Abstract
Background: The preparation of bone for the insertion of an osseointegrated transfemoral implant and the insertion process are performed at very low speeds in order to avoid thermal damages to bone tissue which may potentially jeopardize implant stability. The aim of this study was to quantify the temperature increase in the femur at different sites and insertion depths, relative to the final implant position during the stepwise implantation procedure. Methods: The procedure for installation of the osseointegrated implant was performed on 24 femoral specimens. In one specimen of each pair, the surgery was performed at the clinically practiced speed, while the speed was doubled in the contralateral specimen. Six 0.075 mm K fine gauge thermocouples (RS Components, Sorby, UK) were inserted into the specimen at a distance of 0.5 mm from the final implant surface, and six were inserted at a distance of 1.0 mm. Results: Drilling caused a temperature increase of <2.5 °C and was not statistically significantly different for most drill sizes (0.002 < p < 0.845). The mean increase in temperature during thread tapping and implant insertion was <5.0 °C, whereas the speed had an effect on the temperature increase during thread tapping. Conclusions: Drilling is the most time-consuming part of the surgery. Doubling the clinically practiced speed did not generate more heat during this step, suggesting the speed and thus the time- and cost-effectiveness of the procedure could be increased. The frequent withdrawal of the instruments and removal of the bone chips is beneficial to prevent temperature peaks, especially during thread tapping.
Highlights
Introduction conditions of the Creative CommonsThe traditional method of attaching prostheses for patients who have undergone a transfemoral amputation is by means of socket prostheses
Values given in the text are median, interquartile range (IQR = Q3–Q1), and range (NND) or mean, standard deviation (SD), and range (ND)
During the surgical procedure for the installation of the fixture of a bone-anchored prosthesis, surgeons are trained to maintain a very low speed during drilling, thread tapping, and fixture insertion aiming to minimize the amount of heat generated within the bone tissue
Summary
Introduction conditions of the Creative CommonsThe traditional method of attaching prostheses for patients who have undergone a transfemoral amputation is by means of socket prostheses. The first installed implant was a threaded, cylinder-like, fully implanted component known as a “fixture” made of titanium providing the anchorage “by the formation of bony tissue around it without the growth of fibrous tissue at the bone-implant interface” in a bilateral transfemoral amputee in 1990 [2,3]. Today, this implant system has been further developed and is known as Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) (Integrum AB, Mölndal, Sweden). The frequent withdrawal of the instruments and removal of the bone chips is beneficial to prevent temperature peaks, especially during thread tapping
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