Thermal osteonecrosis and bone drilling parameters revisited

Augustin, Goran; Davila, Slavko; Mihoci, Kristijan; Udiljak, Toma; Vedrina, Denis Stjepan; Antabak, Anko

doi:10.1007/s00402-007-0427-3

Cited by 372 publications

(361 citation statements)

References 31 publications

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“…29,30 Research in rat, 31 canine, 32 and human bone 33,34 has shown that thermal damage delays bone healing, increases bone resorption, and can cause implant loosening or failure. Consequently, a variety of improved drill bits and finely tuned drilling parameters have been developed to reduce thermal necrosis, 29,[35][36][37] although irrigation, both cooled and room temperature, remains the simplest approach. 29,36 The contour and shape of drill burs influences the extent of thermal damage where some commercial drill bits produce less heat than standard equivalents.…”

Section: Microfracture Vs Drilling For Cartilage Repairmentioning

confidence: 99%

“…Consequently, a variety of improved drill bits and finely tuned drilling parameters have been developed to reduce thermal necrosis, 29,[35][36][37] although irrigation, both cooled and room temperature, remains the simplest approach. 29,36 The contour and shape of drill burs influences the extent of thermal damage where some commercial drill bits produce less heat than standard equivalents. 35 Kirschner-wires (or K-wires) are also commonly used, but have a smooth surface without threads and therefore do not remove bone debris, but compress it, leading to increased bone density (as in the MF of our study) and increased heat due to friction.…”

Section: Microfracture Vs Drilling For Cartilage Repairmentioning

confidence: 99%

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Drilling and microfracture lead to different bone structure and necrosis during bone‐marrow stimulation for cartilage repair

Chen

Sun²,

Hoemann

et al. 2009

Journal Orthopaedic Research

242

205

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Bone marrow stimulation is performed using several surgical techniques that have not been systematically compared or optimized for a desired cartilage repair outcome. In this study, we investigated acute osteochondral characteristics following microfracture and comparing to drilling in a mature rabbit model of cartilage repair. Microfracture holes were made to a depth of 2 mm and drill holes to either 2 mm or 6 mm under cooled irrigation. Animals were sacrificed 1 day postoperatively and subchondral bone assessed by histology and micro-CT. We confirmed one hypothesis that microfracture produces fractured and compacted bone around holes, essentially sealing them off from viable bone marrow and potentially impeding repair. In contrast, drilling cleanly removed bone from the holes to provide access channels to marrow stroma. Our second hypothesis that drilling would cause greater osteocyte death than microfracture due to heat necrosis was not substantiated, because more empty osteocyte lacunae were associated with microfracture than drilling, probably due to shearing and crushing of adjacent bone. Drilling deeper to 6 mm versus 2 mm penetrated the epiphyseal scar in this model and led to greater subchondral hematoma. Our study revealed distinct differences between microfracture and drilling for acute subchondral bone structure and osteocyte necrosis. Additional ongoing studies suggest these differences significantly affect long-term cartilage repair outcome. ß

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Section: Microfracture Vs Drilling For Cartilage Repairmentioning

confidence: 99%

Section: Microfracture Vs Drilling For Cartilage Repairmentioning

confidence: 99%

Drilling and microfracture lead to different bone structure and necrosis during bone‐marrow stimulation for cartilage repair

Chen

Sun²,

Hoemann

et al. 2009

Journal Orthopaedic Research

242

205

View full text Add to dashboard Cite

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“…Lee et al 3 performed drilling experiments on bovine bone in the ranges of 800 rpme3800 rpm and concluded that the bone drilling temperature rises with increase in drill speed. The effect of increase in feed rate on temperature is reported by Augustin et al 13 and Lee et al, 3 they found that the temperature decreases with increase in feed rate as the increase in feed rate increases the rate of heat generation rate but causes reduction in drilling time therefore less total heat is generated. The review of the effect of spindle speed on bone drilling temperature suggests no consistent trend.…”

Section: Introductionmentioning

confidence: 88%

“…During bone drilling the value of each response not their mean values must be as low as possible for minimum bone tissue injury. 13 Each combination of experiment is repeated three times and the average of the highest value of each response is considered for analysis.…”

Section: Experimental Designmentioning

confidence: 99%

Optimization of multiple quality characteristics in bone drilling using grey relational analysis

Pandey

Panda

2015

Journal of Orthopaedics

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Bone drillingGrey relational analysis (GRA) Analysis of variance (ANOVA) a b s t r a c t Purpose: Drilling of bone is common during bone fracture treatment to fix the fractured parts with screws wires or plates. Minimally invasive drilling of the bone has a great demand as it helps in better fixation and quick healing of the broken bones. The purpose of the present investigation is to determine the optimum cutting condition for the minimization of the temperature, force and surface roughness simultaneously during bone drilling.Method: In this study, drilling experiments have been performed on bovine bone with different conditions of feed rate and drill rotational speed using full factorial design.Optimal level of the drilling parameters is determined by the grey relational grade (GRG) obtained from the GRA as the performance index of multiple quality characteristics. The effect of each drilling parameter on GRG is determined using analysis of variance (ANOVA) and the results obtained are validated by confirmation experiment.Results: Grey relational analysis showed that the investigation with feed rate of 40 mm/min and spindle speed of 500 rpm has the highest grey relational grade and is recommended setting for minimum temperature, force and surface roughness simultaneously during bone drilling. Feed rate has the highest contribution (59.49%) on the multiple performance characteristics followed by the spindle speed (37.69%) as obtained from ANOVA analysis. Conclusions:The use of grey relational analysis will simplify the complex process of optimization of the multi response characteristics in bone drilling by converting them into a single grey relational grade. The use of the above suggested methodology can greatly minimize the bone tissue injury during drilling.

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“…have been reported [23][4] [5], but varying experimental conditions make comparisons among studies difficult. Whilst it is generally believed that a low rotational speed (around 1000 RPM) and a high feed rate (up to 1 mm/s) leads to a lower overall temperature elevation [23] [3]. The reason for the beneficial lower rotation speed is the reduction of friction.…”

Section: Introductionmentioning

confidence: 99%

Temperature Prediction Model for Bone Drilling Based on Density Distribution and In Vivo Experiments for Minimally Invasive Robotic Cochlear Implantation

et al. 2015

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Surgical robots have been proposed ex vivo to drill precise holes in the temporal bone for minimally invasive cochlear implantation. The main risk of the procedure is damage of the facial nerve due to mechanical interaction or due to temperature elevation during the drilling process.To evaluate the thermal risk of the drilling process, a simplified model is proposed which aims to enable an assessment of risk posed to the facial nerve for a given set of constant process parameters for different mastoid bone densities. The model uses the bone density distribution along the drilling trajectory in the mastoid bone to calculate a time dependent heat production function at the tip of the drill bit. Using a time dependent moving point source Green's function, the heat equation can be solved at a certain point in space so that the resulting temperatures can be calculated over time. The model was calibrated and initially verified with in vivo temperature data. The data was collected in minimally invasive robotic drilling of 12 holes in four different sheep. The sheep were anesthetized and the temperature elevations were measured with a thermocouple which was inserted in a previously drilled hole next to the planned drilling trajectory. Bone density distributions were extracted from pre-operative CT data by averaging Hounsfield values over the drill bit diameter. Post-operative µCT data was used to verify the drilling accuracy of the trajectories. The comparison of measured and calculated temperatures shows a very good match for both heating and cooling phases. The average prediction error of the maximum temperature was less than 0.7°C and the average root mean square error was approximately 0.5°C. To analyze potential thermal damage, the model was used to calculate temperature profiles and cumulative equivalent minutes at 43°C at a minimal distance to the facial nerve. For the selected drilling parameters, temperature elevation profiles and cumulative equivalent minutes suggest that thermal elevation of this minimally invasive cochlear implantation surgery may pose a risk to the facial nerve, especially in sclerotic or high density mastoid bones. Optimized drilling parameters need to be evaluated and the model could be used for future risk evaluation.

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Thermal osteonecrosis and bone drilling parameters revisited

Cited by 372 publications

References 31 publications

Drilling and microfracture lead to different bone structure and necrosis during bone‐marrow stimulation for cartilage repair

Drilling and microfracture lead to different bone structure and necrosis during bone‐marrow stimulation for cartilage repair

Optimization of multiple quality characteristics in bone drilling using grey relational analysis

Temperature Prediction Model for Bone Drilling Based on Density Distribution and In Vivo Experiments for Minimally Invasive Robotic Cochlear Implantation

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