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Robotic guided waterjet cutting technique for high tibial dome osteotomy: A pilot study
Eduardo M Suero1, Ralph Westphal2, David Zaremba3
1Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
Background:
Oscillating saws generate high levels of heat (up to 150°C), which can lead to tissue necrosis, delayed healing and infection. Abrasive waterjet-cutting techniques have been described as a new tool to perform bone cuts, with less heat generation.
Methods:
Four lower-limbs of four human alcohol conserved cadavers were tested. Navigation references were attached to the tibia and an intraoperative fluoroscopy-based 3D scan was obtained. A 1.2 mm diameter nozzle was attached to a robotic arm, which was guided to follow a pre-specified path. In addition, a self-designed jet-absorber was applied to protect the posterior neurovascular structures. Magnesium was added as an abrasive substance to improve the cutting ability of the waterjet.
Results:
In all four cadavers, the osteotomies could be carried out as planned, resulting in smooth cut surfaces. No damage to the soft-tissues was observed.
Conclusions:
The advantages of abrasive waterjet-cutting give it great potential in orthopaedic surgery. A current disadvantage is the amount of magnesium solute that is left on the surgical field and can be harmful to the patient.
