Design and In Vitro Validation of an Orthopaedic Drill Guide for Femoral Stem Revision in Total Hip Arthroplasty

• Published in: IEEE journal of translational engineering in health and medicine Vol. 12; p. 1
• Main Authors: Klok, Jan-Willem, Groenewegen, Jessica, Temmermans, Olivier, Van Straten, Niels, Van Straten, Bart, Dankelman, Jenny, Horeman, Tim
• Format: Journal Article
• Language: English
• Published: United States IEEE 01.01.2024; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Actuators; Arthroplasty, Replacement, Hip - adverse effects; Biomedical materials; Bone cements; Bone Cements - therapeutic use; Bones; Cortical bone; Deviation; Drill positioning; Drilling; Femoral components; Femur; Femur - surgery; Guiding mechanisms; Hemorrhage; Hip; Hip Prosthesis; Humans; Irrigation; Joint replacement surgery; Medical device prototyping; Novel design; Orthopaedic implants; Orthopedics; Perforation; Performance tests; Plugs; Prosthetics; Reoperation; Revisions; Surgery; Sustainable design; Total hip arthroplasty; guiding mechanisms; total hip arthroplasty; Drill positioning; novel design; sustainable design; medical device prototyping
• ISSN: 2168-2372; 2168-2372
• DOI: 10.1109/JTEHM.2024.3365300

Objective: Cemented total hip arthroplasty (THA) demonstrates superior survival rates compared to uncemented procedures. Nevertheless, most younger patients opt for uncemented THA, as removing well-fixed bone cement in the femur during revisions is complex, particularly the distal cement plug. This removal procedure often increases the risk of femoral fracture or perforation, haemorrhage and weakening bone due to poor drill control and positioning. Aim of this study was to design a novel drill guide to improve drill positioning. Methods and procedures: A novel orthopaedic drill guide was developed, featuring a compliant centralizer activated by a drill guide actuator. Bone models were prepared to assess centralizing performance. Three conditions were tested: drilling without guidance, guided drilling with centralizer activation held, and guided drilling with centralizer activation released. Deviations from the bone centre were measured at the entry and exit point of the drill. Results: In the centralizing performance test, the drill guide significantly reduced drill hole deviations in both entry and exit points compared to the control ( p < 0.05). The absolute deviation on the exit side of the cement plug was 10.59mm (SD 1.56) for the 'No drill guide' condition, 3.02mm (SD 2.09) for 'Drill guide - hold' and 2.12mm (SD 1.71) for 'Drill guide - release'. Conclusion: The compliant drill guide centralizer significantly lowered the risk of cortical bone perforation during intramedullary canal drilling in the bone models due to better control of the cement drill position. Clinical and Translational Impact Statement: The drill guide potentially reduces perioperative risks in cemented femoral stem revision. Future research should identify optimal scenarios for its application.