. KG, Bötzinger Strasse 41, 79111 Freiburg, Germany
| | - Martin Thaler
- Medical University of Innsbruck, Department of Orthopaedic and Traumatology, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Michael Nogler
- Medical University of Innsbruck, Department of Orthopaedic and Traumatology - Experimental Orthopaedics, Sonnenburgstrasse 16, 6020 Innsbruck, Austria
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21
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Gursan O, Celtik M, Yanik B, Husemoglu RB, Havitcioglu H. Three-Dimensionally-Printed Joint-Preserving Prosthetic Reconstruction of Massive Bone Defects After Malignant Tumor Resection of the Proximal Tibia. Cureus 2021; 13:e13784. [PMID: 33842159 PMCID: PMC8032040 DOI: 10.7759/cureus.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Joint-preserving prosthetic reconstruction for massive bone defects has the potential to be a new and revolutionary treatment option. In this paper, we discuss the case of a 30-year-old female patient who presented with pain and swelling around the knee for three months. The patient underwent this procedure. Postoperative patient satisfaction, pain scores, and range of motion results were found to be promising. We believe that this method has the potential to be the next stage in the quest for better treatment options for this condition.
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Affiliation(s)
- Onur Gursan
- Department of Orthopedics and Traumatology, Dokuz Eylül University, Izmir, TUR
| | - Mustafa Celtik
- Department of Orthopedics and Traumatology, Dokuz Eylül University, Izmir, TUR
| | - Berkay Yanik
- Department of Orthopedics and Traumatology, Dokuz Eylül University, Izmir, TUR
| | | | - Hasan Havitcioglu
- Department of Orthopedics and Traumatology, Dokuz Eylül University, Izmir, TUR
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22
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Sherman WF, Flick TR, Dranoff CS, Weintraub MJ, Kale NN, Sommi C, Sanchez FL. Variability of Cutting and Thermal Dynamics Between New and Used Acetabular Reamers During Total Hip Arthroplasty. Arthroplast Today 2021; 7:91-97. [PMID: 33521203 PMCID: PMC7818610 DOI: 10.1016/j.artd.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background Aseptic loosening of the acetabular component remains one of the leading causes of early failure of total hip arthroplasty. Poor apposition of bone onto the implant surface can be due to inaccurate reaming and osteonecrosis of the acetabular bone due to the heat generated while reaming. Methods New and used acetabular reamers were tested on an MTS system using a clinically relevant force of 87.6 N. A thermal profile and depth achieved by the reamers were analyzed and compared between the 2 cohorts. Heat generated and force required for the community used reamers to achieve the same depth as the new reamers were subsequently analyzed. Results The new reamers achieved a depth 3.4 mm deeper than the community reamers (P < .001). The new reamers generated 4.1°C less heat than the community reamers (P = .007) under the same force and time. When programmed to ream to the average depth of the new reamers, the community reamers generated 16.8°C more heat (P = .002) and required forces 95-318% greater than the 87.6 N force used by the new reamers. Conclusions Community use of reamers will cause variations in depth of penetration and increased temperatures at a clinically generated force vs new reamers. When community reamers were forced to the same depths the new reamers achieved, a significantly greater amount of heat was generated, and an increased amount of time was needed, both of which are known risk factors for osteonecrosis.
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Affiliation(s)
- William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Travis R Flick
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Charles S Dranoff
- Tulane University School of Science and Engineering, New Orleans, LA, USA
| | | | - Nisha N Kale
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Corinne Sommi
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Fernando L Sanchez
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Minnaard J, Kleipool RP, Baars W, Dankelman J, Stufkens S, Horeman T. A new bone-cutting approach for minimally invasive surgery. Med Eng Phys 2020; 87:56-62. [PMID: 33461674 DOI: 10.1016/j.medengphy.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/21/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
AIMS Resection of bone is performed in over 75% of all orthopaedic procedures and the electrically powered oscillating saw is commonly used to cut bone. Drawbacks are relatively large incisions and tissue damage due to overshooting often occur. Therefore, the goal of this study is to develop an improved bone-cutting system that has minimally invasive characteristics. METHODS A new reusable sawing system was designed that can be used in Minimally Invasive Surgery (MIS) consisting of a steerable wire passer and a tissue saving wire saw guide. The system was tested during surgery on a human cadaveric tibia and calcaneus. RESULTS A MIS steerable compliant Nitinol needle was built and successfully used in a cadaveric surgery to position the cutting wire around a tibia and calcaneus. A wire saw operating system was built that was successfully used to cut the tibia and calcaneus. CONCLUSION A MIS bone-cutting system was successfully designed, manufactured and used in a cadaver study showing that safe minimally invasive bone-cutting is feasible for two bone types with minimal damage to the surrounding tissue. Design optimization is needed to stabilize the compliant Nitinol needle during wire saw positioning and to allow cutting of bones with smaller diameters.
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Affiliation(s)
- Jeffrey Minnaard
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, the Netherland
| | | | - Wim Baars
- Department of Instrument Development, Leidse instrumentmakers school, Leiden, the Netherlands
| | - Jenny Dankelman
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, the Netherland
| | - Sjoerd Stufkens
- Department of Orthopaedic Surgery, Amsterdam UMC, the Netherlands
| | - Tim Horeman
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, the Netherland.
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Alam K, Iqbal M, Umer J, Amjad M, Al-Ghaithi A. Experimental study on biological damage in bone in vibrational drilling. Biomed Mater Eng 2020; 31:269-277. [PMID: 32986649 DOI: 10.3233/bme-201122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Drilling is a well-known mechanical operation performed for fixing fracture at required locations in bone. The process may produce mechanical and thermal alterations in the structure of the bone and surrounding tissues leading to irreversible damage known as osteonecrosis. OBJECTIVE The main purpose of this study was to measure the level of biological damage in bone when a drill assisted by low and high levels of vibrations is penetrated into bone tissue. METHODS Histopathology examination of sections of bones has been performed after drilling the bone using a range of vibrational frequency and rotational speed imposed on the drill with and without supply of saline for cooling. RESULTS Cell damage in bone was caused by the combined effect of drill speed and frequency of vibrations. Histopathology examination revealed more damage to bone cells when a frequency higher than 20 kHz was used in the absence of cooling. Cooling the drilling region helped minimize cell damage more at a shallow depth of drilling compared to deep drilling in the cortex of cortical bone. The contribution of cooling in minimizing cell damage was higher with a lower drill speed and frequency compared to a higher drill speed and frequency. CONCLUSION Vibrational drilling using a lower drill speed and frequency below 25 kHz in the presence of cooling was found to be favorable for safe and efficient drilling in bone.
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Affiliation(s)
- Khurshid Alam
- Mechanical and Industrial Engineering Department, Sultan Qaboos University, Al-Khoud, Sultanate of Oman
| | - Muhammad Iqbal
- Creative Engineering and Management Services, Deans Centre, Peshawar, Pakistan
| | - Jamal Umer
- Department of Mechanical Engineering, University of Engineering and Technology, Lahore, Pakistan
| | - Muhammad Amjad
- Department of Mechanical Engineering, International Islamic University, Sector H-11, Islamabad, Pakistan
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Coyac BR, Salvi G, Leahy B, Li Z, Salmon B, Hoffmann W, Helms JA. A novel system exploits bone debris for implant osseointegration. J Periodontol 2020; 92:716-726. [PMID: 32829495 DOI: 10.1002/jper.20-0099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bone debris generated during site preparation is generally evacuated with irrigation; here, we evaluated whether retention of this autologous material improved the rate of peri-implant bone formation. METHODS In 25 rats, a miniature implant system composed of an osseo-shaping tool and a tri-oval-shaped implant was compared against a conventional drill and round implant system. A split-mouth design was used, and fresh extraction sockets served as implant sites. Histology/histomorphometry, immunohistochemistry, and microcomputed tomography (μCT) imaging were performed immediately after implant placement, and on post-surgery days 3, 7, 14, and 28. RESULTS Compared with a conventional drill design, the osseo-shaping tool produced a textured osteotomy surface and viable bone debris that was retained in the peri-implant environment. Proliferating osteoprogenitor cells, identified by PCNA and Runx2 expression, contributed to faster peri-implant bone formation. Although all implants osseointegrated, sites prepared with the osseo-shaping tool showed evidence of new peri-implant bone sooner than controls. CONCLUSION Bone debris produced by an osseo-shaping tool directly contributed to faster peri-implant bone formation and implant osseointegration.
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Affiliation(s)
- Benjamin R Coyac
- Division of Plastic and Reconstructive Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Giuseppe Salvi
- Division of Plastic and Reconstructive Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Brian Leahy
- Division of Plastic and Reconstructive Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Zhijun Li
- Division of Plastic and Reconstructive Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA.,Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Benjamin Salmon
- Dental Medicine Department, Bretonneau Hospital, Montrouge, France, University of Paris, Paris, France
| | | | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
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Temperature Threshold Values of Bone Necrosis for Thermo-Explantation of Dental Implants-A Systematic Review on Preclinical In Vivo Research. MATERIALS 2020; 13:ma13163461. [PMID: 32781597 PMCID: PMC7476012 DOI: 10.3390/ma13163461] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Very high or low temperatures will lead to bone damage. The objective of this review was to analyze threshold values for thermal bone necrosis. METHODS Histological animal studies evaluating thermal effects on bone necrosis were selected via electronic and hand searches in English and German language journals until 1 November 2019. The outcome measures were temperature-exposure intervals and laser settings effecting bone damage. Furthermore, investigated parameters were the bone-to-implant contact ratios (BIC) and infrabony pockets around dental implants after thermal treatment. For quality assessment of studies, the CAMARADES study quality checklist was applied. RESULTS A total of 455 animals in 25 animal studies were included for data extraction after screening of 45 titles from 957 selected titles of the MEDLINE (PubMed), The Cochrane Library, Embase and Web of Science search. The threshold values for bone necrosis ranged between 47 °C and 55 °C for 1 min. A threshold value for cryoinsult and laser treatment has not yet been defined. However, temperatures in the vicinity of 3.5 °C produce a histologically proven effect on the bone and in the surrounding tissue. At 50 °C for 1 min, BIC values significantly decreased and infrabony pockets increased. Bone quality had an influence on the outcome, as cancellous bone suffered higher bone damage from thermal treatment compared to cortical bone. CONCLUSION No clear threshold value for bone necrosis is available according to the current literature for warm and cold stimuli. More in-depth and clinical studies are required to provide further insights in assessing the potential of thermal necrosis for implant removal.
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Shu L, Bai W, Shimada T, Ying Z, Li S, Sugita N. Thermographic assessment of heat-induced cellular damage during orthopedic surgery. Med Eng Phys 2020; 83:100-105. [PMID: 32505661 DOI: 10.1016/j.medengphy.2020.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/19/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022]
Abstract
The heat generated during orthopedic surgery can cause thermal damage to bone cells, leading to cell necrosis, death, and bone resorption. In this study, the drill-exit surface in cortical bone drilling was firstly investigated by infrared thermography to understand the thermal characteristics of bone cutting. In order to mimic the short-term thermal condition of high temperature during surgical cutting, the osteoblasts were exposed to heat shock for short periods of time to investigate the effect of cutting heat on the bone. Necrosis and apoptosis were investigated immediately after heat shock for 2 s, 5 s, and 15 s at 50 °C, 60 °C, 70 °C, and 80 °C, respectively. The cells were then incubated for 4 days at 37 °C and analyzed by fluorescein annexin V-FITC/PI double staining. The temperature and heat-duration were precisely controlled by a novel heating approach. In comparison to the control group (37 °C), immediate necrotic and apoptotic response to heat shock was found in cells exposed to 50 °C for 5 s (11.8%, p<0.05); however, the response was negligible in cells exposed to 50 °C for 2 s. In addition, recovery was found in the group exposed to 50 °C and 60 °C for 2 s (p ≤ 0.05) after incubation for 4 days. Cell damage depends on the magnitude and duration of heat exposure. These findings provide fundamental knowledge for future developments of surgical tool design and cutting methods.
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Affiliation(s)
- Liming Shu
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan.
| | - Wei Bai
- State Key Lab of Digital Manufacturing Equipment and Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Takehiro Shimada
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Zhenzhi Ying
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Shihao Li
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Naohiko Sugita
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
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Tibial subchondral trabecular bone micromechanical and microarchitectural properties are affected by alignment and osteoarthritis stage. Sci Rep 2020; 10:3975. [PMID: 32132556 PMCID: PMC7055326 DOI: 10.1038/s41598-020-60464-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/04/2019] [Indexed: 11/29/2022] Open
Abstract
At advanced knee osteoarthritis (OA) stages subchondral trabecular bone (STB) is altered. Lower limb alignment plays a role in OA progression and modify the macroscopic loading of the medial and lateral condyles of the tibial plateau. How the properties of the STB relate to alignment and OA stage is not well defined. OA stage (KL scores 2–4) and alignment (HKA from 17° Varus to 8° Valgus) of 30 patients were measured and their tibial plateau were collected after total knee arthroplasty. STB tissue elastic modulus, bone volume fraction (BV/TV) and trabecula thickness (Tb.Th) were evaluated with nanoindentation and µCT scans (8.1 µm voxel-size) of medial and lateral samples of each plateau. HKA and KL scores were statistically significantly associated with STB elastic modulus, BV/TV and Tb.Th. Medial to lateral BV/TV ratio correlated with HKA angle (R = −0.53, p = 0.016), revealing a higher ratio for varus than valgus subjects. STB properties showed lower values for KL stage 4 patients. Tissue elastic modulus ratios and BV.TV ratios were strongly correlated (R = 0.81, p < 0.001). Results showed that both micromechanical and microarchitectural properties of STB are affected by macroscopic loading at late stage knee OA. For the first time, a strong association between tissue stiffness and quantity of OA STB was demonstrated.
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Shu L, Sugita N. Analysis of fracture, force, and temperature in orthogonal elliptical vibration-assisted bone cutting. J Mech Behav Biomed Mater 2020; 103:103599. [DOI: 10.1016/j.jmbbm.2019.103599] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/21/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
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Optimization of factors influencing temperature rise and thermal necrosis of a robot driven piezoelectric osteotomy in bovine cortical bone: An in vitro study using an orthogonal test design. Clin Biomech (Bristol, Avon) 2019; 70:249-256. [PMID: 31675680 DOI: 10.1016/j.clinbiomech.2019.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/04/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to provide a comprehensive investigation into factors influencing the thermal effect in robot assisted osteotomies utilizing a piezoelectric osteotome and to identify an optimal combination of factors that minimize the thermal effect in an orthogonal experimental design. METHODS Fresh bovine cortical bone was cut under standardized conditions using a robot arm, a piezoelectric osteotome, and a cooling system. Temperature was monitored and the histological depth of osteocyte thermal necrosis was examined to quantify the thermal effect(s). Eighteen experimental trials were conducted according to the standard L18 (21 × 37) orthogonal design table to explore the roles of 6 factors: power of the piezoelectric osteotome, cutting depth, cutting speed, coolant type, coolant flow velocity, and coolant temperature. FINDINGS Our data showed that coolant flow velocity, coolant temperature and cutting speed significantly influenced temperature (p < .05), while no significant temperature increase was identified relating to cutting depth, power of the piezoelectric osteotome and coolant type. The findings of histological osteocyte thermal necrosis correlated with the results of the temperature change. INTERPRETATION Coolant flow velocity, coolant temperature and cutting speed were key factors influencing the thermal impact of the piezoelectric osteotome. With proper combination of these 3 factors, a piezoelectric osteotome is safe to use from a thermal perspective.
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31
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Kanaya H, Enokida M, Uehara K, Ueki M, Nagashima H. Thermal damage of osteocytes during pig bone drilling: an in vivo comparative study of currently available and modified drills. Arch Orthop Trauma Surg 2019; 139:1599-1605. [PMID: 31289845 DOI: 10.1007/s00402-019-03239-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The Gekkou-drill® is an industrial drill that is highly efficient due to reduced cutting resistance resulting from its characteristic drill point shape. In this experiment, we compared the degree of thermal damage to bone tissue caused by conventional medical drills and these same drills with Gekkou modifications. METHODS Holes were created in the tibias of living pigs using two different 3.2-mm diameter drills and their modified versions. Regarding the drilling parameters, the thrust force was 10 N and the drilling speeds were 800 revolutions per minute (rpm) and 1500 rpm. We compared the original and modified drills in terms of the bone temperature around the drill bit and the total time necessary to create each hole, the latter calculated using imaging data captured during drilling. In histopathological examination, the percentages of empty lacunae in osteocytes of the cortical bone beneath the periosteum were evaluated at 400 × magnification with an optical microscope. RESULTS Compared to the original drills, the modified drills required significantly less time to create each hole and caused a significantly lower temperature rise during bone drilling. With the modified drills, the percentages of empty lacunae around the drilling holes were about 1/2-1/3 of those with the original drills, and were significantly lower for both drilling speeds. CONCLUSIONS Gekkou-modified medical drills shortened drilling times despite low thrust force, and histopathological assessment demonstrated a significant reduction in osteocyte damage.
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Affiliation(s)
- Haruhisa Kanaya
- Department of Orthopedic Surgery, Tottori University, 36-1 Nish-icho, Yonago, Tottori, 683-8504, Japan
| | - Makoto Enokida
- Department of Orthopedic Surgery, Tottori University, 36-1 Nish-icho, Yonago, Tottori, 683-8504, Japan.
| | - Kazutake Uehara
- Advanced Medicine, Innovation and Clinical Research Center, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Masaru Ueki
- Advanced Medicine, Innovation and Clinical Research Center, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hideki Nagashima
- Department of Orthopedic Surgery, Tottori University, 36-1 Nish-icho, Yonago, Tottori, 683-8504, Japan
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Kusins JR, Tutunea‐Fatan OR, Athwal GS, Ferreira LM. Analysis of the process parameters affecting the bone burring process: An in‐vitro porcine study. Int J Med Robot 2019; 15:e2028. [DOI: 10.1002/rcs.2028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 06/07/2019] [Accepted: 07/25/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan R. Kusins
- Department of Mechanical and Materials EngineeringWestern University Ontario N6A 5B9 London Canada
| | - O. Remus Tutunea‐Fatan
- Department of Mechanical and Materials EngineeringWestern University Ontario N6A 5B9 London Canada
| | - George S. Athwal
- Department of SurgeryWestern University Ontario N6A 4V2 London Canada
| | - Louis M. Ferreira
- Department of Mechanical and Materials EngineeringWestern University Ontario N6A 5B9 London Canada
- Department of SurgeryWestern University Ontario N6A 4V2 London Canada
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Alam K, Al-Ghaithi A, Piya S, Saleem A. In-vitro experimental study of histopathology of bone in vibrational drilling. Med Eng Phys 2019; 67:78-87. [PMID: 30981608 DOI: 10.1016/j.medengphy.2019.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/09/2019] [Accepted: 03/30/2019] [Indexed: 02/06/2023]
Abstract
Drilling is a common surgical procedure for fracture treatment and reconstruction in multiple surgical fields, including orthopaedics, neurology, and dentistry. Drilling delicate tissue (such as bone) with a hard metallic tool is considered notorious for inducing mechanical and thermal damage, which can adversely affect osseointegration and may weaken the bond between the bone and implant, or other fixative devices anchoring the bone. The aim of this study is to explore the benefits of vibrational drilling (VD) in overcoming the complications associated with conventional drilling (CD). Drilling tests were performed on fresh cortical bone with the intention of investigating the effect of a range of frequencies, in combination with drilling speed and feed rate, on biological damage around the drilling region using histological sections of skeletally mature bone. The study examined the most influential factors and optimal combination of parameters for safe and efficient drilling in bone. Results from Taguchi grey relational analysis showed that a lower drilling speed and feed rate combined with a frequency of 20 kHz were favourable parameters for safe drilling in bone. Accordingly, VD using controlled parameters may be an alternative to CD in bone surgical procedures.
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Affiliation(s)
- Khurshid Alam
- Department of Mechanical and Industrial Engineering, Sultan Qaboos University, P.O. Box 33, Al-Khoud 123, Sultanate of Oman.
| | | | - Sujan Piya
- Department of Mechanical and Industrial Engineering, Sultan Qaboos University, P.O. Box 33, Al-Khoud 123, Sultanate of Oman
| | - Ashraf Saleem
- Department of Electrical and Computer Engineering, Sultan Qaboos University, P.O. Box 33, Al-Khoud 123, Sultanate of Oman
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Chen CH, Coyac BR, Arioka M, Leahy B, Tulu US, Aghvami M, Holst S, Hoffmann W, Quarry A, Bahat O, Salmon B, Brunski JB, Helms JA. A Novel Osteotomy Preparation Technique to Preserve Implant Site Viability and Enhance Osteogenesis. J Clin Med 2019; 8:jcm8020170. [PMID: 30717291 PMCID: PMC6406409 DOI: 10.3390/jcm8020170] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/26/2019] [Accepted: 01/27/2019] [Indexed: 12/27/2022] Open
Abstract
The preservation of bone viability at an osteotomy site is a critical variable for subsequent implant osseointegration. Recent biomechanical studies evaluating the consequences of site preparation led us to rethink the design of bone-cutting drills, especially those intended for implant site preparation. We present here a novel drill design that is designed to efficiently cut bone at a very low rotational velocity, obviating the need for irrigation as a coolant. The low-speed cutting produces little heat and, consequently, osteocyte viability is maintained. The lack of irrigation, coupled with the unique design of the cutting flutes, channels into the osteotomy autologous bone chips and osseous coagulum that have inherent osteogenic potential. Collectively, these features result in robust, new bone formation at rates significantly faster than those observed with conventional drilling protocols. These preclinical data have practical implications for the clinical preparation of osteotomies and alveolar bone reconstructive surgeries.
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Affiliation(s)
- Chih-Hao Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
- Craniofacial Research Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan 33305, Taiwan.
| | - Benjamin R Coyac
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Masaki Arioka
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
- Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
| | - Brian Leahy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - U Serdar Tulu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Maziar Aghvami
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Stefan Holst
- Nobel Biocare Services AG P.O. Box, CH-8058 Zürich-Flughafen, Switzerland.
- Department of Prosthodontics, School of Dentistry, Johann-Wolfgang Goethe University, Frankfurt, Germany.
| | - Waldemar Hoffmann
- Nobel Biocare Services AG P.O. Box, CH-8058 Zürich-Flughafen, Switzerland.
| | - Antony Quarry
- Nobel Biocare Services AG P.O. Box, CH-8058 Zürich-Flughafen, Switzerland.
| | - Oded Bahat
- Private Practice, Beverly Hills, CA 90210, USA.
| | - Benjamin Salmon
- Paris Descartes-Sorbonne Paris Cité University, EA2496, Montrouge, France.
- Dental Medicine Department, Bretonneau Hospital, HUPNVS, AP-HP, Paris 75018, France.
| | - John B Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Zhao S, Arnold M, Ma S, Abel RL, Cobb JP, Hansen U, Boughton O. Standardizing compression testing for measuring the stiffness of human bone. Bone Joint Res 2018; 7:524-538. [PMID: 30258572 PMCID: PMC6138811 DOI: 10.1302/2046-3758.78.bjr-2018-0025.r1] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives The ability to determine human bone stiffness is of clinical relevance in many fields, including bone quality assessment and orthopaedic prosthesis design. Stiffness can be measured using compression testing, an experimental technique commonly used to test bone specimens in vitro. This systematic review aims to determine how best to perform compression testing of human bone. Methods A keyword search of all English language articles up until December 2017 of compression testing of bone was undertaken in Medline, Embase, PubMed, and Scopus databases. Studies using bulk tissue, animal tissue, whole bone, or testing techniques other than compression testing were excluded. Results A total of 4712 abstracts were retrieved, with 177 papers included in the analysis; 20 studies directly analyzed the compression testing technique to improve the accuracy of testing. Several influencing factors should be considered when testing bone samples in compression. These include the method of data analysis, specimen storage, specimen preparation, testing configuration, and loading protocol. Conclusion Compression testing is a widely used technique for measuring the stiffness of bone but there is a great deal of inter-study variation in experimental techniques across the literature. Based on best evidence from the literature, suggestions for bone compression testing are made in this review, although further studies are needed to establish standardized bone testing techniques in order to increase the comparability and reliability of bone stiffness studies. Cite this article: S. Zhao, M. Arnold, S. Ma, R. L. Abel, J. P. Cobb, U. Hansen, O. Boughton. Standardizing compression testing for measuring the stiffness of human bone. Bone Joint Res 2018;7:524–538. DOI: 10.1302/2046-3758.78.BJR-2018-0025.R1.
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Affiliation(s)
- S Zhao
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - M Arnold
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - S Ma
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK and Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - R L Abel
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - J P Cobb
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - U Hansen
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - O Boughton
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK and Department of Mechanical Engineering, Imperial College London, London, UK
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Shu L, Sugita N, Oshima M, Mitsuishi M. Design and experimental force analysis of a novel elliptical vibration assisted orthopedic oscillating saw. Med Eng Phys 2018; 54:22-31. [DOI: 10.1016/j.medengphy.2018.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/02/2018] [Accepted: 02/11/2018] [Indexed: 11/30/2022]
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37
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Kusins JR, Tutunea-Fatan OR, Ferreira LM. Experimental analysis of the process parameters affecting bone burring operations. Proc Inst Mech Eng H 2017; 232:33-44. [DOI: 10.1177/0954411917742943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The experimental quantification of the process parameters associated with bone burring represents a desirable outcome both from the perspective of an optimized surgical procedure as well as that of a future implementation into the design of closed-loop controllers used in robot-assisted bone removal operations. Along these lines, the present study presents an experimental investigation of the effects that tool type, rotational speed of the tool, depth of cut, feed rate, cutting track overlap, and tool angle (to a total of 864 total unique combinations) have on bone temperature, tool vibration, and cutting forces associated with superficial bone removal operations. The experimental apparatus developed for this purpose allowed a concurrent measurement of bone temperature, tool vibration, and cutting forces as a function of various process parameter combinations. A fully balanced experimental design involving burring trials performed on a sawbone analog was carried out to establish process trends and subsets leading to local maximums and minimums in temperature and vibration were further investigated. Among the parameters tested, a spherical burr of 6 mm turning at 15,000 r/min and advancing at 2 mm/s with a 50% overlap between adjacent tool paths was found to yield both low temperatures at the bone/tool interface and minimal vibrations. This optimal set of parameters enables a versatile engagement between tool and bone without sacrificing the optimal process outcomes.
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Affiliation(s)
- Jonathan R Kusins
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - O Remus Tutunea-Fatan
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - Louis M Ferreira
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
- Department of Surgery, Western University, London, ON, Canada
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Wang L, Aghvami M, Brunski J, Helms J. Biophysical regulation of osteotomy healing: An animal study. Clin Implant Dent Relat Res 2017; 19:590-599. [PMID: 28608504 DOI: 10.1111/cid.12499] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Osteotomies have been performed for centuries yet there remains a remarkable lack of consensus on optimal methods for cutting bone. There is universal agreement, however, that preserving cell viability is critical. PURPOSE To identify mechanobiological parameters influencing bone formation after osteotomy site preparation. MATERIALS AND METHODS A murine maxillary osteotomy model was used to evaluate healing. Computational modeling characterized stress and strain distributions in the osteotomy, as well as the magnitude and distribution of heat generated by drilling. The impact of osteocyte death and bone composition were assessed using molecular and cellular assays. RESULTS The phases of osteotomy healing in mice align closely with results in large animals; in addition, molecular analyses extended our understanding of osteoprogenitor cell proliferation, differentiation, and mineralization. Computational analyses provided insights into temperature changes caused by drilling and the mechanobiological state in the healing osteotomies, while concomitant cellular assays correlate drill speed with osteocyte apoptosis and bone resorption. Even when drilling was controlled, trabeculated, spongy (Type III) bone healed faster than densely lamellar (Type I) bone because of the abundance of Wnt responsive osteoprogenitor cells in the former. CONCLUSIONS These data provide a mechanobiological framework for evaluating tools and technologies designed to improve osteotomy site preparation.
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Affiliation(s)
- Liao Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, 94305
| | - Maziar Aghvami
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, 94305
| | - John Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, 94305
| | - Jill Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, 94305
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