Highlights
- •Increasing tool speeds while drilling into the osteochondral area of bone leads to an increase in temperature.
- •Increasing drill bit sizes while drilling into the osteochondral area of bone leads to an increase in temperature.
- •Drilling in bone can lead to an increase in temperature that can cause osteonecrosis and cell damage.
Abstract
Background
Drilling is a common technique used in orthopedic surgery procedures but causes increases
in temperature that can lead to cell damage and death. The extent of this depends
largely on the magnitude of the increase in temperature. The commonly accepted limit
to prevent osteonecrosis is less than 47 °C for 60 s. There is controversy when it
comes to the optimal drilling parameters that limit temperature increases and cell
death. In addition to this, less research has been done on the drilling effects in
the osteochondral area of joints. Osteochondral tissue damage can interfere with the
daily lives of patients and if severe enough will need to be treated. We hypothesize
that increasing tool speed and drill bit size will increase temperature that could
be above the osteonecrosis limit.
Methods
Ex-vivo experiments were conducted on porcine shoulder joints that tested the thermal
effects of different tool speeds and drill bit sizes. A thermal camera was used to
record and measure real time temperature changes while drilling. Three drill bit sizes
and five tool speeds were used. Statistical analyses includes Welch's ANOVA with Games-Howell
Post Hoc analyses, multivariate linear regression, and surface response regression
were used to explore the association of tool speeds and drill bit size on temperature.
Results and Conclusions
All the tool speed and drill bit size combinations lead to an increase in temperature
that were under the commonly accepted limit. The highest temperature reached was 44 °C
with a tool speed of 1150 RPM and 3070 RPM and drill bit size 5.159 mm. It was found
that increasing the tool speed increased the temperature change and increasing the
drill bit size increased the temperature change.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- An overview of thermal necrosis: present and future.Curr Med Res Opin. 2019; 35 (Sep): 1555-1562
- Thermographic assessment of heat-induced cellular damage during orthopedic surgery.Med Eng Phys. 2020; 83 (2020/09/01/): 100-105
- Cortical bone drilling and thermal osteonecrosis.Clin Biomech. 2012; 27 (2012/05/01/): 313-325
- Parameters affecting mechanical and thermal responses in bone drilling: a review.J Biomech. 2018; 71 (Apr 11): 4-21
- Drilling of bone: a comprehensive review.J Clin Orthop Trauma. 2013; 4 (Mar): 15-30
- Thermal osteonecrosis and bone drilling parameters revisited.Arch Orthop Trauma Surg. 2008; 128 (Jan): 71-77
- A comparison of the thermal properties of 2- and 3-fluted drills and the effects on bone cell viability and screw pull-out strength in an ovine model.Clin Biomech (Bristol, Avon). 2010; 25 (Jul): 613-617
- Chondrocyte death after drilling and articular screw insertion in a bovine model.Osteoarthritis Cartilage. 2013; 21 (May): 721-729
- Comprehensive analysis on orthopedic drilling: a state-of-the-art review.Proc Inst Mech Eng H. 2020; 234 (Jun): 537-561
- Temperature changes and chondrocyte death during drilling in a bovine cartilage model and chondroprotection by modified irrigation solutions.Int Orthop. 2014; 38 (Nov): 2407-2412
- Cartilage restoration techniques for the patellofemoral joint.JAAOS - J Am Acad Orthopaed Surg. 2017; 25: 321-329
- Damage control articular surgery: maintaining chondrocyte health and minimising iatrogenic injury.Injury. 2020; (May;51 Suppl-S9): S83
Article info
Publication history
Published online: January 03, 2023
Accepted:
January 2,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
