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León-Muñoz VJ, Moya-Angeler J, López-López M, Lisón-Almagro AJ, Martínez-Martínez F, Santonja-Medina F. Integration of Square Fiducial Markers in Patient-Specific Instrumentation and Their Applicability in Knee Surgery. J Pers Med 2023; 13:jpm13050727. [PMID: 37240897 DOI: 10.3390/jpm13050727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/23/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Computer technologies play a crucial role in orthopaedic surgery and are essential in personalising different treatments. Recent advances allow the usage of augmented reality (AR) for many orthopaedic procedures, which include different types of knee surgery. AR assigns the interaction between virtual environments and the physical world, allowing both to intermingle (AR superimposes information on real objects in real-time) through an optical device and allows personalising different processes for each patient. This article aims to describe the integration of fiducial markers in planning knee surgeries and to perform a narrative description of the latest publications on AR applications in knee surgery. Augmented reality-assisted knee surgery is an emerging set of techniques that can increase accuracy, efficiency, and safety and decrease the radiation exposure (in some surgical procedures, such as osteotomies) of other conventional methods. Initial clinical experience with AR projection based on ArUco-type artificial marker sensors has shown promising results and received positive operator feedback. Once initial clinical safety and efficacy have been demonstrated, the continued experience should be studied to validate this technology and generate further innovation in this rapidly evolving field.
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Affiliation(s)
- Vicente J León-Muñoz
- Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Reina Sofía, 30003 Murcia, Spain
- Instituto de Cirugía Avanzada de la Rodilla (ICAR), 30005 Murcia, Spain
| | - Joaquín Moya-Angeler
- Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Reina Sofía, 30003 Murcia, Spain
- Instituto de Cirugía Avanzada de la Rodilla (ICAR), 30005 Murcia, Spain
| | - Mirian López-López
- Subdirección General de Tecnologías de la Información, Servicio Murciano de Salud, 30100 Murcia, Spain
| | - Alonso J Lisón-Almagro
- Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Reina Sofía, 30003 Murcia, Spain
| | - Francisco Martínez-Martínez
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Fernando Santonja-Medina
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
- Department of Surgery, Pediatrics and Obstetrics & Gynecology, Faculty of Medicine, University of Murcia, 30120 Murcia, Spain
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Fan X, Zhu Q, Tu P, Joskowicz L, Chen X. A review of advances in image-guided orthopedic surgery. Phys Med Biol 2023; 68. [PMID: 36595258 DOI: 10.1088/1361-6560/acaae9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
Orthopedic surgery remains technically demanding due to the complex anatomical structures and cumbersome surgical procedures. The introduction of image-guided orthopedic surgery (IGOS) has significantly decreased the surgical risk and improved the operation results. This review focuses on the application of recent advances in artificial intelligence (AI), deep learning (DL), augmented reality (AR) and robotics in image-guided spine surgery, joint arthroplasty, fracture reduction and bone tumor resection. For the pre-operative stage, key technologies of AI and DL based medical image segmentation, 3D visualization and surgical planning procedures are systematically reviewed. For the intra-operative stage, the development of novel image registration, surgical tool calibration and real-time navigation are reviewed. Furthermore, the combination of the surgical navigation system with AR and robotic technology is also discussed. Finally, the current issues and prospects of the IGOS system are discussed, with the goal of establishing a reference and providing guidance for surgeons, engineers, and researchers involved in the research and development of this area.
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Affiliation(s)
- Xingqi Fan
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Qiyang Zhu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Puxun Tu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Guo N, Tian J, Wang L, Sun K, Mi L, Ming H, Zhe Z, Sun F. Discussion on the possibility of multi-layer intelligent technologies to achieve the best recover of musculoskeletal injuries: Smart materials, variable structures, and intelligent therapeutic planning. Front Bioeng Biotechnol 2022; 10:1016598. [PMID: 36246357 PMCID: PMC9561816 DOI: 10.3389/fbioe.2022.1016598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Although intelligent technologies has facilitated the development of precise orthopaedic, simple internal fixation, ligament reconstruction or arthroplasty can only relieve pain of patients in short-term. To achieve the best recover of musculoskeletal injuries, three bottlenecks must be broken through, which includes scientific path planning, bioactive implants and personalized surgical channels building. As scientific surgical path can be planned and built by through AI technology, 4D printing technology can make more bioactive implants be manufactured, and variable structures can establish personalized channels precisely, it is possible to achieve satisfied and effective musculoskeletal injury recovery with the progress of multi-layer intelligent technologies (MLIT).
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Affiliation(s)
- Na Guo
- Department of Computer Science and Technology, Tsinghua University, Beijing, China
- Institute of Precision Medicine, Tsinghua University, Beijing, China
| | - Jiawen Tian
- Department of Computer Science and Technology, Tsinghua University, Beijing, China
- Institute of Precision Medicine, Tsinghua University, Beijing, China
| | - Litao Wang
- College of Engineering, China Agricultural University, Beijing, China
| | - Kai Sun
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Lixin Mi
- Musculoskeletal Department, Beijing Rehabilitation Hospital, Beijing, China
| | - Hao Ming
- Orthopaedics, Chinese PLA General Hospital, Beijing, China
| | - Zhao Zhe
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Fuchun Sun
- Department of Computer Science and Technology, Tsinghua University, Beijing, China
- Institute of Precision Medicine, Tsinghua University, Beijing, China
- *Correspondence: Fuchun Sun,
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Ding G, Yang G, Zhang J, Huang H, Du J, Ren S, Wang Q, Zhou Z, Zhang X, Ao Y. Feasibility and accuracy of orthopaedic surgical robot system for intraoperative navigation to locate bone tunnel in anterior cruciate ligament reconstruction. Int J Med Robot 2021; 18:e2354. [PMID: 34806824 DOI: 10.1002/rcs.2354] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The combination of navigational system and robotics has the potential to accurately identify and drill bone tunnels in anterior cruciate ligament (ACL) reconstruction. This study explores the feasibility and accuracy of bone tunnel positioning using the TiRobot, an orthopaedic surgical robot. METHODS The experiment was divided into two groups. In group A, the bone tunnels were positioned using the TiRobot surgical robot (n = 8). In group B, handheld locators were used for positioning (n = 8). RESULTS TiRobot can be used for positioning the ACL bone tunnel. The accuracy of positioning the femoral tunnel in group A and B was 1.00 ± 0.20 and 3.10 ± 0.59 mm, respectively (t = -9.49, P < 0.001). As for tibial tunnel, the accuracy was 1.02 ± 0.20 and 2.64 ± 0.14 mm, respectively (t = -18.54, P < 0.001). CONCLUSIONS The bone tunnel drilling precision using TiRobot for ACL reconstruction surgery was more accurate than traditional surgical techniques.
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Affiliation(s)
- Guocheng Ding
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Gang Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jiahao Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Hongjie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jianing Du
- Peking University Health Science Center, Beijing, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Qining Wang
- Department of Advanced Manufacturing and Robotics, Peking University, Beijing, China.,Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Zhihao Zhou
- Department of Advanced Manufacturing and Robotics, Peking University, Beijing, China.,Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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Hodel S, Mania S, Vlachopoulos L, Fürnstahl P, Fucentese SF. Influence of femoral tunnel exit on the 3D graft bending angle in anterior cruciate ligament reconstruction. J Exp Orthop 2021; 8:44. [PMID: 34173071 PMCID: PMC8233443 DOI: 10.1186/s40634-021-00364-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/11/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To quantify the influence of the femoral tunnel exit (FTE) on the graft bending angle (GBA) and GBA-excursion throughout a full range of motion (ROM) in single-bundle anterior cruciate ligament (ACL) reconstruction. Methods Three-dimensional (3D) surface models of five healthy knees were generated from a weight-bearing CT obtained throughout a full ROM (0, 30, 60, 90, 120°) and femoral and tibial ACL insertions were computed. The FTE was simulated for 16 predefined positions, referenced to the Blumensaat's line, for each patient throughout a full ROM (0, 30, 60, 90, 120°) resulting in a total of 400 simulations. 3D GBA was calculated between the 3D directional vector of the ACL and the femoral tunnel, while the intra-articular ACL insertions remained unchanged. For each simulation the 3D GBA, GBA-excursion, tunnel length and posterior tunnel blow-out were analysed. Results Overall, mean GBA decreased with increasing knee flexion for each FTE (p < 0.001). A more distal location of the FTE along the Blumensaat's line resulted in an increase of GBA and GBA-excursion of 8.5 ± 0.6° and 17.6 ± 1.1° /cm respectively (p < 0.001), while a more anterior location resulted in a change of GBA and GBA-excursion of -2.3 ± 0.6° /cm (+ 0.6 ± 0.4°/ cm from 0–60° flexion) and 9.8 ± 1.1 /cm respectively (p < 0.001). Mean tunnel length was 38.5 ± 5.2 mm (range 29.6–50.5). Posterior tunnel blow-out did not occur for any FTE. Conclusion Aiming for a more proximal and posterior FTE, with respect to Blumensaat’s line, reliably reduces GBA and GBA-excursion, while preserving adequate tunnel length. This might aid to reduce excessive graft stress at the femoral tunnel aperture, decrease femoral tunnel widening and promote graft-healing. Level of Evidence IV
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Affiliation(s)
- Sandro Hodel
- Department of Orthopedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Sylvano Mania
- Department of Orthopedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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Liu D, Li Y, Li T, Yu Y, Cai G, Yang G, Wang G. The use of a 3D-printed individualized navigation template to assist in the anatomical reconstruction surgery of the anterior cruciate ligament. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1656. [PMID: 33490168 PMCID: PMC7812217 DOI: 10.21037/atm-20-7515] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background To explore the location accuracy and early clinical outcomes of using a 3D-printed individualized navigation template to assist in the reconstruction of the anterior cruciate ligament (ACL). Methods A single center randomized control study was conducted. Patients with ACL injury were treated with a conventional operation or an operation assisted by a 3D-printed individualized navigation template (the 3D group). The primary endpoint was the accuracy of the actual reconstruction compared with the planned position. Results There were 20 and 23 participants in the conventional group and the 3D group, respectively. There were no differences in the bone tunnel position between the actual postoperative position and the preoperative design in the 3D group (P>0.05). Compared with the 3D group, the positioning of the femoral tunnel was more inferior and shallower in the conventional group (P<0.05). The position of the tibia tunnel was closer to the anterior and medial edge of the tibial platform in the conventional group compared to the 3D group (P<0.05). The intraoperative positioning time was shorter in the 3D group than in the conventional group (3.3±1.0 vs. 5.9±1.8 minutes, P<0.001). The Lysholm and International Knee Documentation Committee scores did not differ between the two groups (P>0.05 for both), and all patients improved after surgery (P<0.001). Conclusions The 3D-printed individualized navigation template showed good location accuracy and resulted in reduced intraoperative positioning time compared to the traditional method for ACL reconstruction.
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Affiliation(s)
- Dejian Liu
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanlin Li
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Li
- Department of Trauma Surgery, Affiliated Hospital of Yunnan University, Kunming, China
| | - Yang Yu
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guofeng Cai
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guiran Yang
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guoliang Wang
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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