1
|
Park JW, Chang CB, Lee YK, Suh J, Kim J, Shin T, Kim Y, Kang D, Kim JH. Mitigating polyethylene-mediated periprosthetic tissue inflammation through MEDSAH-grafting. PLoS One 2024; 19:e0301618. [PMID: 38843277 PMCID: PMC11156361 DOI: 10.1371/journal.pone.0301618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/19/2024] [Indexed: 06/09/2024] Open
Abstract
Periprosthetic tissue inflammation is a challenging complication arising in joint replacement surgeries, which is often caused by wear debris from polyethylene (PE) components. In this study, we examined the potential biological effects of grafting a [2-(methacryloyloxy)ethyl]dimethyl-(3-sulfopropyl)ammonium hydroxide (MEDSAH) polymer onto the surface of PE through a solvent-evaporation technique. J774A.1 macrophage-like cells and primary cultured mouse osteoblasts were treated with PE powder with or without the MEDSAH coating. MEDSAH grafting on PE substantially reduced the expression of pro-inflammatory cytokines and other mediators in primary cultured mouse osteoblasts, but did not significantly impact macrophage-mediated inflammation. Our findings suggest that a MEDSAH coating on PE-based materials has potential utility in mitigating periprosthetic tissue inflammation and osteolysis and preventing aseptic loosening in total joint replacements. Further research, including large-scale clinical trials and biomechanical analyses, is needed to assess the long-term performance and clinical implications of MEDSAH-coated PE-based materials in total joint arthroplasty.
Collapse
Affiliation(s)
- Jung-Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jooyeon Suh
- Center for RNA Research, Institute for Basic Science, Seoul, South Korea
- Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, South Korea
| | | | - Taejin Shin
- R&D Center, Corentec Co., Ltd., Seoul, South Korea
| | - YongHwa Kim
- R&D Center, Corentec Co., Ltd., Seoul, South Korea
| | - Donghyun Kang
- Center for RNA Research, Institute for Basic Science, Seoul, South Korea
- Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, South Korea
| | - Jin-Hong Kim
- Center for RNA Research, Institute for Basic Science, Seoul, South Korea
- Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, South Korea
| |
Collapse
|
2
|
Xing D, Li R, Li JJ, Tao K, Lin J, Yan T, Zhou D. Catastrophic Periprosthetic Osteolysis in Total Hip Arthroplasty at 20 Years: A Case Report and Literature Review. Orthop Surg 2022; 14:1918-1926. [PMID: 35819098 PMCID: PMC9363776 DOI: 10.1111/os.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Periprosthetic osteolysis is a serious complication following total hip arthroplasty (THA). However, most orthopedic surgeons only focus on bone loss and hip reconstruction. Thus, it was required to understand the treatment algorithm for periprosthetic osteolysis integrally. CASE PRESENTATION A 52-year-old Asian male presented with chronic hip pain. A mass appeared on the medial side of the proximal left thigh at more than 20 years after bilateral THA. Radiographs revealed catastrophic periprosthetic osteolysis, especially on the acetabular side. Large amounts of necrotic tissue and bloody fluids were thoroughly debrided during revision THA. A modular hemipelvic prosthesis was used for revision of the left hip. Four years later, the patient presented with right hip pain, where a mass appeared on the medial side of the proximal right thigh. A primary acetabular implant with augment was used for revision of the right hip. Laboratory evaluation of bloody fluid retrieved from surgery revealed elevated levels of inflammatory markers. CONCLUSION Inflammatory responses to polyethylene wear debris can lead to severe bone resorption and aseptic loosening in the long-term following THA. Therefore, in spite of revision THA, interrupting the cascade inflammatory might be the treatment principle for periprosthetic osteolysis.
Collapse
Affiliation(s)
- Dan Xing
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Rujun Li
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Ke Tao
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Jianhao Lin
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Diange Zhou
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| |
Collapse
|
3
|
Sefati S, Hegeman R, Iordachita I, Taylor RH, Armand M. A Dexterous Robotic System for Autonomous Debridement of Osteolytic Bone Lesions in Confined Spaces: Human Cadaver Studies. IEEE T ROBOT 2022; 38:1213-1229. [PMID: 35633946 PMCID: PMC9138669 DOI: 10.1109/tro.2021.3091283] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
This article presents a dexterous robotic system for autonomous debridement of osteolytic bone lesions in confined spaces. The proposed system is distinguished from the state-of-the-art orthopedics systems because it combines a rigid-link robot with a continuum manipulator (CM) that enhances reach in difficult-to-access spaces often encountered in surgery. The CM is equipped with flexible debriding instruments and fiber Bragg grating sensors. The surgeon plans on the patient’s preoperative computed tomography and the robotic system performs the task autonomously under the surgeon’s supervision. An optimization-based controller generates control commands on the fly to execute the task while satisfying physical and safety constraints. The system design and controller are discussed and extensive simulation, phantom and human cadaver experiments are carried out to evaluate the performance, workspace, and dexterity in confined spaces. Mean and standard deviation of target placement are 0.5 and 0.18 mm, and the robotic system covers 91% of the workspace behind an acetabular implant in treatment of hip osteolysis, compared to the 54% that is achieved by conventional rigid tools.
Collapse
Affiliation(s)
- Shahriar Sefati
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Rachel Hegeman
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Russell H Taylor
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Mehran Armand
- Department of Orthopedic Surgery, The Johns Hopkins Medical School, Baltimore, MD 21205 USA
| |
Collapse
|
4
|
Gagala J. Minimum 10 years clinical and radiological outcomes of acetabular revisions of total hip arthroplasties with tricalcium phosphate/hydroxyapatite bone graft substitute. BMC Musculoskelet Disord 2021; 22:835. [PMID: 34587917 PMCID: PMC8480101 DOI: 10.1186/s12891-021-04694-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 08/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aseptic loosening is the most frequent indication for revision of total hip arthroplasty. Revision arthroplasty of acetabular component is a challenge for every surgeon because they have to simultaneously deal with the reconstruction of bone defects, adequate implant geometry and stable fixation. Allografts are the most frequently used materials in reconstruction of bone loss during revision surgeries. Because of an increasing number of revision hip arthroplasties and poor availability of allografts, we decided to use bone graft substitutes in acetabular revisions. METHODS Between September 2005 and January 2010, 44 revision arthroplasties in 43 patients were performed with the use of bone graft substitutes for acetabular defect reconstruction in revision of total hip arthroplasty. Acetabular bone defects were classified according to Paprosky. Seventeen hips were classified as IIA, 3 hips IIB, 3 hips IIC, 10 hips IIIA and 11 hips IIIB. Acetabular bone defects were reconstructed with tricalcium phosphate/hydroxyapatite bone graft substitute - BoneSave. Clinical and radiological examination was performed after 3 months, 1 year and then annually. Harris hip score was used for clinical evaluation. Survival analysis was performed with Kaplan-Meier method with aseptic loosening as the definition of endpoint. RESULTS The average follow-up period is 12 (range from 10 to 15) years. During the follow-up, three patients died after 24 months because of causes not related to surgery. None of the patients was lost to follow-up. The evaluation of clinical results revealed an increase in pre-operative HHS from average 38.3 (range 25 to 55) points to average 86.3 (range 45 to 95) points at the most recent follow-up. Radiographic evaluation showed the migration of one revision cage 12 months after surgery. Revision arthroplasty performed after 14 months revealed the partial incorporation of bone graft substitute. There were not any cases of loosening of revision acetabular cup at the most recent follow up examination in the remaining 39 patients. Bone graft substitute was not absorbed in all of these patients. The survival after 10 years amounted to 97.56%. CONCLUSION Bone graft substitute Bone Save may be suitable for acetabular revision surgery, however preoperative bone defect is critical for success and determining of a surgical technique, so this is multifactorial in this challenge surgery.
Collapse
Affiliation(s)
- Jacek Gagala
- Orthopaedic and Traumatology Department, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland.
| |
Collapse
|
5
|
Ma JH, Sefati S, Taylor RH, Armand M. An Active Steering Hand-held Robotic System for Minimally Invasive Orthopaedic Surgery Using a Continuum Manipulator. IEEE Robot Autom Lett 2021; 6:1622-1629. [PMID: 33869745 PMCID: PMC8052093 DOI: 10.1109/lra.2021.3059634] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper presents the development and experimental evaluation of an active steering hand-held robotic system for milling and curved drilling in minimally invasive orthopaedic interventions. The system comprises a cable-driven continuum dexterous manipulator (CDM), an actuation unit with a handpiece, and a flexible, rotary cutting tool. Compared to conventional rigid drills, the proposed system enhances dexterity and reach in confined spaces in surgery, while providing direct control to the surgeon with sufficient stability while cutting/milling hard tissue. Of note, for cases that require precise motion, the system is able to be mounted on a positioning robot for additional controllability. A proportional-derivative (PD) controller for regulating drive cable tension is proposed for the stable steering of the CDM during cutting operations. The robotic system is characterized and tested with various tool rotational speeds and cable tensions, demonstrating successful cutting of three-dimensional and curvilinear tool paths in simulated cancellous bone and bone phantom. Material removal rates (MRRs) of up to 571 mm3/s are achieved for stable cutting, demonstrating great improvement over previous related works.
Collapse
Affiliation(s)
- Justin H Ma
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Shahriar Sefati
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Russell H Taylor
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Mehran Armand
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Johns Hopkins University Medical School, Baltimore, MD, USA
| |
Collapse
|
6
|
Sefati S, Hegeman R, Alambeigi F, Iordachita I, Kazanzides P, Khanuja H, Taylor RH, Armand M. A Surgical Robotic System for Treatment of Pelvic Osteolysis Using an FBG-Equipped Continuum Manipulator and Flexible Instruments. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2021; 26:369-380. [PMID: 34025108 PMCID: PMC8132934 DOI: 10.1109/tmech.2020.3020504] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This paper presents the development and experimental evaluation of a redundant robotic system for the less-invasive treatment of osteolysis (bone degradation) behind the acetabular implant during total hip replacement revision surgery. The system comprises a rigid-link positioning robot and a Continuum Dexterous Manipulator (CDM) equipped with highly flexible debriding tools and a Fiber Bragg Grating (FBG)-based sensor. The robot and the continuum manipulator are controlled concurrently via an optimization-based framework using the Tip Position Estimation (TPE) from the FBG sensor as feedback. Performance of the system is evaluated on a setup that consists of an acetabular cup and saw-bone phantom simulating the bone behind the cup. Experiments consist of performing the surgical procedure on the simulated phantom setup. CDM TPE using FBGs, target location placement, cutting performance, and the concurrent control algorithm capability in achieving the desired tasks are evaluated. Mean and standard deviation of the CDM TPE from the FBG sensor and the robotic system are 0.50 mm, and 0.18 mm, respectively. Using the developed surgical system, accurate positioning and successful cutting of desired straight-line and curvilinear paths on saw-bone phantoms behind the cup with different densities are demonstrated. Compared to the conventional rigid tools, the workspace reach behind the acetabular cup is 2.47 times greater when using the developed robotic system.
Collapse
Affiliation(s)
- Shahriar Sefati
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA, 21218
| | - Rachel Hegeman
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA, 21218; Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - Farshid Alambeigi
- Johns Hopkins University during the completion of this work and he is currently with the Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA, 78712
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA, 21218
| | - Peter Kazanzides
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA, 21218
| | - Harpal Khanuja
- Department of Orthopedic Surgery, The Johns Hopkins Medical School, Baltimore, MD, USA, 21205
| | - Russell H Taylor
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA, 21218
| | - Mehran Armand
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA, 21218; Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA; Department of Orthopedic Surgery, The Johns Hopkins Medical School, Baltimore, MD, USA, 21205
| |
Collapse
|
7
|
Evaluation and Treatment of Patients With Acetabular Osteolysis After Total Hip Arthroplasty. J Am Acad Orthop Surg 2019; 27:e258-e267. [PMID: 30325878 DOI: 10.5435/jaaos-d-16-00685] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
As the demand for total hip arthroplasty (THA) continues to increase, the burden of revision THA is also expected to increase. Although the quality of polyethylene has improved markedly, osteolysis continues to be a risk for older designs and younger, active patients. Although progressive but typically asymptomatic in early stages, osteolysis can result in component failure and complicate revision surgery. Serial radiographs are paramount for monitoring progression. Although select cases may be treated with observation, surgery should be considered based on age, activity level, and projected life span. Well-fixed, noncemented modular acetabular components may be treated with curettage and bone grafting, as well as having to bear liner exchange with retention of the acetabular shell. However, in the setting of osteolysis, it is controversial whether bone grafting and component retention is superior to cup revision. This review explores the pathophysiology of osteolysis after THA and provides a comprehensive analysis of the evaluation and treatment of patients with osteolysis.
Collapse
|
8
|
Outcome of 4 Surgical Treatments for Wear and Osteolysis of Cementless Acetabular Components. J Arthroplasty 2017; 32:2799-2805. [PMID: 28587888 DOI: 10.1016/j.arth.2017.04.028] [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: 07/10/2016] [Revised: 04/17/2017] [Accepted: 04/17/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Loosening and periprosthetic osteolysis are some of the most common long-term complications after hip arthroplasty. The decision-making process and surgical treatment options are controversial. METHODS We retrospectively reviewed 96 acetabular revisions (91 patients) performed between 2002 and 2012, with a minimum of 2 years of follow-up and a mean of 5.7 years of follow-up. Clinical outcome was assessed using the Harris Hip Score. The size and location of osteolytic lesions were evaluated using the preoperative radiographs; healing of the defects was categorized using a standardized protocol. RESULTS Thirty-three (34.4%) hips had isolated liner exchanges (ILEs), 10 (10.4%) hips had cemented liners into well-fixed shells (CLS), 45 (46.9%) hips had full acetabular revisions (FARs), and 8 (8.3%) hips had revision with a roof ring/antiprotrusio cage (RWC). All procedures showed significant improvement in Harris Hip Score after revision (P ≤ .001). Fifteen patients had moderate residual pain (pain score ≤20): 8 (24%) ILE, 3 (30%) CLS, and 4 (9%) FAR. Complete bone defect healing after grafting was lower with acetabular component retention procedures (ILE and CLS; 27%) compared with full acetabular component revision procedures (FAR and RWC; 57%). Fifteen patients underwent reoperation: 3 ILE, 1 CLS, 8 FAR, and 3 RWC. CONCLUSION Acetabular component retention demonstrates a low risk of reoperation; however, residual pain and limited potential for bone graft incorporation are a concern. FAR is technically challenging and may have an elevated risk of reoperation; however, higher degrees of bone graft incorporation and satisfactory clinical outcome can be expected.
Collapse
|
9
|
Gao A, Murphy RJ, Liu H, Iordachita II, Armand M. Mechanical Model of Dexterous Continuum Manipulators with Compliant Joints and Tendon/External Force Interactions. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2017; 22:465-475. [PMID: 28989273 PMCID: PMC5627610 DOI: 10.1109/tmech.2016.2612833] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Dexterous continuum manipulators (DCMs) have been widely adopted for minimally- and less-invasive surgery. During the operation, these DCMs interact with surrounding anatomy actively or passively. The interaction force will inevitably affect the tip position and shape of DCMs, leading to potentially inaccurate control near critical anatomy. In this paper, we demonstrated a 2D mechanical model for a tendon actuated, notched DCM with compliant joints. The model predicted deformation of the DCM accurately in the presence of tendon force, friction force, and external force. A partition approach was proposed to describe the DCM as a series of interconnected rigid and flexible links. Beam mechanics, taking into consideration tendon interaction and external force on the tip and the body, was applied to obtain the deformation of each flexible link of the DCM. The model results were compared with experiments for free bending as well as bending in the presence of external forces acting at either the tip or body of the DCM. The overall mean error of tip position between model predictions and all of the experimental results was 0.62±0.41mm. The results suggest that the proposed model can effectively predict the shape of the DCM.
Collapse
Affiliation(s)
- Anzhu Gao
- State key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang, China; A. Gao is also with University of Chinese Academy of Sciences, Beijing, China
| | - Ryan J Murphy
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723-6099, USA
| | - Hao Liu
- State key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang, China; A. Gao is also with University of Chinese Academy of Sciences, Beijing, China
| | - Iulian I Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD 21218, USA
| | - Mehran Armand
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD 21218, USA. Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723-6099, USA
| |
Collapse
|
10
|
Murphy RJ, Otake Y, Wolfe KC, Taylor RH, Armand M. Effects of tools inserted through snake-like surgical manipulators. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:6854-8. [PMID: 25571571 DOI: 10.1109/embc.2014.6945203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Snake-like manipulators with a large, open lumen can offer improved treatment alternatives for minimally-and less-invasive surgeries. In these procedures, surgeons use the manipulator to introduce and control flexible tools in the surgical environment. This paper describes a predictive algorithm for estimating manipulator configuration given tip position for nonconstant curvature, cable-driven manipulators using energy minimization. During experimental bending of the manipulator with and without a tool inserted in its lumen, images were recorded from an overhead camera in conjunction with actuation cable tension and length. To investigate the accuracy, the estimated manipulator configuration from the model and the ground-truth configuration measured from the image were compared. Additional analysis focused on the response differences for the manipulator with and without a tool inserted through the lumen. Results indicate that the energy minimization model predicts manipulator configuration with an error of 0.24 ± 0.22mm without tools in the lumen and 0.24 ± 0.19mm with tools in the lumen (no significant difference, p = 0.81). Moreover, tools did not introduce noticeable perturbations in the manipulator trajectory; however, there was an increase in requisite force required to reach a configuration. These results support the use of the proposed estimation method for calculating the shape of the manipulator with an tool inserted in its lumen when an accuracy range of at least 1mm is required.
Collapse
|
11
|
Liu H, Farvardin A, Grupp R, Murphy RJ, Taylor RH, Iordachita I, Armand M. Shape Tracking of a Dexterous Continuum Manipulator Utilizing Two Large Deflection Shape Sensors. IEEE SENSORS JOURNAL 2015; 15:5494-5503. [PMID: 27761103 PMCID: PMC5067107 DOI: 10.1109/jsen.2015.2442266] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Dexterous continuum manipulators (DCMs) can largely increase the reachable region and steerability for minimally and less invasive surgery. Many such procedures require the DCM to be capable of producing large deflections. The real-time control of the DCM shape requires sensors that accurately detect and report large deflections. We propose a novel, large deflection, shape sensor to track the shape of a 35 mm DCM designed for a less invasive treatment of osteolysis. Two shape sensors, each with three fiber Bragg grating sensing nodes is embedded within the DCM, and the sensors' distal ends fixed to the DCM. The DCM centerline is computed using the centerlines of each sensor curve. An experimental platform was built and different groups of experiments were carried out, including free bending and three cases of bending with obstacles. For each experiment, the DCM drive cable was pulled with a precise linear slide stage, the DCM centerline was calculated, and a 2D camera image was captured for verification. The reconstructed shape created with the shape sensors is compared with the ground truth generated by executing a 2D-3D registration between the camera image and 3D DCM model. Results show that the distal tip tracking accuracy is 0.40 ± 0.30 mm for the free bending and 0.61 ± 0.15 mm, 0.93 ± 0.05 mm and 0.23 ± 0.10 mm for three cases of bending with obstacles. The data suggest FBG arrays can accurately characterize the shape of large-deflection DCMs.
Collapse
Affiliation(s)
- Hao Liu
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 100080, China, and also with the Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Amirhossein Farvardin
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Robert Grupp
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Ryan J. Murphy
- Applied Physics Laboratory, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Russell H. Taylor
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Mehran Armand
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA, and also with the Applied Physics Laboratory, Johns Hopkins University, Baltimore, MD 21218 USA
| |
Collapse
|
12
|
Abstract
A common situation presenting to the orthopaedic surgeon today is a worn acetabular liner with substantial acetabular and pelvic osteolysis. The surgeon has many options for dealing with osteolytic defects. These include allograft, calcium based substitutes, demineralised bone matrix, or combinations of these options with or without addition of platelet rich plasma. To date there are no clinical studies to determine the efficacy of using bone-stimulating materials in osteolytic defects at the time of revision surgery and there are surprisingly few studies demonstrating the clinical efficacy of these treatment options. Even when radiographs appear to demonstrate incorporation of graft material CT studies have shown that incorporation is incomplete. The surgeon, in choosing a graft material for a surgical procedure must take into account the efficacy, safety, cost and convenience of that material. Cite this article: Bone Joint J 2014;96-B (11 Suppl A):70–2.
Collapse
Affiliation(s)
- J. J. Callaghan
- University of Iowa, Department
of Orthopaedics, 200 Hawkins Drive, UIHC, 01029
JPP, Iowa City, Iowa 52242, USA
| | - S. S. Liu
- University of Iowa, Department
of Orthopaedics, 200 Hawkins Drive, UIHC, 01029
JPP, Iowa City, Iowa 52242, USA
| | - O-A. Phruetthiphat
- University of Iowa, Department
of Orthopaedics, 200 Hawkins Drive, UIHC, 01029
JPP, Iowa City, Iowa 52242, USA
| |
Collapse
|
13
|
Abstract
SUMMARYThis paper presents a cable-driven dexterous manipulator with a large, open lumen. One specific application for the manipulator is the treatment of the degeneration of bone tissue (osteolysis) during a less-invasive hip revision surgery. Rigid tools used in traditional approaches limit the surgeons' ability to comprehensively treat the osteolysis due to the complex geometries of the lesion. The surgical scenario, testing, kinematic modeling, and image-based inverse kinematics are described. Testing shows 94% coverage of a lesion wall; the kinematic model describes manipulator notch positions within 0.15 mm, while the image-based inverse kinematics has 0.36 mm error. This manipulator is potentially useful in treating osteolytic lesions through (1) effective lesion exploration compared to conventional techniques, and (2) rapidly performing inverse kinematics from visual feedback.
Collapse
|
14
|
Periprosthetic osteolysis after total hip replacement: molecular pathology and clinical management. Inflammopharmacology 2013; 21:389-96. [DOI: 10.1007/s10787-013-0192-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
|
15
|
Abstract
Periacetabular osteolysis is a common etiology of prosthesis failure in patients who undergo total hip arthroplasty. These lesions are treated by open and, more recently, percutaneous techniques. The purpose of this study was to determine the relevant surface anatomy and bony landmarks in establishing percutaneous access to periacetabular regions and identifying critical at-risk structures in establishing access. Percutaneous access to the periacetabular region was established superiorly, anteroinferiorly, and posteroinferiorly by using 5 L5-to-mid thigh fixed cadaver pelvises with latex-injected vessels using threaded guidewires. Dissection was completed to identify structures at risk, with the distance from the wires recorded to the nearest millimeter. C-arm position for the optimal visualization and placement of guidewires was recorded. Average distance from the pin and the at-risk structures ranged from 11.2 to 38.7 mm. All 3 approaches allowed for safe percutaneous access to the periacetabular regions without injuring significant anatomical structures. This study established safe starting points and orientation for guidewires and radiograph projections associated with percutaneous access to the periacetabular regions. The findings in this study will be useful for developing minimally invasive approaches to these regions for the treatment of osteolytic lesions of diverse etiology. However, a biomechanical evaluation of the impact of these bony channels on the strength of pelvis under physiological and unanticipated loading must be performed before this technique can be safely translated to clinical practice.
Collapse
Affiliation(s)
- Mark Eilers
- Department of Surgery, Division of Orthopaedics, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | | | | | | | | |
Collapse
|
16
|
Kang P, Yang J, Zhou Z, Shen B, Pei F. Retention of a well-fixed acetabular component in the setting of acetabular osteolysis. INTERNATIONAL ORTHOPAEDICS 2012; 36:949-54. [PMID: 22350140 DOI: 10.1007/s00264-011-1372-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 01/25/2012] [Indexed: 02/05/2023]
Abstract
PURPOSE The treatment strategy for pelvic osteolysis with a well-fixed acetabular component after total hip arthroplasty(THA) involves replacing the acetabular cup liner and femoral head, débriding osteolytic lesions, and grafting. METHODS We investigated whether retention of a well-fixed acetabular component using the two-approach technique—the ilioinguinal approach combined with the posterolateral approach—was compatible with socket survival. Were viewed clinical and radiographic findings for 24 patients(24 hips) who had undergone acetabular revision arthroplasty of a well-fixed socket for progressive osteolysis. The surgical techniques used included osteolytic lesion débridement and bone grafting through the ilioinguinal approach,and replacement of the acetabular liner and femoral head through the posterolateral approach. RESULTS The mean duration of follow-up after revision was 2.3 (range 2.1–3.9) years. At follow-up evaluation, all acetabular components were well fixed and showed no evidence of loosening, osseous integration was apparent and there was no radiographic evidence that any lesions had progressed. No new osteolytic lesions were identified, and there were no clinical or radiographic complications. CONCLUSIONS Curettage and bone grafting under direct vision, cup liner and femoral-head replacement because of progressive retroacetabular osteolysis and retention of well fixed components using the two-approach technique results in good osseous integration of lysis. Larger studies with longer follow-up periods are required to establish the longterm success of this technique.
Collapse
Affiliation(s)
- Pengde Kang
- Department of Orthopaedics, West China Hospital, Sichuan University, 37 Guo-xue Lane, Wu-hou District, Chengdu 610041, China.
| | | | | | | | | |
Collapse
|
17
|
Mall NA, Nunley RM, Smith KE, Maloney WJ, Clohisy JC, Barrack RL. The fate of grafting acetabular defects during revision total hip arthroplasty. Clin Orthop Relat Res 2010; 468:3286-94. [PMID: 20577842 PMCID: PMC2974866 DOI: 10.1007/s11999-010-1427-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acetabular defects are frequently grafted during revision THA. Previous studies using plain radiographs report high rates of graft incorporation. However, given plain radiographs underestimate osteolysis, it is unclear whether plain radiographs adequately reflect graft fill or incorporation. QUESTIONS/PURPOSES We determined if (1) graft fill; or (2) incorporation (measured as graft-bone contact) differed with complete revision and grafting compared to liner exchange and grafting; (3) defect fill and incorporation could be assessed on plain radiographs; and (4) the cost of bone grafting differed with these two procedures. METHODS We identified 40 patients who underwent revision THA for aseptic loosening or polyethylene wear and osteolysis, either with retention of a well-fixed cup or complete acetabular revision in which bone graft was used. Lesion size, percent fill, and graft healing was quantified from CT scans. A limited cost analysis was performed using the current hospital costs for implants, bone grafts, and bone graft substitutes. The minimum followup was 1 year (mean, 4.8 years; range, 1-11 years). RESULTS The average defect fill was 30% (range, 0%-81%). The average percent of healing to host bone was 24% (range, 0-66%). Complete revisions had a higher percent defect fill compared to head/liner changes (47% versus 17%) as well as a higher degree of graft healing to host bone compared to head/liner changes (36% versus 14%). High resolution CT demonstrated lower percentages of defect fill and graft healing than previous reports based on plain radiographs. Bone grafting costs exceeded implant costs in the head/liner exchange group; however, the overall cost was higher in the complete revision group. CONCLUSIONS Higher degrees of defect fill and healing were seen with complete revisions compared to head/liner exchanges. Compared to CT scans, plain radiograph assessment tended to overestimate defect fill and healing.
Collapse
Affiliation(s)
- Nathan A. Mall
- Department of Orthopaedics, Washington University/Barnes Jewish Hospital, St. Louis, MO USA
| | - Ryan M. Nunley
- Department of Orthopaedics, Washington University/Barnes Jewish Hospital, St. Louis, MO USA
| | - Kirk E. Smith
- Mallinkrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
USA
| | | | - John C. Clohisy
- Department of Orthopaedics, Washington University/Barnes Jewish Hospital, St. Louis, MO USA
| | - Robert L. Barrack
- Department of Orthopaedics, Washington University/Barnes Jewish Hospital, St. Louis, MO USA ,Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO 63110 USA
| |
Collapse
|
18
|
Abstract
Periacetabular osteolysis is the greatest challenge for longevity of total hip arthroplasty. The generation of wear debris from the bearing surface is inevitably going to cause bone loss around the implants. The challenges for the arthroplasty surgeon in managing this problem are: detection, knowing when to intervene surgically, and choosing the best reconstructive option. From a surgical standpoint, the options for addressing osteolysis are: (1) liner exchange with or without bone grafting of lytic lesions; or (2) complete component revision. The advantages of "holding 'em" include a faster surgery, no bony disruption, a quicker recovery for the patient, and cost. The downside of isolated liner exchange is that there is a high rate of instability, there may be incomplete access to the lytic lesions, and the limitations of the existing component. There have been techniques developed to provide access to the retroacetabular lesions, particularly superolaterally via a trap-door technique. Alternatively, other surgeons have advocated injection of bone graft substitutes in the retroacetabular regions to fill osteolytic defects. However, one may not be able to take advantage of newer bearing materials, larger head sizes, or component reposition to improve stability and wear properties. The advantages of a complete component revision are access to lytic lesions, and the ability to modify component position and take advantage of newer technologies. The disadvantages are cost, a longer recovery, and bony disruption. Each method of addressing acetabular osteolysis has compelling reasons to use it; individual patient factors such as component type, size of lesion, and remaining bone will play a role in selecting the treatment.
Collapse
Affiliation(s)
- Edwin P Su
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA.
| |
Collapse
|
19
|
A three-dimensional method for evaluating changes in acetabular osteolytic lesions in response to treatment. Clin Orthop Relat Res 2010; 468:480-90. [PMID: 19701674 PMCID: PMC2806972 DOI: 10.1007/s11999-009-1050-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 08/03/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED The treatment of asymptomatic osteolysis among well-fixed cementless cups remains controversial. To compare the effectiveness of different treatment strategies, an objective technique for evaluating bone remodeling would be useful. By matching and comparing serial CT images with the aid of a computer-assisted imaging program, we developed a method to evaluate three-dimensional mineralization changes within osteolytic defects. Preoperative, immediate postoperative, and followup CT images were normalized based on a phantom with known densities and matched using image registration so that the same region could be analyzed on each image. New bone mineralization within the preoperative osteolytic lesion volume was quantified based on a patient-specific trabecular bone density threshold. As a pilot study, we applied this technique in 10 patients treated by polyethylene liner exchange with débridement and grafting of periacetabular osteolytic lesions using a calcium sulfate bone graft substitute. Relative to the preoperative osteolytic lesion volume, an average of 43% (range, 8%-72%) of each defect was filled with graft at revision. After resorption of the graft, an average of 24% (range, 9%-44%) of the original defect volume demonstrated evidence of new mineralization at 1-year followup. The amount of new mineralization was directly proportional (r(2) = 0.70) to the defect filling achieved at revision. CT-based image analysis offers an objective method for quantifying three-dimensional bone remodeling and can be used to evaluate the effectiveness of osteolysis treatment strategies. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
|
20
|
Cook SD, Patron LP, Salkeld SL, Smith KE, Whiting B, Barrack RL. Correlation of computed tomography with histology in the assessment of periprosthetic defect healing. Clin Orthop Relat Res 2009; 467:3213-20. [PMID: 19756903 PMCID: PMC2772920 DOI: 10.1007/s11999-009-1087-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Computed tomography (CT) may more accurately assess the healing of grafted osteolytic lesions around acetabular components compared with plain radiographs, although clinical validation is lacking. To determine whether clinical or micro-CT imaging could assess accurately the grafted lesion compared with histology, we therefore quantified bone healing and ingrowth to determine an effective rhBMP-2 dose and ratio to allograft bone when grafted adjacent to a cementless porous-coated component. We grafted surgically created acetabular defects in canines (n = 20) before uncemented total hip arthroplasty. At 6 weeks, embedded acetabula were imaged and the CT slice images matched to histology section images. The percentage of bone in the defect and growth into the porous surface was assessed quantitatively. Low-dose rhBMP-2 with allograft (1:5 ratio) resulted in a higher percentage of defect healing (43.8%) than rhBMP-2 alone (29.2%) and a higher percentage of bone ingrowth (15.7%) than allograft bone alone (1.1%) as measured by histology. Micro-CT measurements were similar to histologic measurements of defect healing, whereas clinical CT overestimated periprosthetic bone by 38%. Neither clinical CT nor micro-CT techniques are adequate for assessing ingrowth or the bone-implant interface with metal artifacts.
Collapse
Affiliation(s)
| | | | | | - Kirk E. Smith
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO USA
| | - Bruce Whiting
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO USA
| | - Robert L. Barrack
- Charles F. and Joanne Knight Distinguished Professor of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO 63110 USA
| |
Collapse
|
21
|
Pierannunzii L, Fischer F, d'Imporzano M. Retroacetabular osteolytic lesions behind well-fixed prosthetic cups: pilot study of bearings-retaining surgery. J Orthop Traumatol 2008; 9:225-31. [PMID: 19384491 PMCID: PMC2657328 DOI: 10.1007/s10195-008-0031-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 09/12/2008] [Indexed: 12/11/2022] Open
Abstract
Background Osteolytic lesions are common radiological findings behind acetabular prosthetic cups. If the cup is well-fixed, the management is quite controversial. Although implant exchange is the most reliable procedure, in most cases it could be considered overtreatment, with the potential for further morbidity and bone loss. Liner exchange associated with lesion debridement and grafting represents an alternative option that is less invasive. Here we present our experiences from a small pilot study of minimally invasive osteolysis treatment without bearings exchange in patients with no evidence of liner wear. Materials and methods Inclusion criteria: retroacetabular osteolytic lesions in ceramic-on-polyethylene or metal-on-polyethylene cementless total hip arthroplasties, affecting more than 50% of the bone–prosthesis interface on anteroposterior radiography. Exclusion criteria: head penetration into the liner, suspected loosening or infection. Six patients were selected, two asymptomatic and four symptomatic. Only the symptomatic patients accepted the proposed treatment (performed between June 2004 and March 2006). All of them received fluoroscopy-assisted lesion debridement through an iliac cortical window, morcellized bone allograft mixed with autologous platelet-rich plasma, joint exploration for culture and lavage through a small capsular window. Patients were followed up clinically and radiologically at six months, 12 months, and then yearly. Results Three patients out of four showed clinical and radiological improvement. One showed radiological improvement only, and recently underwent cup exchange for subsequent loosening. The visual analog scale (VAS) values for pain decreased on average, but not significantly. No major complications occurred. No recurrence was noted at 2.25–4 years’ follow-up. Conclusions Although the small series does not allow any absolute conclusions to be drawn, the reported results seem to justify further, wider studies. It is still unclear if osteolytic lesions associated with no wear of the poly liner would progress to implant failure if left untreated. Until the problem is better understood, this procedure might represent an interesting way to prevent potential loosening and severe bone loss in intact sockets.
Collapse
Affiliation(s)
- Luca Pierannunzii
- III Division of Orthopaedics and Trauma, Gaetano Pini Orthopaedic Institute, Piazza C. Ferrari, 1, 20122 Milan, Italy.
| | | | | |
Collapse
|