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Zheng H, Feng E, Xiao Y, Liu X, Lai T, Xu Z, Chen J, Xie S, Lin F, Zhang Y. Is AI 3D-printed PSI an accurate option for patients with developmental dysplasia of the hip undergoing THA? BMC Musculoskelet Disord 2024; 25:308. [PMID: 38649919 PMCID: PMC11034034 DOI: 10.1186/s12891-024-07449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In traditional surgical procedures, significant discrepancies are often observed between the pre-planned templated implant sizes and the actual sizes used, particularly in patients with congenital hip dysplasia. These discrepancies arise not only in preoperative planning but also in the precision of implant placement, especially concerning the acetabular component. Our study aims to enhance the accuracy of implant placement during Total Hip Arthroplasty (THA) by integrating AI-enhanced preoperative planning with Patient-Specific Instrumentation (PSI). We also seek to assess the accuracy and clinical outcomes of the AI-PSI (AIPSI) group in comparison to a manual control group. METHODS This study included 60 patients diagnosed with congenital hip dysplasia, randomly assigned to either the AIPSI or manual group, with 30 patients in each. No significant demographic differences between were noted the two groups. A direct anterior surgical approach was employed. Postoperative assessments included X-rays and CT scans to measure parameters such as the acetabular cup anteversion angle, acetabular cup inclination angle, femoral stem anteversion angle, femoral offset, and leg length discrepancy. Functional scores were recorded at 3 days, 1 week, 4 weeks, and 12 weeks post-surgery. Data analysis was conducted using SPSS version 22.0, with the significance level was set at α = 0.05. RESULTS AND CONCLUSION The AIPSI group demonstrated greater prosthesis placement accuracy. With the aid of PSI, AI-planned THA surgery provides surgeons with enhanced precision in prosthesis positioning. This approach potentially offers greater insights and guidelines for managing more complex anatomical variations or cases.
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Affiliation(s)
- Han Zheng
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
- The Second School of Medicine, Fujian University of Traditional Chinese, Fujian, China
| | - Eryou Feng
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China.
- Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma(2020Y2014), Fuzhou, China.
| | - Yao Xiao
- Fuzhou Changle Hospital of Traditional Chinese Medicine, Fuzhou, China
| | - Xingyu Liu
- Longwood Valley Medical Technology Co Ltd, Beijing, China
| | - Tianyu Lai
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Zhibiao Xu
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Jingqiao Chen
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Shiwei Xie
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Feitai Lin
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Yiling Zhang
- Longwood Valley Medical Technology Co Ltd, Beijing, China.
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A 3D-printed Personalized, Combined, Modular Pedicle Subtraction Osteotomy Guide Plate System: An Experimental Study. Spine (Phila Pa 1976) 2022; 47:931-937. [PMID: 34559763 DOI: 10.1097/brs.0000000000004229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/18/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Experimental study. OBJECTIVES The goal of this study was to develop a threedimensional (3D)-printed pedicle subtraction osteotomy (PSO) guide plate system. A 3D model and postoperative computed tomography (CT) data were used to evaluate the accuracy of osteotomy with this system. SUMMARY OF BACKGROUND DATA The key to the success of spinal orthopedic treatment is an effectively performed osteotomy. A 3D-printed osteotomy plate can be used for preoperative surgical planning. Due to the anatomical complexity of the spinal region, the clinical application of 3D-printed osteotomy plates remains challenging. METHODS The CT scans of 10 patients with thoracolumbar spinal deformities were obtained in the digital imaging and communication in medicine (DICOM) format. The diseased vertebrae and adjacent vertebrae were reconstructed and reduced by computer- aided design software, and an osteotomy plate was designed for the diseased vertebrae. The 3D-printed spinal model and osteotomy plate were used to simulate the operation for PSO. After the operation, the vertebral body treated by osteotomy underwent a CT scan, and the findings were compared with the preoperative design to evaluate the osteotomy accuracy. RESULTS The new 3D guide plate and spine model were used to successfully simulate 10 cases of PSO, and the comparison of the preoperative and postoperative states indicated that the osteotomy outcomes were excellent. CONCLUSIONS The new 3D-printed PSO guide plate system can be used for preoperative osteotomy planning and demonstrates good accuracy. The results can be used to develop 3D-printed plans for PSO in clinical practice.
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Zakani S, Chapman C, Saule A, Cooper A, Mulpuri K, Wilson DR. Computer-assisted subcapital correction osteotomy in slipped capital femoral epiphysis using individualized drill templates. 3D Print Med 2021; 7:18. [PMID: 34228206 PMCID: PMC8259369 DOI: 10.1186/s41205-021-00108-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background Subcapital osteotomy by means of surgical hip dislocation is a treatment approach offered for moderate-to-severe cases of Slipped Capital Femoral Epiphysis (SCFE). This procedure is demanding, highly dependent on the surgeon’s experience, and requires considerable radiation exposure for monitoring and securing the spatial alignment of the femoral head. We propose the use of individualized drill guides as an accurate method for placing K-wires during subcapital correction osteotomies in SCFE patients. Methods Five CT scans of the hip joint from otherwise healthy patients with moderate-to-severe SCFE were selected (ages 11–14). Three dimensional models of each patient’s femur were reconstructed by manual segmentation and physically replicated using additive manufacturing techniques. Five orthopaedic surgeons virtually identified the optimal entry point and direction of the two threaded wires for each case. 3D printed drill guides were designed specific to each surgical plan, with one side shaped to fit the patient’s bone and the other side containing holes to guide the surgical drill. Each surgeon performed three guided (using the drill guides) and three conventional (freehand) simulated procedures on each case. Each femur model was laser scanned and digitally matched to the preoperative model for evaluation of entry points and wire angulations. We compared wire entry point, wire angulation, procedure time and number of x-rays between guided and freehand simulated surgeries. Results The guided group (1.4 ± 0.9 mm; 2.5° ± 1.4°) was significantly more accurate than the freehand group (5.8 ± 3.2 mm; 5.3° ± 4.4°) for wire entry location and angulation (p < 0.001). Guided surgeries required significantly less drilling time and intraoperative x-rays (90.5 ± 42.2 s, 3 ± 1 scans) compared to the conventional surgeries (246.8 ± 122.1 s, 14 ± 5 scans) (p < 0.001). Conclusions We conclude that CT-based preoperative planning and intraoperative navigation using individualized drill guides allow for improved accuracy of wires, reduced operative time and less radiation exposure in simulated hips. Clinical relevance This preliminary study shows promising results, suggesting potential direct benefits to SCFE patients by necessitating less time under anesthesia and less intra-operative radiation exposure to patients, and increasing surgical accuracy.
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Affiliation(s)
- Sima Zakani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Chapman
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Adam Saule
- Department of Mechanical Engineering, Dalhousie University, Halifax, NS, Canada
| | - Anthony Cooper
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Kishore Mulpuri
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada. .,Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
| | - David R Wilson
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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陆 声, 辛 欣, 黄 文, 李 严. [Progress in clinical application of 3D printed navigational template in orthopedic surgery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1220-1224. [PMID: 32895187 PMCID: PMC7429156 DOI: 10.12122/j.issn.1673-4254.2020.08.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Indexed: 11/24/2022]
Abstract
Orthopedic 3D printed surgical navigational template is an instrument that is prepared by 3D reconstruction based on preoperative radiological data of the patient using computer-aided design (CAD) and 3D printing techniques. The 3D printed navigational template allows accurate intra-operative assessment of the relative spatial distance, angular relationship, direction and depth. The application of 3D printed navigational template technique in orthopedics surgeries achieves the conversion of preoperative planning from 2/3D graphics to 3D models, and provides a new method for individualized and precise treatment. Herein we review the evolution, clinical application, and basic classification of 3D printed navigation template technique, analyze its advantages and disadvantages, and discuss the current problems and the future development of this technique.
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Affiliation(s)
- 声 陆
- 云南省第一人民医院骨科//云南省数字骨科重点实验室,云南 昆明 650000First People's Hospital of Yunnan Province//Yunnan Provincial Key Laboratory of Digital Orthopaedics, Kunming 650000, China
| | - 欣 辛
- 陕西省安康市中心医院骨科,陕西 安康 725000Ankang General Hospital, Ankang 725000, China
| | - 文华 黄
- 南方医科大学基础医学院人体解剖学教研室//广东省医用生物力学重点实验室,广东 广州 510515Department of Human Anatomy, School of Basic Medical Science, Southern Medical University//Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou 510515, China
| | - 严兵 李
- 南方医科大学基础医学院人体解剖学教研室//广东省医用生物力学重点实验室,广东 广州 510515Department of Human Anatomy, School of Basic Medical Science, Southern Medical University//Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou 510515, China
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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: 116] [Impact Index Per Article: 29.0] [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.
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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
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Yan L, Wang P, Zhou H. 3D Printing Navigation Template Used in Total Hip Arthroplasty for Developmental Dysplasia of the Hip. Indian J Orthop 2020; 54:856-862. [PMID: 33133409 PMCID: PMC7572928 DOI: 10.1007/s43465-020-00093-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of our study was to explore the feasibility of 3D printing navigation template used in total hip arthroplasty (THA) for adult developmental dysplasia of the hip (DDH). MATERIALS AND METHODS 25 patients who received THA for DDH from February 2014 to May 2018 were randomized into the control or intervention group. Of these patients, 12 received THAs assisted with 3D printing navigation templates, 13 THAs underwent THAs without navigation templates. The mean follow-up was 1.6 (range, 1.2-3.8) years. Clinical scores and radiographic results were evaluated for two groups. RESULTS Operating time, intra- and postoperative hemorrhage and Harris Hip Score (HHS) at 6 months postoperatively in the 3D printing group were better than those for patients in the conventional hip replacement group, while infection and implant loosening were 0 in the two groups. There were no significant differences in anteversion angle, abduction angle and the distance from rotation center to the ischial tuberosity line in 3D printing group as compared to the normal side. The abduction angle and the distance from rotation center to the ischial tuberosity line were significantly different between the two sides in the traditional group. CONCLUSION Application of the 3D printing template for THA with DDH can facilitate the surgical procedure and create an ideal artificial acetabulum placement.
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Affiliation(s)
- Liang Yan
- grid.263761.70000 0001 0198 0694Department of Orthopedics, The Second Affiliate Hospital of Soochow University, Soochow, 215000 Jiangsu China ,Department of Orthopedics, Nantong Rich Hospital, Nantong, 226300 Jiangsu China
| | - Peng Wang
- Department of Orthopedics, Nantong Rich Hospital, Nantong, 226300 Jiangsu China
| | - Haibin Zhou
- grid.263761.70000 0001 0198 0694Department of Orthopedics, The Second Affiliate Hospital of Soochow University, Soochow, 215000 Jiangsu China
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Minto J, Zhou X, Osborn J, Zhang LG, Sarkar K, Rao RD. Three-Dimensional Printing: A Catalyst for a Changing Orthopaedic Landscape. JBJS Rev 2020; 8:e0076. [DOI: 10.2106/jbjs.rvw.19.00076] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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López Gualdrón CI, Bravo Ibarra ER, Murillo Bohórquez AP, Garnica Bohórquez I. Present and future for technologies to develop patient-specific medical devices: a systematic review approach. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:253-273. [PMID: 31496840 PMCID: PMC6689557 DOI: 10.2147/mder.s215947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/08/2019] [Indexed: 01/25/2023] Open
Abstract
The main purpose of this investigation was to systematically review the literature regarding case studies on patient-specific implants and devices, with the goal of analyzing the process of developing custom-made medical devices. A content analysis was performed to identify design processes and methodologies implemented to develop devices such as implants adapted to bone geometries. Reverse engineering, computer-aided design, simulation of assets, and rapid prototyping technologies were selected according to their interoperability in a process framework for developing new products. Finally, results from the case studies and process stages identified in the consulted research were analyzed. These results showed a relationship between the scope and complexity of the process and the stage of technology integration of the patient-specific device development. The analyzed case studies were characterized by technical, scientific, and multidisciplinary components to achieve research goals. Likewise, integration of technologies using patient-specific technologies is needed for product development that converges into designing devices, such as implants, biomodels, and cutting drilling guides.
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Affiliation(s)
| | - Edna-Rocío Bravo Ibarra
- Industrial and Business Studies School, Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | - Israel Garnica Bohórquez
- Industrial and Business Studies School, Universidad Industrial de Santander, Bucaramanga, Colombia
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Ramos A, Soares dos Santos MP, Mesnard M. Predictions of Birmingham hip resurfacing implant offset - In vitro and numerical models. Comput Methods Biomech Biomed Engin 2019; 22:352-363. [DOI: 10.1080/10255842.2018.1556973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A. Ramos
- Biomechanics Research Group, TEMA, University of Aveiro, Aveiro, Portugal
| | | | - M. Mesnard
- Institut de Mécanique et d'Ingénierie, Université de Bordeaux, Talence, France
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Hall EL, Baines S, Bilmont A, Oxley B. Accuracy of patient-specific three-dimensional-printed osteotomy and reduction guides for distal femoral osteotomy in dogs with medial patella luxation. Vet Surg 2018; 48:584-591. [PMID: 30446995 DOI: 10.1111/vsu.13126] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/16/2018] [Accepted: 10/06/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare precorrectional and postcorrectional femoral alignment following distal femoral osteotomy using patient-specific 3-dimensional (3D)-printed osteotomy and reduction guides in vivo and ex vivo. STUDY DESIGN Prospective study. SAMPLE POPULATION Ten client-owned dogs and matching 3D-printed plastic bone models. METHODS Distal femoral osteotomy was performed via a standard approach using osteotomy and reduction guides developed with computer-aided design software prior to 3D-printing. Femoral osteotomy and reduction was also performed on 3D-printed models of each femur with identical reprinted guides. Femoral varus angle (FVA) and femoral torsion angle (FTA) were measured on postoperative computed tomographic images by 3 observers. RESULTS In vivo, the mean difference between target and achieved postoperative was 2.29° (±2.29°, P = .0076) for the FVA, and 1.67° (±2.08°, P = .300) for the FTA. Ex vivo, the mean difference between target and achieved postoperative was 0.29° (±1.50°, P = .813) for the FVA, and -2.33° (±3.21°, P = .336) for the FTA. Intraobserver intraclass correlation coefficients (ICC; 0.736-0.998) and interobserver ICC (0.829 to 0.996) were consistent with an excellent agreement. CONCLUSION Use of 3D-printed osteotomy and reduction guides allowed accurate correction of FTA in vivo and both FVA and FTA ex vivo. CLINICAL SIGNIFICANCE Use of 3D-printed osteotomy and reduction guides may improve the accuracy of correction of femoral alignment but warrant further evaluation of surgical time, perioperative complications, and patient outcomes compared with conventional techniques.
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Affiliation(s)
- Emma L Hall
- Willows Veterinary Centre and Referral Service, England, United Kingdom
| | - Stephen Baines
- Willows Veterinary Centre and Referral Service, England, United Kingdom
| | - Alexis Bilmont
- Willows Veterinary Centre and Referral Service, England, United Kingdom
| | - Bill Oxley
- Willows Veterinary Centre and Referral Service, England, United Kingdom
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3D Printed Anatomy-Specific Fixture for Consistent Glenoid Cavity Position in Shoulder Simulator. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:2572730. [PMID: 30402211 PMCID: PMC6198554 DOI: 10.1155/2018/2572730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/30/2018] [Accepted: 08/23/2018] [Indexed: 11/17/2022]
Abstract
Purpose Fixation methods for consistent anatomical structure positioning in biomechanical testing can be challenging. Image-based 3D printing is an attractive method for fabrication of biomechanical supports of anatomical structure due to its ability to precisely locate anatomical features with respect to the loading system. Method A case study is presented to provide a design guide for fixation block fabrication. The anatomy of interest was CT scanned and reconstructed in 3D. The model was imported into commercially available CAD software and modified into a solid object and to create the fixture block. The CAD fixture block is standardized such that anatomical features are always in the same position for the testing system by subtracting the anatomy from a base fixture block. Results This method allowed a strong immobilization of anatomical specimens and a controlled and consistent positioning feature with respect to the testing system. Furthermore, the fixture block can be easily modified and adapted to anatomical structures of interest using CAD software. Conclusion This approach allows preservation of the bony anatomy integrity and provides a repeatable and consistent anatomical positioning with respect to the testing system. It can be adapted for other anatomical structures in various other biomechanical settings.
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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.
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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
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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.
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Zheng G, Nolte LP. Computer-Aided Orthopaedic Surgery: State-of-the-Art and Future Perspectives. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:1-20. [DOI: 10.1007/978-981-13-1396-7_1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Lee S, Kim JY, Hong J, Baek SH, Kim SY. CT-based Navigation System Using a Patient-Specific Instrument for Femoral Component Positioning: An Experimental in vitro Study with a Sawbone Model. Yonsei Med J 2018; 59:769-780. [PMID: 29978614 PMCID: PMC6037596 DOI: 10.3349/ymj.2018.59.6.769] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The intraoperative version of the femoral component is usually determined by visual appraisal of the stem position relative to the distal femoral condylar axis. However, several studies have suggested that a surgeon's visual assessment of the stem position has a high probability of misinterpretation. We developed a computed tomography (CT)-based navigation system with a patient-specific instrument (PSI) capable of three-dimensional (3D) printing and investigated its accuracy and consistency in comparison to the conventional technique of visual assessment of the stem position. MATERIALS AND METHODS A CT scan of a femur sawbone model was performed, and pre-experimental planning was completed. We conducted 30 femoral neck osteotomies using the conventional technique and another 30 femoral neck osteotomies using the proposed technique. The femoral medullary canals were identified in both groups using a box chisel. RESULTS For the absolute deviation between the measured and planned values, the mean two-dimensional anteversions of the proposed and conventional techniques were 1.41° and 4.78°, while their mean 3D anteversions were 1.15° and 3.31°. The mean θ₁, θ₂, θ₃, and d, all of which are parameters for evaluating femoral neck osteotomy, were 2.93°, 1.96°, 5.29°, and 0.48 mm for the proposed technique and 4.26°, 3.17°, 4.43°, and 3.15 mm for the conventional technique, respectively. CONCLUSION The CT-based navigation system with PSI was more accurate and consistent than the conventional technique for assessment of stem position. Therefore, it can be used to reduce the frequency of incorrect assessments of the stem position among surgeons and to help with accurate determination of stem anteversion.
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Affiliation(s)
- Seongpung Lee
- Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Jun Young Kim
- Department of Orthopaedic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea.
| | - Jaesung Hong
- Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Seung Hoon Baek
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Shin Yoon Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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Resende RA, Kirkwood RN, Rudan JF, Deluzio KJ. How symmetric are metal-on-metal hip resurfacing patients during gait? Insights for the rehabilitation. J Biomech 2017; 58:37-44. [DOI: 10.1016/j.jbiomech.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/10/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
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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.
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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
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Electromagnetically tracked personalized templates for surgical navigation. Int J Comput Assist Radiol Surg 2017; 12:1049-1058. [PMID: 28332159 DOI: 10.1007/s11548-017-1563-z] [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: 01/30/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE An electromagnetic (EM) surgical tracking system was developed for orthopedic navigation. The reportedly poor accuracy of point-based EM navigation was improved by using anatomical impressions, which were EM-tracked personalized templates. Lines, rather than points, were consistently used for calibration and error evaluation. METHODS Technical accuracy was tested using models derived from CT scans of ten cadaver shoulders. Tracked impressions were first designed, calibrated, and tested using lines as fiducial objects. Next, tracked impressions were tested against EM point-based navigation and optical point-based navigation, in environments that were either relatively empty or that included surgical instruments. Finally, a tracked impression was tested on a cadaver forearm in a simulated fracture-repair task. RESULTS Calibration of anatomical impressions to EM tracking was highly accurate, with mean fiducial localization errors in positions of 0.3 mm and in angles of [Formula: see text]. Technical accuracy on physical shoulder models was also highly accurate; in an EM field with surgical instruments, the mean of target registration errors in positions was 2.2 mm and in angles was [Formula: see text]. Preclinical accuracy in a cadaver forearm in positions was 0.4 mm and in angles was [Formula: see text]. The technical accuracy was significantly better than point-based navigation, whether by EM tracking or by optical tracking. The preclinical accuracy was comparable to that achieved by point-based optical navigation. CONCLUSIONS EM-tracked impressions-a hybrid of personalized templates and EM navigation-are a promising technology for orthopedic applications. The two technical contributions are the novel hybrid navigation and the consistent use of lines as fiducial objects, replacing traditional point-based computations. The accuracy improvement was attributed to the combination of physical surfaces and line directions in the processes of calibration and registration. The technical studies and preclinical trial suggest that EM-tracked impressions are an accurate, ergonomic innovation in image-guided orthopedic surgery.
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Zheng P, Xu P, Yao Q, Tang K, Lou Y. 3D-printed navigation template in proximal femoral osteotomy for older children with developmental dysplasia of the hip. Sci Rep 2017; 7:44993. [PMID: 28322290 PMCID: PMC5359566 DOI: 10.1038/srep44993] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/17/2017] [Indexed: 12/15/2022] Open
Abstract
To explore the feasibility of 3D-printed navigation template in proximal femoral varus rotation and shortening osteotomy for older children with developmental dysplasia of the hip (DDH). Between June 2014 and May 2015, navigation templates were designed and used for 12 DDH patients. Surgical information and outcomes were compared to 13 patients undergoing the same surgery but without navigation template. In template-guided patient group, operation time (21.08 min vs. 46.92 min), number of X-ray exposures (3.92 vs. 6.69), and occurrence of femoral epiphysis damage (0 vs. 0.92) were significantly decreased (P < 0.05). Furthermore, after 12–18 months follow-up, 66.7% and 16.7% of the hips in template-guided group were rated as excellent or good, respectively, according to the McKay criteria; 83.3% and 16.7% by using the Severin criteria respectively. By contrast, 46.2% and 23.1% of the hips in traditional operation group were classed as excellent or good, respectively, using the McKay criteria; 46.2% and 30.8% by using the Severin criteria respectively. The template-guided group achieved a better outcome; however, there was no significant difference. Application of the navigation template for older DDH children can reduce the operation time, radiation exposure, and epiphysis damage, which also simplifies surgery and improves precision.
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Affiliation(s)
- Pengfei Zheng
- Department of Pediatric Orthopaedics, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210008, China.,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, 210006, China
| | - Peng Xu
- Department of Pediatric Orthopaedics, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210008, China.,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, 210006, China
| | - Qingqiang Yao
- Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, 210006, China.,Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, China
| | - Kai Tang
- Department of Pediatric Orthopaedics, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210008, China.,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, 210006, China
| | - Yue Lou
- Department of Pediatric Orthopaedics, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210008, China.,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, 210006, China
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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.
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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
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Pornrattanamaneewong C, Narkbunnam R, Chareancholvanich K. CUSTOMIZED GUIDE FOR FEMORAL COMPONENT POSITIONING IN HIP RESURFACING ARTHROPLASTY. ACTA ORTOPEDICA BRASILEIRA 2017. [PMID: 28642661 PMCID: PMC5474423 DOI: 10.1590/1413-785220172502167422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To prove the accuracy of a customized guide developed according to our method. Methods: This customized guide was developed from a three-dimensional model of proximal femur reconstructed using computed tomography data. Based on the new technique, the position of the guide pin insertion was selected and adjusted using the reference of the anatomical femoral neck axis. The customized guide consists of a hemispheric covering designed to fit the posterior part of the femoral neck. The performance of the customized guide was tested in eight patients scheduled for total hip arthroplasty. The stability of the customized guide was assessed by orthopedic surgeons. An intraoperative image intensifier was used to assess the accuracy. Results: The customized guide was stabilized with full contact and was fixed in place in all patients. The mean angular deviations in relation to the what was planned in anteroposterior and lateral hip radiographs were 0.5º ± 1.8º in valgus and 1.0º ± 2.4º in retroversion, respectively. Conclusion: From this pilot test, the authors suggest that the proposed technique could be applied as a customized guide to the positioning device for hip resurfacing arthroplasty with acceptable accuracy and user-friendly interface. Level of Evidence IV, Cases Series.
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Application of computer-aided design and 3D-printed navigation template in Locking Compression Pediatric Hip Plate ΤΜ placement for pediatric hip disease. Int J Comput Assist Radiol Surg 2017; 12:865-871. [PMID: 28190127 DOI: 10.1007/s11548-017-1535-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/01/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND To investigate the feasibility and accuracy of a drill template based on computer-aided design (CAD) and 3D printing technology for the placement of screws in Locking Compression Pediatric Hip Plate (LCP-PHP). METHODS LCP-PHP was used in 11 children [5 with femoral neck fracture and 6 with development dysplasia of hip (DDH)]. Using the CT data, the proximal femur model was created by a 3D printer. Fracture reduction and the placement of the screw in the femoral neck and the LCP-PHP were simulated by the computer. The navigation template was designed by the software to match the proximal femur. After the feasibility of the 3D model operation was demonstrated before the operation, the guide pins and the screws were inserted with the help of the navigate template in the operation. RESULTS During surgery, the navigation template for each case was matched to the bony markers of the proximal femur. With the help of the template, in femoral neck fracture cases, three screws could be accurately inserted into the femoral neck to implant the LCP-PHP and stabilize the fracture. The template for DDH includes all operation parameters and steps for proximal femoral varus rotation and shortening osteotomy, which made the surgery much easier to perform. Radiographs taken after surgery showed that the postoperative results closely corresponded to the preoperative computer simulation. The average time taken for LCP-PHP placement was 26.5 min; radiography was used during surgery only for an average of 6.0 times. Postoperative radiographs showed good results. CONCLUSION With the use of CAD and 3D printing technology, accurate placement of individualized navigation template of LCP-PHP can be achieved. This technology can reduce intraoperative damage to the femoral neck epiphysis, decrease operation time, reduce intraoperative hemorrhage, and decrease radiation exposure to patients and personnel during the surgery.
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Component Position and Metal Ion Levels in Computer-Navigated Hip Resurfacing Arthroplasty. J Arthroplasty 2017; 32:119-124. [PMID: 27430186 DOI: 10.1016/j.arth.2016.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Metal ion levels are used as a surrogate marker for wear in hip resurfacing arthroplasties. Improper component position, particularly on the acetabular side, plays an important role in problems with the bearing surfaces, such as edge loading, impingement on the acetabular component rim, lack of fluid-film lubrication, and acetabular component deformation. There are little data regarding femoral component position and its possible implications on wear and failure rates. The purpose of this investigation was to determine both femoral and acetabular component positions in our cohort of mechanically stable hip resurfacing arthroplasties and to determine if these were related to metal ion levels. METHODS One hundred fourteen patients who had undergone a computer-assisted metal-on-metal hip resurfacing were prospectively followed. Cobalt and chromium levels, Harris Hip, and UCLA activity scores in addition to measures of the acetabular and femoral component position and angles of the femur and acetabulum were recorded. RESULTS Significant changes included increases in the position of the acetabular component compared to the native acetabulum; increase in femoral vertical offset; and decreases in global offset, gluteus medius activation angle, and abductor arm angle (P < .05). Multiple regression analysis found no significant predictors of cobalt and chromium metal ion levels. CONCLUSION Femoral and acetabular components placed in acceptable position failed to predict increased metal ion levels, and increased levels did not adversely impact patient function or satisfaction. Further research is necessary to clarify factors contributing to prosthesis wear.
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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: 548] [Impact Index Per Article: 68.5] [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.
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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
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25
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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.
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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
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Zheng G, Nolte LP. Computer-Assisted Orthopedic Surgery: Current State and Future Perspective. Front Surg 2015; 2:66. [PMID: 26779486 PMCID: PMC4688391 DOI: 10.3389/fsurg.2015.00066] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/07/2015] [Indexed: 11/13/2022] Open
Abstract
Introduced about two decades ago, computer-assisted orthopedic surgery (CAOS) has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopedics and traumatology, increasing availability of different imaging modalities, and advances in analytics and navigation tools. The aim of this paper is to present the basic elements of CAOS devices and to review state-of-the-art examples of different imaging modalities used to create the virtual representations, of different position tracking devices for navigation systems, of different surgical robots, of different methods for registration and referencing, and of CAOS modules that have been realized for different surgical procedures. Future perspectives will also be outlined.
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Affiliation(s)
- Guoyan Zheng
- Institute for Surgical Technology and Biomechanics, University of Bern , Bern , Switzerland
| | - Lutz P Nolte
- Institute for Surgical Technology and Biomechanics, University of Bern , Bern , Switzerland
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Computer-assisted hip resurfacing planning using Lie group shape models. Int J Comput Assist Radiol Surg 2015; 10:707-15. [PMID: 25930713 DOI: 10.1007/s11548-015-1209-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hip resurfacing is a surgical option for osteoarthritis young and active patients. Early failures has been reported due to improper implant placement. Computer-assisted surgery is a promising avenue for more successful procedures. PURPOSE This paper presents a novel automatic surgical planning for computer-assisted hip resurfacing procedures. The plan defined the femoral head axis that was used to place the implant. The automatic planning was based on a Lie group statistical shape model. METHODS A statistical shape model was constructed using 50 femurs from osteoarthritis patients who underwent computer-assisted hip resurfacing. The model was constructed using product Lie groups representation of shapes and nonlinear analysis on the manifold of shapes. A surgical plan was drawn for the derived base shape. The base shape was transformed to 14 femurs with known manual plans. The transformed base plan was used as the computed plan for each femur. Both actual and computed plans were compared. RESULTS The method showed a success by computing plans that differ from the actual plans within the surgical admissible ranges. The minimum crossing distance between the two plans had a mean of 0.75 mm with a standard deviation of 0.54 mm. The angular difference between the two plans had the mean of 5.94° with a standard deviation of 2.145.94°. CONCLUSION Product Lie groups shape models were proved to be successful in automatic planning for hip resurfacing computer-assisted surgeries. The method can be extended to other orthopedic and general surgeries.
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Kunz M, Balaketheeswaran S, Ellis RE, Rudan JF. The influence of osteophyte depiction in CT for patient-specific guided hip resurfacing procedures. Int J Comput Assist Radiol Surg 2015; 10:717-26. [PMID: 25861892 DOI: 10.1007/s11548-015-1200-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/01/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE An accurate fit of a patient-specific instrument guide during an intervention is one of the critical factors affecting accuracy of the surgical procedure. In this study, we investigated how well osteophytes, which are abnormal bone growths that form along joints, are depicted in clinical preoperative CT scans and estimated the influence of such depiction errors on the intraoperative accuracy of the guide. METHODS In 34 hip resurfacing patients, 227 osteophyte surface points on the anterior aspect of the femoral neck were collected intraoperatively, using an optoelectronic navigation system. These points were registered to a preoperative CT scan of the patient, and distances between collected points and segmented virtual bone surface, as well as Hounsfield units for these points, were determined. We simulated the registration error of a patient-specific guide, using a modified registration algorithm, to test placement on the anterior aspect of the femoral neck without removing any osteophytes. This error was then applied to the surgical plan of the femoral central-pin position and orientation for evaluation. RESULTS The average distance between the collected points and the segmented surface was 2.6 mm. We estimated the average error for the entrance point of the central-pin to be 0.7 mm in the distal direction and 3.2 mm in the anterior direction. The average orientation error was 2.8° in anteversion. CONCLUSIONS The depiction of osteophytes in clinical preoperative CT scans for proximal femurs can be unreliable and can possibly result in significant intraoperative instrument alignment errors during image-guided surgeries.
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Affiliation(s)
- M Kunz
- School of Computing, Queen's University, 557 Goodwin Hall, Kingston, ON, K7L 2N8, Canada,
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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.
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Olsen M, Naudie DD, Edwards MR, Sellan ME, McCalden RW, Schemitsch EH. Evaluation of a patient specific femoral alignment guide for hip resurfacing. J Arthroplasty 2014; 29:590-5. [PMID: 24034907 DOI: 10.1016/j.arth.2013.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/28/2013] [Accepted: 08/01/2013] [Indexed: 02/01/2023] Open
Abstract
A novel alternative to conventional instrumentation for femoral component insertion in hip resurfacing is a patient specific, computed tomography based femoral alignment guide. A benchside study using cadaveric femora was performed comparing a custom alignment guide to conventional instrumentation and computer navigation. A clinical series of twenty-five hip resurfacings utilizing a custom alignment guide was conducted by three surgeons experienced in hip resurfacing. Using cadaveric femora, the custom guide was comparable to conventional instrumentation with computer navigation proving superior to both. Clinical femoral component alignment accuracy was 3.7° and measured within ± 5° of plan in 20 of 24 cases. Patient specific femoral alignment guides provide a satisfactory level of accuracy and may be a better alternative to conventional instrumentation for initial femoral guidewire placement in hip resurfacing.
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Affiliation(s)
- Michael Olsen
- Martin Orthopaedic Biomechanics Laboratory, St. Michael's Hospital, University of Toronto, B114 Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Douglas D Naudie
- Department of Surgery, Division of Orthopaedic Surgery, London Health Sciences Centre, Western University, London, ON, Canada
| | - Max R Edwards
- Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael E Sellan
- Martin Orthopaedic Biomechanics Laboratory, St. Michael's Hospital, University of Toronto, B114 Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Richard W McCalden
- Department of Surgery, Division of Orthopaedic Surgery, London Health Sciences Centre, Western University, London, ON, Canada
| | - Emil H Schemitsch
- Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, ON, Canada
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Cho B, Matsumoto N, Mori M, Komune S, Hashizume M. Image-guided placement of the Bonebridge™ without surgical navigation equipment. Int J Comput Assist Radiol Surg 2014; 9:845-55. [PMID: 24395700 DOI: 10.1007/s11548-013-0973-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/27/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Most of the current Bonebridge surgeries undergo preoperative simulation planning in a computer. However, surgeons usually use the landmarks on the bone surface to determine the location where to implant the device, using the simulation image in the computer only as a reference (conventional method). We developed an image-guided method for precisely replicating simulation surgery upon performing Bonebridge implantation. METHODS Based on our previous development of the surface template-assisted marker positioning (STAMP) method for performing image-guided otologic surgery, we fabricated templates that fit only at the designated location on the patient's temporal bone surface. The Bonebridge STAMP (BB-STAMP) plate shows the exact location where to start drilling. The BB-STAMP was also combined with a perforator-guiding sleeve, so that the location, direction and depth of the cylindrical well could be precisely replicated as simulated. We also created a STAMP plate for confirmation that fits only after sufficient drilling at the correct location is finished. To evaluate the proposed methods, we performed simulation surgery on four cadaveric temporal bones and their 12 replicas (three each for four bones). The time used and the degree of mismatch between the simulated location and the drilled location were compared. RESULTS A feasibility study was successfully conducted using the proposed BB-STAMP methods and the conventional method. The amount of time required for the procedure did not differ significantly between the surgical methods, although using the BB-STAMP and perforator guide was always quicker. The degree of mismatch between the simulation and resected models had tendency to be smaller when the surgery was guided by the BB-STAMP with or without a perforator guide, although the difference was not statistically significant. CONCLUSIONS The proposed BB-STAMP is a promising method for replicating exactly what is performed during simulation without using a surgical navigation system.
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Affiliation(s)
- Byunghyun Cho
- Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka , 812-8582, Japan
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Ma B, Kunz M, Gammon B, Ellis RE, Pichora DR. A laboratory comparison of computer navigation and individualized guides for distal radius osteotomy. Int J Comput Assist Radiol Surg 2013; 9:713-24. [PMID: 24323402 DOI: 10.1007/s11548-013-0966-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/19/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE This article presents the results of a multiuser, randomized laboratory trial comparing the accuracy and precision of image-based navigation against individualized guides for distal radius osteotomy (DRO). METHODS Six surgeons each performed four DROs using image-based navigation and four DROs using individualized guides in a laboratory setting with plastic phantom replicas of radii from patients who had received DRO as treatment for radial deformity. Time required and correction errors of ulnar variance, radial inclination, and volar tilt were measured. RESULTS There were no statistically significant differences in the average correction errors. There was a statistically significant difference in the standard deviation of ulnar variance error (2.0 mm for navigation vs. 0.6 mm for guides). There was a statistically significant difference in the standard deviation of radial inclination error ([Formula: see text] for navigation vs. [Formula: see text] for guides). There were statistically significant differences in the times required (705 s for navigation vs. 214 s for guides) and their standard deviations (144 s for navigation vs. 98 s for guides). CONCLUSIONS Compared to navigated DRO, individualized guides were easier to use, faster, and produced more precise correction of ulnar variance and radial inclination. The combination of true three-dimensional planning, ease of use, and accurate and precise corrective guidance makes the individualized guide technique a promising approach for performing corrective osteotomy of the distal radius.
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Affiliation(s)
- Burton Ma
- Department of Electrical Engineering and Computing Science, York University, Toronto, ON, Canada,
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Kunz M, Devlin SM, Hurtig MB, Waldman SD, Rudan JF, Bardana DD, Stewart AJ. Image-Guided Techniques Improve the Short-Term Outcome of Autologous Osteochondral Cartilage Repair Surgeries: An Animal Trial. Cartilage 2013; 4:153-64. [PMID: 26069658 PMCID: PMC4297103 DOI: 10.1177/1947603512470683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Autologous osteochondral cartilage repair is a valuable reconstruction option for cartilage defects, but the accuracy to harvest and deliver osteochondral grafts remains problematic. We investigated whether image-guided methods (optically guided and template guided) can improve the outcome of these procedures. DESIGN Fifteen sheep were operated to create traumatic chondral injuries in each knee. After 4 months, the chondral defect in one knee was repaired using (a) conventional approach, (b) optically guided method, or (c) template-guided method. For both image-guided groups, harvest and delivery sites were preoperatively planned using custom-made software. During optically guided surgery, instrument position and orientation were tracked and superimposed onto the surgical plan. For the template-guided group, plastic templates were manufactured to allow an exact fit between template and the joint anatomy. Cylindrical holes within the template guided surgical tools according to the plan. Three months postsurgery, both knees were harvested and computed tomography scans were used to compare the reconstructed versus the native pre-injury joint surfaces. For each repaired defect, macroscopic (International Cartilage Repair Society [ICRS]) and histological repair (ICRS II) scores were assessed. RESULTS Three months after repair surgery, both image-guided surgical approaches resulted in significantly better histology scores compared with the conventional approach (improvement by 55%, P < 0.02). Interestingly, there were no significant differences found in cartilage surface reconstruction and macroscopic scores between the image-guided and the conventional surgeries.
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Affiliation(s)
- Manuela Kunz
- School of Computing, Queen’s University, Kingston, Ontario, Canada
| | - Steven M. Devlin
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, Ontario, Canada
| | - Mark B. Hurtig
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Stephen D. Waldman
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, Ontario, Canada,Department of Chemical Engineering, Queen’s University, Kingston, Ontario, Canada
| | - John F. Rudan
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Davide D. Bardana
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - A. James Stewart
- School of Computing, Queen’s University, Kingston, Ontario, Canada
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Kitada M, Sakai T, Murase T, Hanada T, Nakamura N, Sugano N. Validation of the femoral component placement during hip resurfacing: a comparison between the conventional jig, patient-specific template, and CT-based navigation. Int J Med Robot 2013; 9:223-9. [PMID: 23460526 DOI: 10.1002/rcs.1490] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Makoto Kitada
- Center of Arthroplasty; Kyowakai-Hospital; Osaka Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery; Osaka University Graduate School of Medicine; Osaka Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery; Osaka University Graduate School of Medicine; Osaka Japan
| | | | | | - Nobuhiko Sugano
- Department of Orthopaedic Surgery; Osaka University Graduate School of Medicine; Osaka Japan
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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: 114] [Impact Index Per Article: 10.4] [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.
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Affiliation(s)
- Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan.
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Smith EJ, Anstey JA, Venne G, Ellis RE. Using additive manufacturing in accuracy evaluation of reconstructions from computed tomography. Proc Inst Mech Eng H 2013; 227:551-9. [DOI: 10.1177/0954411912474612] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bone models derived from patient imaging and fabricated using additive manufacturing technology have many potential uses including surgical planning, training, and research. This study evaluated the accuracy of bone surface reconstruction of two diarthrodial joints, the hip and shoulder, from computed tomography. Image segmentation of the tomographic series was used to develop a three-dimensional virtual model, which was fabricated using fused deposition modelling. Laser scanning was used to compare cadaver bones, printed models, and intermediate segmentations. The overall bone reconstruction process had a reproducibility of 0.3 ± 0.4 mm. Production of the model had an accuracy of 0.1 ± 0.1 mm, while the segmentation had an accuracy of 0.3 ± 0.4 mm, indicating that segmentation accuracy was the key factor in reconstruction. Generally, the shape of the articular surfaces was reproduced accurately, with poorer accuracy near the periphery of the articular surfaces, particularly in regions with periosteum covering and where osteophytes were apparent.
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Affiliation(s)
- Erin J Smith
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
| | - Joseph A Anstey
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Gabriel Venne
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Randy E Ellis
- School of Computing, Queen’s University, Kingston, ON, Canada
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Wong K, Kumta S, Sze K, Wong C. Use of a patient-specific CAD/CAM surgical jig in extremity bone tumor resection and custom prosthetic reconstruction. ACTA ACUST UNITED AC 2012; 17:284-93. [DOI: 10.3109/10929088.2012.725771] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hip resurfacing with individualized drill templates—comparison between anterolateral and posterior approach. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e318267f5f9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Are hip resurfacing arthroplasties meeting the needs of our patients? A 2-year follow-up study. J Arthroplasty 2012; 27:984-9. [PMID: 22425301 DOI: 10.1016/j.arth.2012.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/23/2012] [Indexed: 02/01/2023] Open
Abstract
Hip resurfacing arthroplasty (HRA) is a treatment of end-stage hip arthritis in young patients with excellent bone stock. One hundred four consecutive HRAs (Depuy ASR, Warsaw, Ind) were performed with 36-Item Short Form Health Survey (SF-36), Western Ontario and McMaster University Osteoarthritis Index, Harris Hip Scores, and University of California, Los Angeles activity ratings obtained preoperatively, at 6 months, and at 1 and 2 years postoperatively. Four patients required conversion to total hip arthroplasty. All patients showed significant improvements in their activity, pain, stiffness, and function postoperatively. Patients with lower SF-36 mental component scores (MCSs) improved their MCS compared with those of the general population, as well as improving their pain and physical functioning scores. These findings demonstrate reliable improvements in standard quality of life measures in patients undergoing HRA, including those with low preoperative SF-36 MCS.
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Kunz M, Waldman SD, Rudan JF, Bardana DD, Stewart AJ. Computer-assisted mosaic arthroplasty using patient-specific instrument guides. Knee Surg Sports Traumatol Arthrosc 2012; 20:857-61. [PMID: 21845467 DOI: 10.1007/s00167-011-1638-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 07/26/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Success of mosaic arthroplasty requires that the transplanted plugs be positioned to reconstruct the curvature and height of the original articular surface. This case report demonstrates how to achieve correct plug positioning using patient-specific instrument guides manufactured on a 3D printer. METHODS Using a 3D computer model of bone and cartilage, the harvesting of plugs and their placement at the defect site was planned on the computer. Instrument guides were manufactured in thermoplastic on a 3D printer; the bottom surface of the guides fit to the contour of the knee and the top surface contained holes to precisely position the surgical instruments. The instrument guides were used on a young female patient to repair a large articular cartilage defect in the left knee. RESULTS The patient showed an increased range of motion in the knee and also a decrease in pain and discomfort at her 2-year follow-up. A CT arthrogram at 2 years postoperative showed a smooth and appropriate contour of the reconstructed cartilage over the defect. CONCLUSIONS Image-based preoperative planning and the use of patient-specific instrument guides can yield a good patient outcome without requiring optically tracked intraoperative guidance.
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Affiliation(s)
- Manuela Kunz
- Department of Surgery, Kingston General Hospital, Queen's University, Kingston, ON, K7L 3N6, Canada
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Pompeu-Robinson A, Kunz M, Falkson CB, Schreiner LJ, Joshi CP, Fichtinger G. Immobilization and catheter guidance for breast brachytherapy. Int J Comput Assist Radiol Surg 2011; 7:65-72. [DOI: 10.1007/s11548-011-0600-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 04/26/2011] [Indexed: 11/28/2022]
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Abstract
With experience in metal-metal resurfacing, several opportunities to improve resurfacing technology have been identified. There is a need for better education on hip resurfacing in residency training programs. The majority of short-term complications associated with resurfacing are related to surgical technique or component position. Innovations to improve acetabular component position and femoral-acetabular mating are needed. Although the majority of high wear and adverse local tissue reactions (ALTR) can be prevented by proper component positioning, the variable exposure to metal particles and ions associated with metal-metal resurfacing components continues to be a concern and bearing surface technology will evolve.
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