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Alnemer MS, Kotliar KE, Neuhaus V, Pape HC, Ciritsis BD. Cost-effectiveness analysis of surgical proximal femur fracture prevention in elderly: a Markov cohort simulation model. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:77. [PMID: 37880692 PMCID: PMC10601292 DOI: 10.1186/s12962-023-00482-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Hip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices. METHODS This study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results. RESULTS With a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side's prophylaxis, the patient's age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold. CONCLUSION Due to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks.
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Affiliation(s)
- Momin S. Alnemer
- Department of Medical Engineering and Technomathematics, Aachen University of Applied Sciences, Campus Juelich, Heinrich-Mussmann-Str. 1, 52428 Juelich, Germany
| | - Konstantin E. Kotliar
- Department of Medical Engineering and Technomathematics, Aachen University of Applied Sciences, Campus Juelich, Heinrich-Mussmann-Str. 1, 52428 Juelich, Germany
| | - Valentin Neuhaus
- Trauma Surgery Unit, Universitätsspital Zürich, Rämistrasse 100, Zürich, 8091 Switzerland
| | - Hans-Christoph Pape
- Trauma Surgery Unit, Universitätsspital Zürich, Rämistrasse 100, Zürich, 8091 Switzerland
| | - Bernhard D. Ciritsis
- Orthopaedic Surgery Unit, Centro Ortopedico di Quadrante, Lungolago Buozzi, 25, Omegna, VB 28887 Italy
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Yang Y, Wang Y, Zheng N, Cheng R, Zou D, Zhao J, Tsai TY. Development and Validation of a Novel In Vitro Joint Testing System for Reproduction of In Vivo Dynamic Muscle Force. Bioengineering (Basel) 2023; 10:1006. [PMID: 37760108 PMCID: PMC10525521 DOI: 10.3390/bioengineering10091006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/28/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
In vitro biomechanical experiments utilizing cadaveric specimens are one of the most effective methods for rehearsing surgical procedures, testing implants, and guiding postoperative rehabilitation. Applying dynamic physiological muscle force to the specimens is a challenge to reconstructing the environment of bionic mechanics in vivo, which is often ignored in the in vitro experiment. The current work aims to establish a hardware platform and numerical computation methods to reproduce dynamic muscle forces that can be applied to mechanical testing on in vitro specimens. Dynamic muscle loading is simulated through numerical computation, and the inputs of the platform will be derived. Then, the accuracy and robustness of the platform will be evaluated through actual muscle loading tests in vitro. The tests were run on three muscles (gastrocnemius lateralis, the rectus femoris, and the semitendinosus) around the knee joint and the results showed that the platform can accurately reproduce the magnitude of muscle strength (errors range from -6.2% to 1.81%) and changing pattern (goodness-of-fit range coefficient ranges from 0.00 to 0.06) of target muscle forces. The robustness of the platform is mainly manifested in that the platform can still accurately reproduce muscle force after changing the hardware combination. Additionally, the standard deviation of repeated test results is very small (standard ranges of hardware combination 1: 0.34 N~2.79 N vs. hardware combination 2: 0.68 N~2.93 N). Thus, the platform can stably and accurately reproduce muscle forces in vitro, and it has great potential to be applied in the future musculoskeletal loading system.
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Affiliation(s)
- Yangyang Yang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Yufan Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Jie Zhao
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Bakhtiarinejad M, Gao C, Farvardin A, Zhu G, Wang Y, Oni JK, Taylor RH, Armand M. A Surgical Robotic System for Osteoporotic Hip Augmentation: System Development and Experimental Evaluation. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2023; 5:18-29. [PMID: 37213937 PMCID: PMC10195101 DOI: 10.1109/tmrb.2023.3241589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Minimally-invasive Osteoporotic Hip Augmentation (OHA) by injecting bone cement is a potential treatment option to reduce the risk of hip fracture. This treatment can significantly benefit from computer-assisted planning and execution system to optimize the pattern of cement injection. We present a novel robotic system for the execution of OHA that consists of a 6-DOF robotic arm and integrated drilling and injection component. The minimally-invasive procedure is performed by registering the robot and preoperative images to the surgical scene using multiview image-based 2D/3D registration with no external fiducial attached to the body. The performance of the system is evaluated through experimental sawbone studies as well as cadaveric experiments with intact soft tissues. In the cadaver experiments, distance errors of 3.28mm and 2.64mm for entry and target points and orientation error of 2.30° are calculated. Moreover, the mean surface distance error of 2.13mm with translational error of 4.47mm is reported between injected and planned cement profiles. The experimental results demonstrate the first application of the proposed Robot-Assisted combined Drilling and Injection System (RADIS), incorporating biomechanical planning and intraoperative fiducial-less 2D/3D registration on human cadavers with intact soft tissues.
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Affiliation(s)
- Mahsan Bakhtiarinejad
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Cong Gao
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Amirhossein Farvardin
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Gang Zhu
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Yu Wang
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Julius K Oni
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Russell H Taylor
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Mehran Armand
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
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Sas A, Sermon A, van Lenthe GH. Experimental validation of a voxel-based finite element model simulating femoroplasty of lytic lesions in the proximal femur. Sci Rep 2022; 12:7602. [PMID: 35534595 PMCID: PMC9085891 DOI: 10.1038/s41598-022-11667-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/15/2022] [Indexed: 11/09/2022] Open
Abstract
Femoroplasty is a procedure where bone cement is injected percutaneously into a weakened proximal femur. Uncertainty exists whether femoroplasty provides sufficient mechanical strengthening to prevent fractures in patients with femoral bone metastases. Finite element models are promising tools to evaluate the mechanical effectiveness of femoroplasty, but a thorough validation is required. This study validated a voxel-based finite element model against experimental data from eight pairs of human cadaver femurs with artificial metastatic lesions. One femur from each pair was left untreated, while the contralateral femur was augmented with bone cement. Finite element models accurately predicted the femoral strength in the defect (R2 = 0.96) and augmented (R2 = 0.93) femurs. The modelled surface strain distributions showed a good qualitative match with results from digital image correlation; yet, quantitatively, only moderate correlation coefficients were found for the defect (mean R2 = 0.78) and augmented (mean R2 = 0.76) femurs. This was attributed to the presence of vessel holes in the femurs and the jagged surface representation of our voxel-based models. Despite some inaccuracies in the surface measurements, the FE models accurately predicted the global bone strength and qualitative deformation behavior, both before and after femoroplasty. Hence, they can offer a useful biomechanical tool to assist clinicians in assessing the need for prophylactic augmentation in patients with metastatic bone disease, as well as in identifying suitable patients for femoroplasty.
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Affiliation(s)
- Amelie Sas
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300C, 3001, Leuven, Belgium
| | - An Sermon
- Department of Traumatology, University Hospitals Gasthuisberg, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - G Harry van Lenthe
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300C, 3001, Leuven, Belgium.
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