1
|
Hess S, Husarek J, Müller M, Eberlein SC, Klenke FM, Hecker A. Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: A systematic review and meta-analysis. J Exp Orthop 2024; 11:e12096. [PMID: 39135870 PMCID: PMC11317891 DOI: 10.1002/jeo2.12096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 08/15/2024] Open
Abstract
Background Patient-Specific Surgical Guides (PSSGs) are advocated for reducing radiation exposure, operation time and enhancing precision in surgery. However, existing accuracy assessments are limited to specific surgeries, leaving uncertainties about variations in accuracy across different anatomical sites, three-dimensional (3D) printing technologies and manufacturers (traditional vs. printed at the point of care). This study aimed to evaluate PSSGs accuracy in traumatology and orthopaedic surgery, considering anatomical regions, printing methods and manufacturers. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were eligible if they (1) assessed the accuracy of PSSGs by comparing preoperative planning and postoperative results in at least two different planes (2) used either computer tomography or magnetic resonance imaging (3) covered the field of orthopaedic surgery or traumatology and (4) were available in English or German language. The 'Quality Assessment Tool for Quantitative Studies' was used for methodological quality assessment. Descriptive statistics, including mean, standard deviation, and ranges, are presented. A random effects meta-analysis was performed to determine the pooled mean absolute deviation between preoperative plan and postoperative result for each anatomic region (shoulder, hip, spine, and knee). Results Of 4212 initially eligible studies, 33 were included in the final analysis (8 for shoulder, 5 for hip, 5 for spine, 14 for knee and 1 for trauma). Pooled mean deviation (95% confidence interval) for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), total hip arthroplasty (THA) and spine surgery (pedicle screw placement during spondylodesis) were 1.82° (1.48, 2.15), 2.52° (1.9, 3.13), 3.49° (3.04, 3.93) and 2.67° (1.64, 3.69), respectively. Accuracy varied between TKA and THA and between TKA and TSA. Conclusion Accuracy of PSSGs depends on the type of surgery but averages around 2-3° deviation from the plan. The use of PSSGs might be considered for selected complex cases. Level of Evidence Level 3 (meta-analysis including Level 3 studies).
Collapse
Affiliation(s)
- Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Julius Husarek
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
- Faculty of MedicineUniversity of BernBernSwitzerland
- Faculty of MedicineMedical University of SofiaSofiaBulgaria
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Sophie C. Eberlein
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Frank M. Klenke
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Andreas Hecker
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| |
Collapse
|
2
|
Aguado-Maestro I, Simón-Pérez C, García-Alonso M, Ailagas-De Las Heras JJ, Paredes-Herrero E. Clinical Applications of "In-Hospital" 3D Printing in Hip Surgery: A Systematic Narrative Review. J Clin Med 2024; 13:599. [PMID: 38276105 PMCID: PMC10816368 DOI: 10.3390/jcm13020599] [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: 11/26/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Introduction: Interest in 3D printing for orthopedic surgery has been increasing since its progressive adoption in most of the hospitals around the world. The aim of the study is to describe all the current applications of 3D printing in patients undergoing hip surgery of any type at the present time. Materials and Methods: We conducted a systematic narrative review of publications indexed in MedLine through the search engine PubMed, with the following parameters: 3D printing AND (orthopedics OR traumatology) NOT tissue engineering NOT scaffold NOT in vitro and deadline 31 July 2023. After reading the abstracts of the articles, papers were selected according to the following criteria: full text in English or Spanish and content related to hip surgery. Those publications involving experimental studies (in vitro or with anatomical specimens) or 3D printing outside of hospital facilities as well as 3D-printed commercial implants were excluded. Results are presented as a reference guide classified by disease, including the used software and the steps required for the development of the idea. Results: We found a total of 27 indications for in-house 3D printing for hip surgery, which are described in the article. Conclusions: There are many surgical applications of 3D printing in hip surgery, most of them based on CT images. Most of the publications lack evidence, and further randomized studies should be encouraged to assess the advantages of these indications.
Collapse
Affiliation(s)
- Ignacio Aguado-Maestro
- Department of Traumatology and Orthopedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain
- Institute of Orthopedic Surgery and Traumatology (ICOTVA), Hospital Sagrado Corazón, 47002 Valladolid, Spain
| | - Clarisa Simón-Pérez
- Department of Traumatology and Orthopedic Surgery, Clínico University Hospital, 47003 Valladolid, Spain
| | - Manuel García-Alonso
- Institute of Orthopedic Surgery and Traumatology (ICOTVA), Hospital Sagrado Corazón, 47002 Valladolid, Spain
| | | | - Elena Paredes-Herrero
- Department of Traumatology and Orthopedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain
| |
Collapse
|
3
|
Ballard DH, Mills P, Duszak R, Weisman JA, Rybicki FJ, Woodard PK. Medical 3D Printing Cost-Savings in Orthopedic and Maxillofacial Surgery: Cost Analysis of Operating Room Time Saved with 3D Printed Anatomic Models and Surgical Guides. Acad Radiol 2020; 27:1103-1113. [PMID: 31542197 DOI: 10.1016/j.acra.2019.08.011] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVE Three-dimensional (3D) printed anatomic models and surgical guides have been shown to reduce operative time. The purpose of this study was to generate an economic analysis of the cost-saving potential of 3D printed anatomic models and surgical guides in orthopedic and maxillofacial surgical applications. MATERIALS AND METHODS A targeted literature search identified operating room cost-per-minute and studies that quantified time saved using 3D printed constructs. Studies that reported operative time differences due to 3D printed anatomic models or surgical guides were reviewed and cataloged. A mean of $62 per operating room minute (range of $22-$133 per minute) was used as the reference standard for operating room time cost. Different financial scenarios were modeled with the provided cost-per-minute of operating room time (using high, mean, and low values) and mean time saved using 3D printed constructs. RESULTS Seven studies using 3D printed anatomic models in surgical care demonstrated a mean 62 minutes ($3720/case saved from reduced time) of time saved, and 25 studies of 3D printed surgical guides demonstrated a mean 23 minutes time saved ($1488/case saved from reduced time). An estimated 63 models or guides per year (or 1.2/week) were predicted to be the minimum number to breakeven and account for annual fixed costs. CONCLUSION Based on the literature-based financial analyses, medical 3D printing appears to reduce operating room costs secondary to shortening procedure times. While resource-intensive, 3D printed constructs used in patients' operative care provides considerable downstream value to health systems.
Collapse
Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110.
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffery A Weisman
- University of Illinois at Chicago Occupational Medicine, Chicago, Illinois
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| |
Collapse
|
4
|
3D preoperative planning for humeral head selection in total shoulder arthroplasty. Musculoskelet Surg 2019; 104:155-161. [PMID: 30949924 DOI: 10.1007/s12306-019-00602-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Recreation of glenohumeral biomechanics and humeral anatomy has been shown to improve outcomes in shoulder arthroplasty. Recent research has focused on utilizing simulation software and intraoperative instrumentation to improve glenoid implant selection and positioning, but no study had evaluated the reliability of new features in 3D preoperative planning software for humeral planning in total shoulder arthroplasty. MATERIALS AND METHODS Preoperative plans were created for 26 patients using three different simulation software programs: an independent preoperative planning simulation (IPPS) software (OrthoVis) and two automated manufacturers preoperative simulation systems: ArthrexVIP™ (AMPS I) and Tornier Blueprint™ 3D Planning (AMPS II). Preoperative plans were compared for reliability and consistency among different software systems based on available variables including humeral head diameter (HD) and head height (HH). RESULTS The measured HD was consistent between the three systems with a maximum mean difference of 0.2 mm for HD among IPPS, AMPS I, and AMPS II (p = 0.964). There was a significant difference in measured humeral HH with 1.7 mm difference between IPPS and AMPS II (p ≤ 0.001). The strongest correlation when comparing humeral head measurements (diameter or height) obtained from all systems was seen between IPPS and AMPS I for humeral HD (r = 0.8; p ≤ 0.001). CONCLUSION There was a high level of consistency between independent and manufacturer preoperative planning software for humeral head measurements. These preoperative planning systems can improve efficiency and workflow during surgery by guiding surgeons on implant size selection to optimally reconstruct the glenohumeral kinematics, in order to improve patient outcomes. LEVEL OF EVIDENCE Level III, study of nonconsecutive patients and without a universally applied "gold" standard study of diagnostic test.
Collapse
|
5
|
|
6
|
Aqil A, Patel S, Wiik A, Jones G, Bridle A, Cobb JP. Patient-specific guides improve hip arthroplasty surgical accuracy. Comput Methods Biomech Biomed Engin 2018; 21:579-584. [PMID: 30366507 DOI: 10.1080/10255842.2018.1496241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The role of patient-specific (PS) technology in total hip arthroplasty remains relatively unexplored. We asked whether PS guides: (1) Reduced average surgical errors? (2) Reduced outlier error frequencies? (3) Could predict the size of implants used? A single surgeon implanted femurs using either standard or PS guides and was blinded to the pre-operative plans. There were significant differences in median leg length errors between standard (3.3 mm) and PS groups (1.4 mm), U = 110, z = -2.3, p = 0.02. In contrast to the PS group, the standard group had significantly more outlier errors and frequently undersized implants. PS guides improve hip arthroplasty surgical accuracy.Abbreviations: PS: patient specific; THA: total hip arthroplasty; LLD: leg length discrepancies; HRA: hip resurfacing arthroplasty.
Collapse
Affiliation(s)
- Adeel Aqil
- a MSK Lab, Charing Cross Hospital, Imperial College London , London , U.K
| | - Sanya Patel
- a MSK Lab, Charing Cross Hospital, Imperial College London , London , U.K
| | - Anatole Wiik
- a MSK Lab, Charing Cross Hospital, Imperial College London , London , U.K
| | - Gareth Jones
- a MSK Lab, Charing Cross Hospital, Imperial College London , London , U.K
| | - Alex Bridle
- a MSK Lab, Charing Cross Hospital, Imperial College London , London , U.K
| | - Justin P Cobb
- a MSK Lab, Charing Cross Hospital, Imperial College London , London , U.K
| |
Collapse
|
7
|
Patient-Specific Surgical Guide for Total Hip Arthroplasty. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018. [PMID: 30306490 DOI: 10.1007/978-981-13-1396-7_23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Three-dimensional printing technique has been adapted for orthopedic surgery, and a patient-specific surgical guide (PSG) has been introduced as a convenient surgical instrument and implicated in the ideal positioning of the components, including acetabular and femoral components in total hip arthroplasty (THA). PSG is designed and manufactured based on preoperative imaging data, mainly computed tomography (CT) data. PSGs for implantation in THA are classified into three types: PSG for guidewire insertion, PSG for bone cutting, and PSG for bone reaming and implant fixation. PSG positioning accuracy depends on the PSG design and surgical preparation in contact area on the bone surface. PSGs for the acetabular component, for the conventional femoral component, and for the resurfacing femoral component have been clinically used. To achieve precise implantation, precise PSG setting needs and careful surgical preparation of soft tissues are important.
Collapse
|
8
|
Abstract
The field of pediatric and adult congenital cardiac catheterization has evolved rapidly in recent years. This review will focus on some of the newer endovascular technological and management strategies now being applied in the pediatric interventional laboratory. Emerging imaging techniques such as three-dimensional (3D) rotational angiography, multi-modal image fusion, 3D printing, and holographic imaging have the potential to enhance our understanding of complex congenital heart lesions for diagnostic or interventional purposes. While fluoroscopy and standard angiography remain procedural cornerstones, improved equipment design has allowed for effective radiation exposure reduction strategies. Innovations in device design and implantation techniques have enabled the application of percutaneous therapies in a wider range of patients, especially those with prohibitive surgical risk. For example, there is growing experience in transcatheter duct occlusion in symptomatic low-weight or premature infants and stent implantation into the right ventricular outflow tract or arterial duct in cyanotic neonates with duct-dependent pulmonary circulations. The application of percutaneous pulmonary valve implantation has been extended to a broader patient population with dysfunctional ‘native’ right ventricular outflow tracts and has spurred the development of novel techniques and devices to solve associated anatomic challenges. Finally, hybrid strategies, combining cardiosurgical and interventional approaches, have enhanced our capabilities to provide care for those with the most complex of lesions while optimizing efficacy and safety.
Collapse
Affiliation(s)
- Sok-Leng Kang
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada.,Department of Pediatric Cardiology, Bristol Royal Hospital for Children, Bristol, BS2 OJJ, UK
| | - Lee Benson
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada
| |
Collapse
|
9
|
Abstract
Background Traditional ACL reconstruction with non-anatomic techniques can demonstrate unsatisfactory long-term outcomes with regards instability and the degenerative knee changes observed with these results. Anatomic ACL reconstruction attempts to closely reproduce the patient's individual anatomic characteristics with the aim of restoring knee kinematics, in order to improve patient short and long-term outcomes. We designed an arthroscopic, patient-specific, ACL femoral tunnel guide to aid anatomical placement of the ACL graft within the femoral tunnel. Methods The guide design was based on MRI scan of the subject's uninjured contralateral knee, identifying the femoral footprint and its anatomical position relative to the borders of the femoral articular cartilage. Image processing software was used to create a 3D computer aided design which was subsequently exported to a 3D-printing service. Results Transparent acrylic based photopolymer, PA220 plastic and 316L stainless steel patient-specific ACL femoral tunnel guides were created; the models produced were accurate with no statistical difference in size and positioning of the center of the ACL femoral footprint guide to MRI (p=0.344, p=0.189, p=0.233 respectively). The guides aim to provide accurate marking of the starting point of the femoral tunnel in arthroscopic ACL reconstruction. Conclusion This study serves as a proof of concept for the accurate creation of 3D-printed patient-specific guides for the anatomical placement of the femoral tunnel during ACL reconstruction.
Collapse
Affiliation(s)
- Iain Rankin
- Aberdeen Royal Infirmary - Trauma and Orthopaedic Surgery, Foresterhill Aberdeen AB25 2ZN, United Kingdom of Great Britain and Northern Ireland
| | - Haroon Rehman
- Aberdeen Royal Infirmary - Trauma and Orthopaedic Surgery, Foresterhill Aberdeen AB25 2ZN, United Kingdom of Great Britain and Northern Ireland
| | - Mark Frame
- University Hospital Southampton NHS Foundation Trust Ringgold standard institution - Trauma and Orthopaedic Surgery Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
10
|
Krämer M, Kahrs LA, Friese KI, von Falck C, Hurschler C. Inter- and intra-operator reliability in patient-specific template positioning for total hip arthroplasty. A cadaver study. Int J Med Robot 2018; 14. [PMID: 29336121 DOI: 10.1002/rcs.1887] [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: 01/25/2017] [Revised: 10/05/2017] [Accepted: 11/19/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The implantation of the acetabular cup essentially determines the clinical outcome of total hip arthroplasty. To address this issue, the aim of this study was to build patient-specific instruments (PSIs) with various reference surfaces, followed by in vitro investigations to examine the inter- and intra-operator reliability as well as the overall precision of these patient-specific templates. METHODS Seven human hemi-pelvis specimens were used for this study. After a CT scan, PSIs with different imprint heights were created. The overall precision of the templates and the inter- and intra-operator reliabilities were calculated. RESULTS Strong differences in precision between the PSI designs could be observed. The desired orientation of the acetabular cup could be adjusted with a precision of up to 1.55°. CONCLUSION Based on our results, we believe that the application of the PSI-based acetabular cup positioning in total hip arthroplasty procedures can potentially increase the precision of cup placement.
Collapse
Affiliation(s)
- Manuel Krämer
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Lüder A Kahrs
- Institute of Mechatronic Systems, Leibniz Universität Hannover, Hannover, Germany
| | | | - Christian von Falck
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| |
Collapse
|
11
|
Sakai T, Hamada H, Takao M, Murase T, Yoshikawa H, Sugano N. Validation of patient-specific surgical guides for femoral neck cutting in total hip arthroplasty through the anterolateral approach. Int J Med Robot 2017; 13. [PMID: 28480999 DOI: 10.1002/rcs.1830] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to validate the effectiveness of neck-cut patient-specific surgical guides (PSGs) for femoral component implantation in total hip arthroplasty (THA) through the anterolateral approach compared with that without PSG. METHODS A total of 32 fresh cadaveric hips were included. Anatomical stem implantation with wide-base-contact PSG (AWP group) and without PSG (control group) were compared. The absolute errors between preoperative planning and PSG setting (E1), as well as those between preoperative planning and postoperative component implantation (E2) were evaluated using CT. RESULTS The E1/E2 values of AWP were 0.9±0.3°/0.6±0.6° in the coronal plane, and 1.7±0.8°/1.0±0.9° in the sagittal plane, and 1.0±0.6 mm/1.0±1.1 mm for the medial height. The E2 value in the sagittal plane (P=0.037) and the medial height (P=0.011) of AWP were significantly smaller than those of control group. CONCLUSIONS The neck-cut PSG through the anterolateral approach is effective for femoral component implantation.
Collapse
Affiliation(s)
- Takashi Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Japan
| |
Collapse
|
12
|
Chang JD, Kim IS, Bhardwaj AM, Badami RN. The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications. Hip Pelvis 2017; 29:1-14. [PMID: 28316957 PMCID: PMC5352720 DOI: 10.5371/hp.2017.29.1.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/31/2017] [Accepted: 02/09/2017] [Indexed: 12/27/2022] Open
Abstract
In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly.
Collapse
Affiliation(s)
- Jun-Dong Chang
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - In-Sung Kim
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Atul M Bhardwaj
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Ramachandra N Badami
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| |
Collapse
|
13
|
Meier LM, Meineri M, Qua Hiansen J, Horlick EM. Structural and congenital heart disease interventions: the role of three-dimensional printing. Neth Heart J 2017; 25:65-75. [PMID: 28083857 PMCID: PMC5260628 DOI: 10.1007/s12471-016-0942-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Advances in catheter-based interventions in structural and congenital heart disease have mandated an increased demand for three-dimensional (3D) visualisation of complex cardiac anatomy. Despite progress in 3D imaging modalities, the pre- and periprocedural visualisation of spatial anatomy is relegated to two-dimensional flat screen representations. 3D printing is an evolving technology based on the concept of additive manufacturing, where computerised digital surface renders are converted into physical models. Printed models replicate complex structures in tangible forms that cardiovascular physicians and surgeons can use for education, preprocedural planning and device testing. In this review we discuss the different steps of the 3D printing process, which include image acquisition, segmentation, printing methods and materials. We also examine the expanded applications of 3D printing in the catheter-based treatment of adult patients with structural and congenital heart disease while highlighting the current limitations of this technology in terms of segmentation, model accuracy and dynamic capabilities. Furthermore, we provide information on the resources needed to establish a hospital-based 3D printing laboratory.
Collapse
Affiliation(s)
- L M Meier
- Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - M Meineri
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - J Qua Hiansen
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - E M Horlick
- Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
14
|
Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online 2016; 15:115. [PMID: 27769304 PMCID: PMC5073919 DOI: 10.1186/s12938-016-0236-4] [Citation(s) in RCA: 535] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/09/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. METHODS Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. RESULTS 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. CONCLUSION 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis.
Collapse
Affiliation(s)
- Philip Tack
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Jan Victor
- Ghent University Hospital, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Paul Gemmel
- Departement of Economics & Business Administration, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| |
Collapse
|
15
|
Martelli N, Serrano C, van den Brink H, Pineau J, Prognon P, Borget I, El Batti S. Advantages and disadvantages of 3-dimensional printing in surgery: A systematic review. Surgery 2016; 159:1485-1500. [PMID: 26832986 DOI: 10.1016/j.surg.2015.12.017] [Citation(s) in RCA: 345] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/02/2015] [Accepted: 12/11/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Three-dimensional (3D) printing is becoming increasingly important in medicine and especially in surgery. The aim of the present work was to identify the advantages and disadvantages of 3D printing applied in surgery. METHODS We conducted a systematic review of articles on 3D printing applications in surgery published between 2005 and 2015 and identified using a PubMed and EMBASE search. Studies dealing with bioprinting, dentistry, and limb prosthesis or those not conducted in a hospital setting were excluded. RESULTS A total of 158 studies met the inclusion criteria. Three-dimensional printing was used to produce anatomic models (n = 113, 71.5%), surgical guides and templates (n = 40, 25.3%), implants (n = 15, 9.5%) and molds (n = 10, 6.3%), and primarily in maxillofacial (n = 79, 50.0%) and orthopedic (n = 39, 24.7%) operations. The main advantages reported were the possibilities for preoperative planning (n = 77, 48.7%), the accuracy of the process used (n = 53, 33.5%), and the time saved in the operating room (n = 52, 32.9%); 34 studies (21.5%) stressed that the accuracy was not satisfactory. The time needed to prepare the object (n = 31, 19.6%) and the additional costs (n = 30, 19.0%) were also seen as important limitations for routine use of 3D printing. CONCLUSION The additional cost and the time needed to produce devices by current 3D technology still limit its widespread use in hospitals. The development of guidelines to improve the reporting of experience with 3D printing in surgery is highly desirable.
Collapse
Affiliation(s)
- Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France; University Paris-Sud, GRADES, Faculty of Pharmacy, Châtenay-Malabry, France.
| | - Carole Serrano
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | | | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Isabelle Borget
- University Paris-Sud, GRADES, Faculty of Pharmacy, Châtenay-Malabry, France; Department of Health Economics, Gustave Roussy Institute, Villejuif, France
| | - Salma El Batti
- Department of Cardiac and Vascular Surgery, Georges Pompidou European Hospital, Paris, France; URDIA - Unité de Recherche en Développement, Imagerie et Anatomie - EA 4465, Université Paris Descartes, Paris, France
| |
Collapse
|
16
|
Baauw M, van Hellemondt GG, van Hooff ML, Spruit M. The accuracy of positioning of a custom-made implant within a large acetabular defect at revision arthroplasty of the hip. Bone Joint J 2015; 97-B:780-5. [DOI: 10.1302/0301-620x.97b6.35129] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated the accuracy with which a custom-made acetabular component could be positioned at revision arthroplasty of the hip in patients with a Paprosky type 3 acetabular defect. A total of 16 patients with a Paprosky type 3 defect underwent revision surgery using a custom-made trabecular titanium implant. There were four men and 12 women with a median age of 67 years (48 to 79). The planned inclination (INCL), anteversion (AV), rotation and centre of rotation (COR) of the implant were compared with the post-operative position using CT scans. A total of seven implants were malpositioned in one or more parameters: one with respect to INCL, three with respect to AV, four with respect to rotation and five with respect to the COR. To the best of our knowledge, this is the first study in which CT data acquired for the pre-operative planning of a custom-made revision acetabular implant have been compared with CT data on the post-operative position. The results are encouraging. Cite this article: Bone Joint J 2015; 97-B:780–5.
Collapse
Affiliation(s)
- M. Baauw
- Sint Maartenskliniek, P.
O. Box 9011, 6500 GM Nijmegen, The
Netherlands
| | | | - M. L. van Hooff
- Sint Maartenskliniek, P.
O. Box 9011, 6500 GM Nijmegen, The
Netherlands
| | - M. Spruit
- Sint Maartenskliniek, P.
O. Box 9011, 6500 GM Nijmegen, The
Netherlands
| |
Collapse
|
17
|
Biglino G, Capelli C, Wray J, Schievano S, Leaver LK, Khambadkone S, Giardini A, Derrick G, Jones A, Taylor AM. 3D-manufactured patient-specific models of congenital heart defects for communication in clinical practice: feasibility and acceptability. BMJ Open 2015; 5:e007165. [PMID: 25933810 PMCID: PMC4420970 DOI: 10.1136/bmjopen-2014-007165] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To assess the communication potential of three-dimensional (3D) patient-specific models of congenital heart defects and their acceptability in clinical practice for cardiology consultations. DESIGN This was a questionnaire-based study in which participants were randomised into two groups: the 'model group' received a 3D model of the cardiac lesion(s) being discussed during their appointment, while the 'control group' had a routine visit. SETTING Outpatient clinic, cardiology follow-up visits. PARTICIPANTS 103 parents of children with congenital heart disease were recruited (parental age: 43±8 years; patient age: 12±6 years). In order to have a 3D model made, patients needed to have a recent cardiac MRI examination; this was the crucial inclusion criterion. INTERVENTIONS Questionnaires were administered to the participants before and after the visits and an additional questionnaire was administered to the attending cardiologist. MAIN OUTCOME MEASURES Rating (1-10) for the liking of the 3D model, its usefulness and the clarity of the explanation received were recorded, as well as rating (1-10) of the parental understanding and their engagement according to the cardiologist. Furthermore, parental knowledge was assessed by asking them to mark diagrams, tick keywords and provide free text answers. The duration of consultations was recorded and parent feedback collected. RESULTS Parents and cardiologists both found the models to be very useful and helpful in engaging the parents in discussing congenital heart defects. Parental knowledge was not associated with their level of education (p=0.2) and did not improve following their visit. Consultations involving 3D models lasted on average 5 min longer (p=0.02). CONCLUSIONS Patient-specific models can enhance engagement with parents and improve communication between cardiologists and parents, potentially impacting on parent and patient psychological adjustment following treatment. However, in the short-term, parental understanding of their child's condition did not improve.
Collapse
Affiliation(s)
- Giovanni Biglino
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| | - Claudio Capelli
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| | - Jo Wray
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| | - Lindsay-Kay Leaver
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Sachin Khambadkone
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Alessandro Giardini
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Graham Derrick
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Alexander Jones
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| |
Collapse
|
18
|
Stegman J, Casstevens C, Kelley T, Nistor V. Patient-Specific Guides for Total Hip Arthroplasty: A Paired Acetabular and Femoral Implantation Approach. J Med Device 2015. [DOI: 10.1115/1.4028945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
While total hip arthroplasty (THA) is a common orthopedic procedure for treatment of hip arthritis, current techniques demonstrate poor implant alignment accuracy and precision, which is critical to the replacement's long-term survivorship. Patient-specific instruments to guide bone preparation and implantation could improve accuracy, thereby improving replacement survivorship. A single cadaver was CT (computer tomography) scanned to extract the 3D bone geometry, from which the operating surgeon planned a THA. Patient-specific guides were designed, 3D printed, and used in the cadaveric THA procedure. Postprocedural CT data were used to compare measured implant positioning versus the preprocedural template. Implanted component accuracy ranged from 1 deg–12 deg.
Collapse
Affiliation(s)
- Jacob Stegman
- Department of Biomedical, Chemical, and Environmental Engineering, College of Engineering and Applied Science, University of Cincinnati, Engineering Research Center—601, Cincinnati, OH 45221-0012 e-mail:
| | - Chris Casstevens
- Department of Orthopaedic Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0212, Cincinnati, OH 45267-0212 e-mail:
| | - Todd Kelley
- Department of Orthopaedic Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0212, Cincinnati, OH 45267-0212 e-mail:
| | - Vasile Nistor
- Mem. ASME Department of Biomedical, Chemical, and Environmental Engineering, College of Engineering and Applied Science, University of Cincinnati, Engineering Research Center—601, Cincinnati, OH 45221-0012 e-mail:
| |
Collapse
|
19
|
Sakai T, Hanada T, Murase T, Kitada M, Hamada H, Yoshikawa H, Sugano N. Validation of patient specific surgical guides in total hip arthroplasty. Int J Med Robot 2014; 10:113-20. [PMID: 24749171 DOI: 10.1002/rcs.1547] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The validation of patient-specific surgical guides (PSGs) by their design and the comparison of planned and actual PSG setting in total hip arthroplasty (THA) have not previously been reported. METHODS The errors between preoperative planning and computed tomography (CT)-based PSG setting (E1), and between preoperative planning and implantation (E2) were evaluated using CT in 16 fresh cadaveric hips. RESULTS E2 was significantly smaller with the wide-base-contact resurfacing-THA PSG than with the narrow-base-contact type (P<0.05). E1/E2 of the wide-base-contact neck-cut PSG was 1.6±0.7°/2.4±1.1° for the coronal plane and 1.2±0.8 mm/0.7±0.5mm for the medial neck-cut height. E1/E2 of the wide-base-contact cup-impaction PSG was 1.0±0.9°/3.4±1.9° for inclination and 1.7±1.1°/6.6±4.4° for anteversion. CONCLUSIONS The wide-base-contact PSG in resurfacing-THA and the PSG for neck-cut in THA could be applied clinically. Although cup-impaction PSG setting was acceptable, errors were made due to the impaction process during cup implantation.
Collapse
|
20
|
Sugano N. Computer-assisted orthopaedic surgery and robotic surgery in total hip arthroplasty. Clin Orthop Surg 2013; 5:1-9. [PMID: 23467021 PMCID: PMC3582865 DOI: 10.4055/cios.2013.5.1.1] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 07/23/2012] [Indexed: 11/30/2022] Open
Abstract
Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy. Fluoroscopic navigation is good for trauma and spine surgeries, but its benefits are limited in the hip and knee reconstruction surgeries. Several studies have shown that the cup alignment with navigation is more precise than that of the conventional mechanical instruments, and that it is useful for optimizing limb length, range of motion, and stability. Recently, patient specific templates, based on CT images, have attracted attention and some early reports on cup placement, and resurfacing showed improved accuracy of the procedures. These various CAOS systems have pros and cons. Nonetheless, CAOS is a useful tool to help surgeons perform accurately what surgeons want to do in order to better achieve their clinical objectives. Thus, it is important that the surgeon fully understands what he or she should be trying to achieve in THA for each patient.
Collapse
Affiliation(s)
- Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan.
| |
Collapse
|
21
|
|
22
|
Lantada AD, Morgado PL. Rapid prototyping for biomedical engineering: current capabilities and challenges. Annu Rev Biomed Eng 2012; 14:73-96. [PMID: 22524389 DOI: 10.1146/annurev-bioeng-071811-150112] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A new set of manufacturing technologies has emerged in the past decades to address market requirements in a customized way and to provide support for research tasks that require prototypes. These new techniques and technologies are usually referred to as rapid prototyping and manufacturing technologies, and they allow prototypes to be produced in a wide range of materials with remarkable precision in a couple of hours. Although they have been rapidly incorporated into product development methodologies, they are still under development, and their applications in bioengineering are continuously evolving. Rapid prototyping and manufacturing technologies can be of assistance in every stage of the development process of novel biodevices, to address various problems that can arise in the devices' interactions with biological systems and the fact that the design decisions must be tested carefully. This review focuses on the main fields of application for rapid prototyping in biomedical engineering and health sciences, as well as on the most remarkable challenges and research trends.
Collapse
Affiliation(s)
- Andrés Díaz Lantada
- Product Development Laboratory, Mechanical Engineering Department, Universidad Politécnica de Madrid, 28006 Madrid, Spain.
| | | |
Collapse
|
23
|
Vaccarella A, Enquobahrie A, Ferrigno G, Momi ED. Modular multiple sensors information management for computer-integrated surgery. Int J Med Robot 2012; 8:253-60. [PMID: 22407822 DOI: 10.1002/rcs.1412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND In the past 20 years, technological advancements have modified the concept of modern operating rooms (ORs) with the introduction of computer-integrated surgery (CIS) systems, which promise to enhance the outcomes, safety and standardization of surgical procedures. With CIS, different types of sensor (mainly position-sensing devices, force sensors and intra-operative imaging devices) are widely used. Recently, the need for a combined use of different sensors raised issues related to synchronization and spatial consistency of data from different sources of information. METHODS In this study, we propose a centralized, multi-sensor management software architecture for a distributed CIS system, which addresses sensor information consistency in both space and time. The software was developed as a data server module in a client-server architecture, using two open-source software libraries: Image-Guided Surgery Toolkit (IGSTK) and OpenCV. The ROBOCAST project (FP7 ICT 215190), which aims at integrating robotic and navigation devices and technologies in order to improve the outcome of the surgical intervention, was used as the benchmark. An experimental protocol was designed in order to prove the feasibility of a centralized module for data acquisition and to test the application latency when dealing with optical and electromagnetic tracking systems and ultrasound (US) imaging devices. RESULTS Our results show that a centralized approach is suitable for minimizing synchronization errors; latency in the client-server communication was estimated to be 2 ms (median value) for tracking systems and 40 ms (median value) for US images. CONCLUSION The proposed centralized approach proved to be adequate for neurosurgery requirements. Latency introduced by the proposed architecture does not affect tracking system performance in terms of frame rate and limits US images frame rate at 25 fps, which is acceptable for providing visual feedback to the surgeon in the OR.
Collapse
Affiliation(s)
- Alberto Vaccarella
- NearLab, Dipartimento di Bioingegneria, Politecnico di Milano, Milano, Italy.
| | | | | | | |
Collapse
|
24
|
Lethaus B, Kessler P, Boeckman R, Poort LJ, Tolba R. Reconstruction of a maxillary defect with a fibula graft and titanium mesh using CAD/CAM techniques. Head Face Med 2010; 6:16. [PMID: 20642821 PMCID: PMC2917404 DOI: 10.1186/1746-160x-6-16] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/19/2010] [Indexed: 11/10/2022] Open
Abstract
We present a case of maxillary and orbital floor reconstruction with a microvascular fibula graft and an individualized titanium mesh. Both were planned virtually; templates were made by rapid prototyping. The postoperative computer tomography scans showed that the planned positions were achieved correctly. This case report illustrates maxillary reconstruction performed with a special template technique and demonstrates the possibilities of computer aided design/computer aided manufacturing (CAD/CAM) applications in reconstructive surgery.
Collapse
Affiliation(s)
- Bernd Lethaus
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, The Netherlands.
| | | | | | | | | |
Collapse
|
25
|
Tailor-made Surgical Guide Reduces Incidence of Outliers of Cup Placement. Clin Orthop Relat Res 2010; 468:1088-95. [PMID: 19629605 PMCID: PMC2835612 DOI: 10.1007/s11999-009-0994-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 07/07/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Malalignment of the cup in total hip arthroplasty (THA) increases the risks of postoperative complications such as neck cup impingement, dislocation, and wear. We asked whether a tailor-made surgical guide based on CT images would reduce the incidence of outliers beyond 10 degrees from preoperatively planned alignment of the cup compared with those without the surgical guide. We prospectively followed 38 patients (38 hips, Group 1) having primary THA with the conventional technique and 31 patients (31 hips, Group 2) using the surgical guide. We designed the guide for Group 2 based on CT images and fixed it to the acetabular edge with a Kirschner wire to indicate the planned cup direction. Postoperative CT images showed the guide reduced the number of outliers compared with the conventional method (Group 1, 23.7%; Group 2, 0%). The surgical guide provided more reliable cup insertion compared with conventional techniques. LEVEL OF EVIDENCE Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
|