A national survey of instrument sharpening guidelines

Most orthopaedic procedures involve high-speed tools, which can cause thermal necrosis of bone. Blunt instruments are likely to generate more heat, thereby increasing the chances of thermal necrosis. This could greatly compromise the outcome of even the best prosthesis in good surgical hands. In today's age a lot of emphasis is laid on high performance and longevity of the implant. Therefore, it is worthwhile that we consider the relevance and importance of instrument sharpening. We carried out a survey across hospitals in UK to find out whether they follow any guidelines or protocol with regards to instrument sharpening. Upto 75% of hospitals did not follow any guideline or policy, while 20% of hospitals carried out some sort of quality checks on instruments. This implies that there could be a significant risk of suboptimal outcome due to unnecessary osteonecrosis that can affect most operative orthopaedic interventions, particularly joint arthroplasties. Blunt instruments are too common in orthopaedic theatres and this problem needs to be addressed. Our study brings to light the fact that there seems to be no consensus on this issue and there is theoretically a significant risk of suboptimal outcome because of unnecessary osteonecrosis. This potentially may affect the long and short-term results even in good hands and with excellent prosthesis (cemented or uncemented).