title: The water jet as a new tool for endoprosthesis revision surgery--an in vitro study on human bone and bone cement.
abstract: In revision surgeries of endoprostheses, the interface between implant and bone cement or bone must be loosened. Conventional tools have many disadvantages because of their size and limited range. Taking advantage of the selective and athermic cutting process, a plain water jet is already used in order to cut soft tissues. This study investigates the possibilities of both a plain and an abrasive water jet as cutting tools for revision surgery. Samples of the mid-diaphysis of human femora and bone cement (CMW3) were cut with a plain water jet (PWJ) and an abrasive water jet (AWJ) at two different jet-to-surface angles (30 degrees,90 degrees ) and at five different pressure levels (30, 40, 50, 60, 70 MPa). For a PWJ a selective pressure range was identified, where only bone cement was cut. Injecting a bio-compatible abrasive (lactose) to the jet stream resulted in significantly higher cut depths in both materials. Material removal in bone was significantly less at the smaller jet-to-surface angle for both techniques. No clear selectivity between bone and bone cement was observed for application of the AWJ. However, the material removal rate was significantly higher for bone cement than for bone at all pressure levels. The results indicate that an AWJ might be an alternative tool for cement removal. The possibility for localised cutting at interfaces could be an advantage for revision of a non-cemented prosthesis.
authors.affiliation: Barmbek General Hospital, Department of Orthopaedic Surgery, Rübenkamp 148, 22307 Hamburg, Germany. honl@ortho-hamburg.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Honl
authors.forename: Reemt
authors.initials: R
authors.lastname: Rentzsch
authors.forename: Karsten
authors.initials: K
authors.lastname: Schwieger
authors.forename: Volker
authors.initials: V
authors.lastname: Carrero
authors.forename: Oliver
authors.initials: O
authors.lastname: Dierk
authors.forename: Sebastian
authors.initials: S
authors.lastname: Dries
authors.forename: Hartmut
authors.initials: H
authors.lastname: Louis
authors.forename: Frank
authors.initials: F
authors.lastname: Pude
authors.forename: Nick
authors.initials: N
authors.lastname: Bishop
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Hille
authors.forename: Michael
authors.initials: M
authors.lastname: Morlock
mesh_terms: D000368:Aged; D020906:Air Abrasion, Dental / Q000295:instrumentation / Q000379:methods; D001843:Bone Cements; D003646:Debridement / Q000295:instrumentation / Q000379:methods; D019544:Equipment Failure Analysis; D005269:Femur / Q000601:surgery* / Q000648:ultrastructure*; D006801:Humans; D006874:Hydrostatic Pressure; D066298:In Vitro Techniques; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D012086:Reoperation / Q000295:instrumentation* / Q000379:methods*; D013525:Surgical Instruments
chemical_list: D001843:Bone Cements