The quality of bone cuts is assessed by the accuracy and biological potency of the cut surfaces. Conventional tools (such as saws and milling machines) can cause thermal damage to bone tissue. Water jet cutting is nonthermal; that is, it does not generate heat. This study investigates whether the abrasive jet cutting quality in cancellous bone with a biocompatible abrasive is sufficient for the implantation of endoprostheses or for osteotomies. Sixty porcine femoral condyles were cut with an abrasive water jet and with an oscillating saw. alpha-lactose-monohydrate was used as a biocompatible abrasive. Water pressure (pW = 35 and 70 MPa) and abrasive feed rate (m = 0.5, 1, and 2 g/s) were varied. As a measure of the quality of the cut surface the cutting gap angle (delta) and the surface roughness (Ra) were determined. The surface roughness was lowest for an abrasive feed rate of m = 2 g/s (jet direction: 39 +/- 16 microm, advance direction: 54 +/- 22 microm). However, this was still significantly higher than the surface roughness for the saw group (jet direction: 28 +/- 12 microm, advance direction: 36 +/- 19 microm) (p < 0.001 for both directions). At both pressure levels the greatest cutting gap angle was observed for a mass flow rate of m = 1 g/s (pW = 35 MPa: delta = 2.40 +/- 4.67 degrees ; pW = 70 MPa: delta = 4.13 +/- 4.65 degrees), which was greater than for m = 0.5 g/s (pW = 35 MPa: delta = 1.63 +/- 3.89 degrees ; pW = 70 MPa: delta = 0.36 +/- 1.70 degrees) and m = 2 g/s (pW =70 MPa: delta = 0.06 +/- 2.40 degrees). Abrasive water jets are suitable for cutting cancellous bone. The large variation of the cutting gap angle is, however, unfavorable, as the jet direction cannot be adjusted by a predefined value. If it is possible to improve the cutting quality by a further parameter optimization, the abrasive water jet may be the cutting technique of the future for robotic usage.

Water-jet cutting techniques have been used in industrial applications for many different materials. Recently these techniques have been developed into a revolutionary cutting tool for soft tissues in visceral surgery. The present study investigates the usage of this cutting technology for the revision surgery of endoprostheses. In the first part of the study, samples of bovine bone and acrylic bone cement (PMMA) were cut using an industrial jet cutting device with pure water. Below 400 bar, only PMMA was cut; above 400 bar, bone was also cut, but only pressures above 800 bar resulted in clinically useful rates of material removal (cut depth 2. 4 mm at 10 mm/min traverse speed). In the second part of the study, the effect of adding biocompatible abrasives to the water in order to reduce the required pressure was investigated, resulting in a significantly higher removal of material. At 600 bar, PMMA was cut 5. 2 mm deep with plain water and 15.2 mm deep with added abrasives. The quality of the cuts was increased by the abrasive. Though there was no clear selectivity between bone and PMMA any more, the rate of material removal at similar pressures was significantly higher for PMMA than for bone (600 bar: 1.6 mm cut depth for bone samples, 15.2 mm for PMMA). The measured cut depths with either method were not influenced by a change of the cutting direction with respect to the main direction of the osteons in the bone. However, a reduction of the jet surface angle (90 degrees to 23 degrees ) resulted for bone in a significantly lower cut depth at 600 bar (plain water: 0.62 mm vs. 0.06 mm; abrasive: 1.61 mm vs. 0.60 mm). The laboratory experiments indicate that abrasive water jets may be suitable for cutting biomaterials like bone and bone cement.

Schlüsselwörter: Knochen, Knpchenzement, Endoprothese, Revision, Wassersträhl Konventionelle Werkzeuge haben bei Prothesenrevisionen nur eine limitierte Reichweite im schmalen Zementmantel. Das Druckwasserstrahlschneiden erlaubt eine schmale und präzise Schnittführung und kommt daher als alternative Methode für die Knochenzemententfernung in Frage. Diese Studie vergleicht die Schneidleistung eines gepulsten Wasserstrahls mit jener eines kontinuierlichen Wasserstrahls in Knochenzement (PMMA) und Knochen. 55 Knochen-Proben (Rinderfemora.) und 32 Proben aus PMMA wurden mit einem kontinuierlichen und einem gepulsten Wasserstrahl bei unterschiedlichen Druckniveaus (40 MPa, 60 MPa) und Pulsfrequenzen (0 Hz, 50 Hz, 250 Hz) gekerbt. Um einen Vergleich zu ermöglichen, wurden die Kerbtiefen auf die hydraulische Leistung des auf das Material auftreffenden Strahlanteils bezogen. Während die leistungsbezogenen Kerbtiefen

Water jet techniques have been used in industrial cutting, drilling and cleaning applications for more than 30 years. Plain water is typically used for the cutting of non-metallic materials. The addition of abrasive substances to the stream allows almost any material to be cut. The first medical applications were reported in the early 1980s, when the water jet was used to cut organs. The present study investigates the use of water jet cutting technology for endoprosthesis revision surgery. Bone and PMMA (polymethylmethacrylate) samples were cut at different pressures using an industrial water jet cutting device. Using plain water at 400 bar, PMMA was cut selectively without damaging the bone; above 400 bar, bone was also cut, but the cutting depths in PMMA were significantly greater (p < 0.05). Adding a water-soluble abrasive disaccharide to the water results in a significantly higher removal rate for both materials (p < 0.05), but selectivity is lost, although the differences in cutting depth between the two materials was significant (p < 0.05). With an abrasive, the quality of the cut was better for both materials. The water jet technology--in particular the abrasive technique--can be used to cut biomaterials such as bone and bone cement. The diameter of the jet is a great advantage when working in the confined area at the prosthesis interface. The cutting process is essentially cold, thus eliminating a thermal effect, and the jet reaction forces are relatively low. Accurate manipulation of the hydro jet nozzle is possible both manually and by robot. The results obtained show that it is possible to remove prostheses with this cutting technique, rapidly and with little damage to the surrounding tissue. Problem areas are the development of sterile pumps and the "depth control" of the jet.

The different mechanical properties of the joint capsule and the stratum subsynoviale lead to the selective cutting of the water jet. Since the joint capsule was not damaged, the feasibility of WJ synovectomy has been proven. The device can be used for synovectomy in parts of the joint that are not visible as well as in very small joints.