The correct, safe and efficient use ( cutting technique ) of a power bone saw has become a fundamental task in modern orthopedic surgery. Using the cut guide helps by limiting the margin of error for saw cuts and determining the thickness of the saw blade. It is important for the surgeon to understand cutting techniques and power tool selection techniques on the incision guide. For laymen, it is helpful to place the saw at full power to observe the travel distance and to observe the width of the effective cutting arc compared to the physical surgical saw blade. Similarly, observing the distance between the saw blade and the hand is an important practice for understanding angle changes that can affect over- or under-resection of the cutting jig.
The design and manufacture of the surgical saw blade is an important factor related to cutting properties in surgical procedures such as total knee arthroplasty. There are five important features associated with saw blades. These are:
The quality of the metal is important for the ability to maintain and hold the sharpness of the saw teeth. The choice of metal hardness determines the ability of the metal to protect and keep sharp saw teeth.
The asymmetrical tooth structure of the saw blade can affect the difficulties encountered during cutting and the behavior of the saw. This is especially the case when the left or right side of the saw blade only comes into contact with the bone and can cause the blade to move to the right or left. However, this tendency is minimized as the saw blade approaches the center of the bone arc. The asymmetrical tooth structure can be designed to compensate for the tendency of the saw blade to bend or deflect, and when used with the right orientation, it can provide a more stable cut. Therefore, the asymmetrical tooth structure of the saw blade in cutting operations is an important factor to consider.
TEETH ARRANGEMENT OF ACF SAW BLADES IN DIFFERENT SIZES
The other feature to be analyzed is the saw blade length. The length of the saw blade is associated with the size of the bone front part and the problem of the moment handle. Longer saw blades can reach a larger cutting area, but may be less powerful. The length and flexibility of the saw blade can affect the accuracy of bone cutting. To summarize, the design and choice of saw blade has a direct impact on the cutting properties, which affects the success of the surgical procedure. These described features are also important for your cutting technique to be feasible.
1. Cutting pressure: To improve cutting efficiency, it is important to apply the saw to the bone with an appropriate pressure. A surgeon’s constant adjustment of pressure and direction can provide more effective cutting.
2. Tactile sensitivity: In blind cuts, the surgeon’s tactile sensitivity is important. In cuts made with a saw blade, the fact that the saw blade vibrates or does not move fully in the bone can reduce cutting efficiency. Therefore, it is important for the surgeon to feel the vibrations in the handpiece and that the saw blade is against the bone.
3. Bone feeling: The ability of the saw blade to feel the bone is important for cutting efficiency. Feeling the bone prevents the blade from working outside the bone and reduces the risk of damaging soft tissue. This feeling plays an important role in surgical procedures based on feeling the bone.
4. Whittle’s principle: The Whittle principle refers to the orientation of the saw to a narrow surface for more effective cutting. Approaching the saw blade at a narrow angle allows energy to be focused on a smaller cutting area. This principle allows the saw blade to swing into a narrow space and increase cutting efficiency.
5. Change of direction: As the bone hardens or the cut deepens, cutting efficiency can be increased by changing direction. This change of direction allows the saw blade to oscillate to a smaller surface and increases cutting efficiency. The change of direction should be carried out with care for the whitening effect.
These characteristics are factors to consider to improve cutting efficiency and provide more effective cuts in surgical procedures.
When the saw blade comes into contact with the bone, it can sometimes lose its position when activated and may need to be positioned again. The surgeon follows the resistance as he approaches the bone and tries to change the direction or position of the blade to create a smaller or softer bone front. When the cut is initiated, the surgeon must try to create his or her own cleft apparatus to complete the incision along the bone surface. This involves completing the incision in a close direction, but it may be pulled into a more superficial area when cutting a new section of bone before it is entered deeply.
Picture 1. Mihalko W.;Krackow K., Mont M.,(1990), The Technique of Total Knee Arthroplasty,Elsevier/ As the saw is approaching the bone a cutting front is created along the entire extent of the bone. As the progress slows, the blade can be withdrawn and angled 10-45 degrees to allow a different smaller bone front against the sawblade to allow greater power directed against a smaller cutting surface. This can be done as needed and also allow the saw blade to be angled away from vital soft tissue structures. Care should be taken to make sure the throw of the blade is not outside the edge of the bone.
Difficulties may be experienced during initiation of cuts, especially with harder bones, due to the shear angle. After most of the bone has been removed, the surgeon can use a gentle hand to create an anterior cut in the softer bone surface. It can then push the cutting attachment towards the leading edge to make a straight, unraised cut. Usually a thicker and wider saw blade tends to bend less in this case.
It is important to pay attention to the limited areas of bone during cutting. The front part of the cut is usually not the full length of the cutting surface and is limited by limited depth variation. The incision guide should be used along the full length of the saw blade or to the point where the cut is complete. When the incision guides are removed, special care should be taken to complete the cuttings. The surgeon should use the previously cut surface as an incision guide to complete the cut in a deeper direction. When performing free hand work, one should approach from the far side of the proud direction for safety and create an edge to work with. These instructions should be followed by the surgeon to ensure that the cuts are controlled and the desired results are achieved.
Picture 2. Mihalko W.;Krackow K., Mont M.,(1990), The Technique of Total Knee Arthroplasty,Elsevier/ Creation of a self made cutting slot can “entrap” the saw blade while maximizing the contact of the saw blade against the cutting jig. The direction of the sawblade can be modified as needed to achieve the cut.
Picture 3. Mihalko W.;Krackow K., Mont M.,(1990), The Technique of Total Knee Arthroplasty,Elsevier/ Adjusting a previously made bone cut by approaching from the higher side can assist in modifying the cut. If using the previously cut deeper side, care should be taken to avoid blade lift off or arcing the sawblade to avoid over or under resection of the previous cut surface.
In the target of a successful arthroplasty operation; The surgical saw blade reveals its importance in the following area. The first step is to use a quality raw material as mentioned in the literature. Quality raw materials, combined with the researches made by the companies during the saw blade design phase and the field feedbacks collected, and the revisions applied afterwards, enable physicians to make accurate and smooth incisions with a design that suits their needs.
The information that physicians need when choosing a saw blade is; In addition to the suitable raw material of the saw, its compatibility with the implant system in terms of tooth structure and thickness.
Appropriate raw material can be understood by the quality and raw material certificates of saw blade manufacturers. Thickness information is available in the surgical techniques of implant manufacturers.
Our recommendation to our valuable saw blade users, namely our physicians; about the saw and power tool they use; information before surgery. The selection of instruments, which are of such high importance, should not be left to anyone other than the physician.
Cutting technique should be studied in depth after selection of suitable equipment.
Mihalko W.;Krackow K., Mont M.,(1990), The Technique of Total Knee Arthroplasty,Elsevier
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