Abstract
BackgroundOsteotomes 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.MethodsChanges 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.ResultsAfter 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.ConclusionsThe 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.
Highlights
Osteotomes are bone cutting tools commonly reused in orthopedic surgical procedures
One osteotome was electroless nickel coated to a thickness of 8 μm, another was titanium nitride (TiN) coated using physical vapor deposition (PVD) to a thickness of 2 μm, and the remaining one was left in the as-supplied state
Each cutting-edge sample underwent scanning electron microscopy (SEM) analysis (Hitachi SU-70) to qualitatively assess and compare the degree of wear and Visual assessment Upon completion of all bone cutting tests, and after cleaning and sterilization, visual assessment failed to detect any degradation in cutting-edge condition in any of the osteotomes
Summary
Osteotomes are bone cutting tools commonly reused in orthopedic surgical procedures. Stainless steel is commonly used in the manufacture of osteotomes, mainly for its low cost, biocompatibility, and ability to resist corrosion. This type of steel has multiple positive benefits, it lacks the ability to maintain a sharp edge when used as a cutting tool, compared to other harder metal alloys. Hard surface coatings, such as electroless nickel and titanium nitride (TiN), potentially offer a low-cost solution to this problem. A blunt osteotome could produce bone fragments and bone microfractures rather than clean cuts, potentially causing damage to the surrounding soft tissue and leading to poor surgical outcomes [1]
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