Ultra-Pulsed CO₂ Laser Osteotomy: A New Method for the Bone Preparation of Total Knee Arthroplasty

Cementless total knee arthroplasty (TKA) can achieve long-term biological fixation, but its application is limited by the risk of early aseptic loosening. One of the important reasons for early aseptic loosening is that mechanical osteotomy tools cannot achieve ideal bone preparation because of poor accuracy and serious bone tissue damage produced by them. Therefore, we designed an ultra-pulsed CO₂ laser osteotomy system to solve these problems. To reveal the safety at the tissue and cell levels of the ultra-pulsed CO₂ laser osteotomy system, a series of experiments on distal femur osteotomy in animals were performed. Then, the bone surface characteristics were analyzed through scanning electron microscopy, and the bone thermal and mechanical damage was evaluated via histological analysis. Finally, mesenchymal stem cells (MSCs) were inoculated on the bone surfaces prepared by the two osteotomy tools, and the effect of cell adhesion was analyzed through a confocal laser scanning microscope (CLSM). We successfully achieved TKA bone preparation of animal knees with the ultra-pulsed CO₂ laser osteotomy system. Moreover, the biological evaluation results indicated that compared with the traditional mechanical saw, the laser can preserve the natural bone structure and cause no thermal damage to the bone. In addition, CLSM examination results showed that the laser-cut bone surface was more conducive to cell adhesion and infiltration than the bone surface cut by a mechanical saw. Overall, these results indicate that ultra-pulsed CO₂ laser can achieve non-invasive bone cutting, which can be a new option for TKA bone preparation and has the potential to lead in the future.