A review of bone cutting in surgery

Bone cutting is a basic and vital clinical operation in surgery. Traditional mechanical processing methods such as drilling, grinding, and milling, are widely applied in bone surgery. Bone is a hard biological tissue with a complex structure. The compact bone structure is similar to a brittle fiber-reinforced composite. It is easy to damage bone tissue and reduce bone activity during cutting. The quality and efficiency of bone cutting are related to the therapeutic and rehabilitative outcomes of patients. A correct understanding of bone-cutting processes and mechanisms, optimizing the process parameters of bone cutting, and developing advanced bone-cutting surgical tools are important ways to reduce cutting-induced thermal-mechanical damage from bone cutting and improve the postoperative rehabilitation of patients. This article reviewed published works related to constitutive models of bone tissue, bone cutting processes, and the cutting mechanisms used in different bone-cutting surgeries, with a main focus on the effect of machining parameters and tool design. The latest techniques and challenges in ultrasonic bone cutting were also discussed. Finally, it is concluded that bone-cutting research should address the following aspects: (1) improving the constitutive model for numerically simulating bone cutting; (2) constructing a systemic bone-material-cutting theory that explains the cutting mechanism as it relates to the chip morphology of bone material; (3) further refining the development of cutting tools for bone materials; (4) recognizing the advantages of ultrasonic bone cutting, including high safety levels, less damage, and faster healing, which will guide the development trends of future clinical bone-cutting operations.