Executive Summary : | An increase in life expectancy rate in recent times is a significant achievement of medical science. However, it has also led to the rise in problems associated not only with old age but the younger generation is also affected. One of the significant problems is debilitating arthritis which can be in the form of osteoarthritis, osteonecrosis, and rheumatoid arthritis. In this condition, severe pain, swelling, and degradation in functioning and motion of the hip joint take place. The remedy to this problem is Total Hip Arthroplasty(THA), the majority of which uses bone cement during the implantation of the femoral prosthesis. The bone cement function as grout and provide a tight mechanical interlock between the prosthetic femoral stem and the irregular bone surface of the femur. However, after a few years, some of the primaries cemented total hip arthroplasties fail due to aseptic loosening, cement-bone interface failure, and infection being the significant reasons. This requires revision of THA involving removal or extraction of the diseased implant component as well as bone cement from the femoral medullary canal. The removal of bone cement especially used in the distal fixation of implant stem in the femoral canal remains a challenging task for surgeons. Presently chisels, hammers, and other mechanical tools are used for cement removal from the femoral canal, which may cause intra-operative femoral fractures, cortical perforation, increased blood loss during surgery, and bone loss. Extended trochanteric osteotomy provides direct visual access to the femoral medullary canal for removal of femoral implant and bone cement, but it is associated with complications like non-union and the requirement of additional hardware for stabilization. The last few decades show increased numbers of revision THA for which several instruments and procedures have been mentioned in the literature, especially for bone cement removal. Few newer techniques such as an ultrasonically driven tool, shock wave, extracorporeal lithotripsy, and lasers are in the experimental stage. These techniques are facing shortcomings such as the risk of the splitting of neighboring bone, thermal necrosis due to frictional heat, low depth of laser penetration, and long surgical duration. Therefore, a new minimally invasive method for the extraction of bone cement from the femoral intramedullary canal without damaging neighboring bones and tissues is needed. In this project, a critical investigation is proposed to use Pulsating Liquid jet (PLJ) technology as the non-thermal selective cutting and drilling with low tool diameter acting over small areas, which enables its use for minimally invasive treatment, thus reducing the duration of surgery and decreasing intraoperative blood loss with fewer complications. The outcome of the project may lead to the possibility of the development of a hand-held working prototype of PLJ based tool for the disintegrating bone cement during revision THA. |