Pilot investigation into osteotome hard surface coating and cutting-edge degradation

Abstract

Background: Osteotomes are bone cutting tools commonly reused in orthopedic surgical procedures. Despite undergoing rigorous cleaning, visual inspection, and sterilization procedures between every use, the condition of the cutting blade edge is commonly not qualitatively assessed. Subjective feedback from surgeons suggests a large variation in osteotome cutting-edge sharpness is found during use. This study seeks to investigate the retention of osteotome cutting-edge sharpness by comparing the wear resistance of as-supplied, electroless nickel, and titanium nitride coated osteotomes following a series of bone cutting tests. Methods: Changes in edge sharpness were assessed using visual inspection, depth penetration testing that quantified change in the blade sharpness index, and scanning electron microscopy visual analysis. Visual inspection of each osteotome blade edge was then compared to qualitative blade sharpness index measurement. Results: After use, no cutting-edge damage or change in blade sharpness was detected by visual examination of all three osteotomes; however, the as-supplied osteotome demonstrated 50% loss of blade sharpness index compared to 30% and 15% reduction for the electroless nickel and titanium nitride coated osteotomes, respectively. This finding was supported by scanning electron microscopy evaluation that found greater mechanical damage had occurred along the cutting edge of the as-supplied osteotome compared to the two coated with wear resistant materials. Conclusions: The rapid loss of blade sharpness found in the as-supplied osteotome supports the degradation in cutting performance frequently reported by surgeons. The findings from this study demonstrate blade sharpness index better detects cutting-edge wear compared to visual inspection. Results from this pilot study also suggest the coating of osteotomes in hard-wearing biocompatible materials assists in retaining cutting-edge sharpness over multiple uses. Further study using a larger sample size is required to validate these findings.

Pilot study: Post-surgical infections could be related with lack of sharpness in surgical tools

“…Each bone cutting cycle removed a 40-mm length of cuticle bone to a depth of 5 mm along the axial direction of the freshly excised adult bovine femur. The same bone sample was utilized to ensure consistency of bone strength between each test following the same procedure described in previous work [ 6 ]. Upon completion of all four bone cutting cycles, each osteotome was then thoroughly cleaned and sterilized (described later) before a small 5 mm × 10 mm sample of the osteotome cutting edge was removed by wire spark-erosion.…”

“…They also possess excellent properties of corrosion resistance, biocompatibility, and cost-effectiveness. Osteotomies are re-used in surgical procedures however lack of regular maintenance can lead to a dull or damaged cutting edge forming [ 6 ].…”

“…Previous study has shown degradation in osteotome cutting performance occurs after very little use [ 6 ]. We hypothesise that surface defects, due to wear along the osteotome cutting edge, could harbour pathogens that remain after post-surgery cleaning and sterilization routines, potentially exposing subsequent patients to cross-contamination and increasing the risk of post-operative infections [ 7 ].…”