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Intramedullary canal pressure distribution: an experimental parametric study.

Daniel Dobrjanski1, Ziad Saghir, Kamran Behdinan

  • 1Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, Ontario, Canada.

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Hammering implants during joint replacement can cause dangerous pressure buildup. Using slower insertion, less force, a rubber hammer, and a wider gap reduces this risk, especially in the low-viscosity distal femur.

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Biomaterials Science

Background:

  • Intramedullary instrument insertion during total joint replacement can lead to high intramedullary pressures.
  • These pressures pose a risk for clinical fat embolism syndrome.

Purpose of the Study:

  • To evaluate the effects of process parameters on intramedullary pressure during implant insertion.
  • To identify methods for reducing intramedullary pressure generation in simulated bone.

Main Methods:

  • Utilized a simulated femur analogue to model implant insertion.
  • Varied parameters including insertion speed, hammering force, hammer type (rubber vs. steel), and radial gap.
  • Measured intramedullary pressure generation during the hammering process.

Main Results:

  • Lower implant insertion speed, reduced hammering force, a rubber-tipped hammer, and a larger bone-to-implant radial gap all decreased intramedullary pressure.
  • Increased marrow viscosity led to more hammer strikes but lower peak intramedullary pressure.
  • Employing multiple lower-force strikes with a rubber hammer tip significantly reduced pressure compared to fewer high-force strikes.

Conclusions:

  • Process parameters significantly influence intramedullary pressure during implant insertion.
  • Slower insertion, reduced force, rubber hammer use, and larger radial gaps are recommended to mitigate pressure.
  • Particular caution is advised for distal femur procedures due to low viscosity and high pressure potential.