A comparison of past, present and future bone surgery tools

Abstract

The ability to cut and shape bone is a requirement for orthopaedic and maxillofacial surgery. Modern tools are just powered versions of traditional instruments. New methods of cutting have potential benefits that are difficult or impossible to achieve with existing tools, such as miniaturisation or an inherent protection against cutting soft tissues. However, these new cutting technologies must still prove to be successful in cutting mineralised tissues.

An amputation saw, powered sagittal saw (commonly used for arthroplasty procedures) and new ultrasonic bone scalpel, representing the last 200 years of bone surgery, were compared in a standardised fashion. Cutting time, temperature and cell death were evaluated.

The amputation saw was found to cut with the lowest temperature and the least cell death but required the greatest bone exposure. The sagittal saw cut the fastest but also resulted in the greatest cell death. The ultrasonic powered blade created the greatest temperature and also was the slowest, but caused less cell death than the currently used sagittal saw. However, temperature and cell death were significantly reduced by the application of a cooling spray.

It was concluded that current ultrasonic devices are not suitable for thick cortical bone, but may be useful for cutting thinner bones, especially those close to critical soft tissues.