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Safali S, Berk T, Makelov B, Acar MA, Gueorguiev B, Pape HC. The Possibilities of Personalized 3D Printed Implants-A Case Series Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020249. [PMID: 36837451 PMCID: PMC9959288 DOI: 10.3390/medicina59020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
Background and Objectives: Following the most recent software and 3D printing developments, the use of personalized 3D printed orthopedic implants for treatment of complicated surgical cases has gained more popularity. Today, orthopedic problems that cannot be solved with standard implants may be effectively addressed using personalized prostheses. The aim of this study is to present the designing, modeling and production stages of four different personalized 3D printed prostheses and their application in clinical cases of patients who underwent treatment in various anatomical locations with a precisely specified indication for implantation. Materials and Methods: Based on computed tomography scanning, personalized 3D printed prostheses were designed, produced and used in four patients within a period of three to five days after injury or admission. Results: Early term follow-ups demonstrated good to excellent results. Conclusions: Personalized 3D printed prostheses offer an opportunity for a treatment of choice and provide good anatomical and functional results, shortened surgical time, less complications, and high satisfaction in patients with appropriate indications. The method should be considered primarily for patients with large bone defects, or such indicated for resection. Personalized 3D printed prostheses have the potential to become more common and beneficial in the future.
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Affiliation(s)
- Selim Safali
- Orthopaedics and Traumatology Department, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Till Berk
- AO Research Institute Davos, 7270 Davos, Switzerland
- Department of Trauma, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Biser Makelov
- University Multiprofile Hospital for Active Treatment ‘Prof. Stoyan Kirkovitch’, Trakia University, 6003 Stara Zagora, Bulgaria
| | - Mehmet Ali Acar
- Orthopaedics and Traumatology Department, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland
- Correspondence:
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Göksel F, Aycan A, Ermutlu C, Gölge UH, Sarısözen B. COMPARISON OF RADIOFREQUENCY ABLATION AND CURETTAGE IN OSTEOID OSTEOMA IN CHILDREN. ACTA ORTOPEDICA BRASILEIRA 2019; 27:100-103. [PMID: 30988655 PMCID: PMC6442716 DOI: 10.1590/1413-785220192702158113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Objective: Osteoid osteoma, which is observed in the adolescent and young adult population as benign bone tumors, appears as a single nidus with a diameter < 2 cm and is treated with open surgery. However, technological advances in medicine have made it possible to apply less invasive procedures in surgery. Methods: Between 2006–2014, 24 patients < 18 years of age were treated for osteoid osteoma. Patient demographic data, surgical data, complications, and recurrences were noted. Results: Twenty-four patients (mean age, 11 [2–18] years) were treated and followed up for a mean 3.58 (range, 1–9) years. Mean patient age in the curettage group was 12.1 (range, 3–18) years. Mean operation length was 69.5 (range, 60–120) minutes. Mean hospital stay was 1.3 (range, 0–2) days. Mean patient age in the radiofrequency ablation (RFA) group was 10.7 (range, 2–17) years. Five patients were female and 8 were male. Mean operation length was 49.6 (range, 20–90) minutes. Mean hospital stay was 0.3 (range, 0–1) days. Mean follow-up time was 1.76 (range, 1–4) years. Mean operation length, hospital stay, and follow-up were significantly shorter in the RFA group. Conclusions: Considering reduced costs due to shorter hospitalization periods and the ability to reach anatomically difficult locations, percutaneous procedures are likely to replace the conventional open approach. Level of evidence: II, retrospective study.
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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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Prod’homme M, Sans-Merce M, Pitteloud N, Damet J, Lascombes P. Intraoperative 2D C-arm and 3D O-arm in children: a comparative phantom study. J Child Orthop 2018; 12:550-557. [PMID: 30294382 PMCID: PMC6169555 DOI: 10.1302/1863-2548.12.180016] [Citation(s) in RCA: 6] [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] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Exposure to ionizing radiation is a concern for children during intraoperative imaging. We aimed to assess the radiation exposure to the paediatric patient with 2D and 3D imaging. METHODS To evaluate the radiation exposure, patient absorbed doses to the organs were measured in an anthropomorphic phantom representing a five-year-old child, using thermoluminescent dosimeters. For comparative purposes, organ doses were measured using a C-arm for one minute of fluoroscopy and one acquisition with an O-arm. The cone-beam was centred on the pelvis. Direct and scattered irradiations were measured and compared (Student's t-test). Skin entrance dose rates were also evaluated. RESULTS All radiation doses were expressed in µGy. Direct radiation doses of pelvic organs were between 631.22 and 1691.87 for the O-arm and between 214.08 and 737.51 for the C-arm, and were not significant (p = 0.07). Close scattered radiation on abdominal organs were between 25.11 and 114.85 for the O-arm and between 8.03 and 55.34 for the C-arm, and were not significant (p = 0.07). Far scattered radiation doses on thorax, neck and head varied from 0.86 to 6.42 for the O-arm and from 0.04 to 3.08 for the C-arm, and were significant (p = 0.02). The dose rate at the skin entrance was 328.58 µGy.s-1 for the O-arm and 1.90 with the C-arm. CONCLUSION During imaging of the pelvis, absorbed doses for a 3D O-arm acquisition were higher than with one minute fluoroscopy with the C-arm. Further clinical studies comparing effective doses are needed to assess ionizing risks of the intraoperative imaging systems in children.
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Affiliation(s)
- M. Prod’homme
- Medical University of Geneva, Geneva, Switzerland,Paediatric Orthopaedic Division, Geneva University Hospital (HUG), Geneva, Switzerland, Correspondence should be sent to M. Prod’homme, Paediatric Orthopaedic Division, Geneva University Hospital (HUG), Rue Willy-Donzé 6, CH-1211 Geneva, Switzerland. E-mail:
| | - M. Sans-Merce
- Radiology Division, Geneva University Hospital (HUG), Geneva, Switzerland,Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - N. Pitteloud
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland,Physics Section, University of Geneva, Geneva, Switzerland
| | - J. Damet
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland,Department of Radiology, University of Otago, Christchurch, New Zealand
| | - P. Lascombes
- Medical University of Geneva, Geneva, Switzerland,Paediatric Orthopaedic Division, Geneva University Hospital (HUG), Geneva, Switzerland
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Percutaneous excision of difficult osteoid osteomas using intraoperative AIRO CT navigation: a preliminary report. J Pediatr Orthop B 2018; 27:456-460. [PMID: 29035938 DOI: 10.1097/bpb.0000000000000505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Osteoid osteomas are well known for intraoperative technical difficulties for localization and adequate excision, especially when they are not clearly visualized on plain radiographs or when they occur in difficult and inaccessible situations. Localization in the radiology suite and shifting the patient to the operating room can be cumbersome, and can result in errors because of lack of real-time imaging. In these scenarios, intraoperative navigation will be useful. We report a technique of intraoperative computed tomography (CT) navigation for localization and excision of osteoid osteomas of the long bones. Six patients (four femoral and two tibial lesions) with a radiological diagnosis of osteoid osteoma, in whom the nidus could not be visualized clearly on plain radiographs, were treated with this technique. Intraoperative CT navigation with AIRO was performed and the images were registered to the computer. The lesion was then localized and excised using a high-speed burr. All patients underwent postexcision on-table CT scans, which showed complete excision of the nidus. All patients became symptom free and are doing well at a minimum follow-up of 6 months. Intraoperative CT navigation helps to exactly localize the nidus and also helps to confirm complete excision of the nidus. This is a safe, effective and minimally invasive method to treat osteoid osteomas, particularly those that are not amenable to excision under C arm guidance.
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Arıkan Y, Yavuz U, Lapcin O, Sökücü S, Özkan B, Kabukçuoğlu Y. Percutaneous radiofrequency ablation for osteoid osteoma under guidance of threedimensional fluoroscopy. J Orthop Surg (Hong Kong) 2016; 24:398-402. [PMID: 28031515 DOI: 10.1177/1602400326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the outcome of percutaneous radiofrequency ablation under guidance of 3-dimensional fluoroscopy in 17 patients with osteoid osteoma. METHODS Records of 11 male and 6 female consecutive patients aged 4 to 28 (mean, 13.8) years who underwent radiofrequency ablation under guidance of 3-dimensional fluoroscopy for osteoid osteoma and were followed up for a mean of 15.8 (range, 12-28) months were reviewed. All patients had been treated with analgesics but failed to achieve lasting pain relief. Visual analogue score (VAS) for pain was assessed pre- and post-operatively. Absence of pain was considered recovery. RESULTS The mean operating time was 55 (range, 20-95) minutes, and the mean length of hospital stay was 2.8 (range, 2-7) days. The mean amount of radiation was 390.2 (range, 330.5-423.6) mGy/cm. Relief of pain occurred within the first 24 hours in 11 patients and by the end of the first week in 3 patients. Pain persisted in 3 patients at one month; they underwent revision surgery and achieved complete recovery. The mean VAS for pain was 7.2 (range, 6-9) in 17 patients preoperatively and decreased to 0.64 (range, 0-2) in the 14 patients with pain relief and 0.66 (range, 0-1) in the 3 patients after revision surgery. Two patients had severe discharge from the wound secondary to fat necrosis, which resolved within a week with antibiotics and local dressings. No patient had cellulitis, vasomotor instability, neurovascular injury, fracture, or deep infection. CONCLUSION Percutaneous radiofrequency ablation under guidance of 3-dimensional fluoroscopy is a viable treatment option for osteoid osteoma.
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Affiliation(s)
- Yavuz Arıkan
- Orthopaedics and Traumatology Department, MS Baltalimani Bone Diseases Training and Research Hospital, Turkey
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Outani H, Hamada K, Takenaka S, Imura Y, Oshima K, Sotobori T, Naka N, Araki N, Yoshikawa H, Myoui A. Radiofrequency ablation of osteoid osteoma using a three-dimensional navigation system. J Orthop Sci 2016; 21:678-82. [PMID: 27320819 DOI: 10.1016/j.jos.2016.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to report the clinical outcomes for patients with osteoid osteoma (OO) treated by radiofrequency ablation (RFA) using a three-dimensional (3D) navigation system. METHODS We performed RFA using a 3D navigation system on 32 patients with clinically and radiologically diagnosed OO. This study included 25 males and 7 females with a median age of 20 years (range, 10-39 years). The median duration of follow-up was 18 months (range, 1-65 months). We investigated technical specifications, tumor localization, technical success, clinical success, biopsy success, complications, incomplete treatment, and recurrences. RESULTS Eighteen tumors were located in the femur, seven in the tibia, two in the humerus, and one each in the fibula, scapula, patella, lumbar vertebra, and acetabula. All procedures were technically successful, and pain relief was achieved in all patients. However, local recurrence developed in one patient, needing additional RFA. The clinical success rate was 96.8%. Biopsy showed OO in 12 patients (37%). Complications occurred in three patients (9%), two cases of fractures and one of osteomyelitis. CONCLUSIONS A 3D navigation provides real-time imaging and enables us to set the RFA needle in the correct position, particularly in case of OO-aroused complex anatomical structures. Our initial results indicated that radiofrequency ablation using a 3D navigation system is feasible and safe for patients with OO.
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Affiliation(s)
- Hidetatsu Outani
- Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashiknari, Osaka, 537-8511, Japan.
| | - Kenichiro Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Takenaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yoshinori Imura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kazuya Oshima
- Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashiknari, Osaka, 537-8511, Japan
| | - Tsukasa Sotobori
- Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashiknari, Osaka, 537-8511, Japan
| | - Norifumi Naka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Nobuhito Araki
- Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashiknari, Osaka, 537-8511, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Akira Myoui
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
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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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Yu F, Niu XH, Zhang Q, Zhao HT, Xu LH, Deng ZP. Radiofrequency ablation under 3D intraoperative Iso-C C-arm navigation for the treatment of osteoid osteomas. Br J Radiol 2015; 88:20140535. [PMID: 26415989 DOI: 10.1259/bjr.20140535] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of intraoperative three-dimensional (3D) Iso-C C-arm-navigated percutaneous radiofrequency ablation (RFA) of osteoid osteomas. METHODS 35 patients (20 males and 15 females) with osteoid osteomas underwent treatment with intraoperative 3D Iso-C C-arm navigation-guided RFA. The tumour was first biopsied for pathological examination, the core needle was removed and the RFA needle was inserted into the nidus. Post-operative X-rays and CT scans were performed to evaluate the degree of ablation and to assess for recurrence at 3-month follow-up. Patients also completed a visual analogue scale (VAS) both pre-operatively and 3 days post-operatively to subjectively assess pain. RESULTS Pathological diagnosis confirmed osteoid osteoma in 19 cases. The other 16 cases were not pathologically diagnosed owing to inadequate biopsy specimens. In all cases, localized pain was immediately relieved following RFA. Patients reported significantly decreased pain, with mean pre-operative VAS scores of 3.4 reducing to 0.80 at 3 days post-operatively and further to 0.06 at 3-month follow-up (p < 0.05). The mean follow-up time was 15.5 months (range: 3-38 months). CONCLUSION 3D Iso-C C-arm navigation-guided RFA is a safe and effective option for the treatment of osteoid osteomas and may be considered in place of intraoperative CT-guided and open resection. ADVANCES IN KNOWLEDGE C-arm image-guided percutaneous RFA mitigates the need for pre-operative CT as well as intraoperative scintigraphy, provides real-time imaging of the anatomy, facilitates accurate resection of the tumour and enables immediate confirmation of excision.
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Affiliation(s)
- Feng Yu
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Xiao-Hui Niu
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Qing Zhang
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Hai-Tao Zhao
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Li-Hui Xu
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Zhi-Ping Deng
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Peking University, Beijing, China
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Raux S, Abelin-Genevois K, Canterino I, Chotel F, Kohler R. Osteoid osteoma of the proximal femur: treatment by percutaneous bone resection and drilling (PBRD). A report of 44 cases. Orthop Traumatol Surg Res 2014; 100:641-5. [PMID: 25217029 DOI: 10.1016/j.otsr.2014.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/09/2014] [Accepted: 05/02/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteoid osteoma is a benign osteogenic tumor that is mainly located in the lower limbs. According to Campanacci the proximal femur is involved in 25% of cases. We present a series of 44 cases of osteoid osteoma located in the neck of the femur or the lesser trochanter treated by the minimally invasive method, CT-guided percutaneous bone resection and drilling (PBRD). MATERIALS AND METHODS This series included 44 patients, 20 girls and 24 boys, treated between 1987 and 2012. The average age at surgery was 12.7 years old (range 4-34). The diagnosis was based on the "association" of scintigraphy (hyperfixation) - CT scan (nidus located on the femoral neck or near the lesser trochanter). These patients underwent CT-guided PBRD under general anesthesia. Specific ancillary material was used to reach and remove the nidus and a cylinder of bone was sent to the pathologist for assessment. A lateral or anterior approach was used in all cases except one in which a posterior incision was made. Histological confirmation was obtained in 23 cases (the bone fragment was damaged in 21 cases). RESULTS Forty-two patients were reviewed after a minimum follow-up of one year (12-56 months). Two patients were lost to follow-up. Results were evaluated clinically and on CT scan 1 year after surgery: there were 35 cures with complete and permanent pain relief. There were 5 failures and 1 case of recurrence requiring a second CT-guided PBRD procedure as well 2 complications involving femoral fracture (one associated with failure). DISCUSSION The proximal femur is a common location of osteoid osteoma. Treatment requires careful preoperative planning to determine the surgical approach for safe removal. PBRD is a minimally invasive technique, allowing complete resection with suitable ancillary equipment. This method should be compared with thermoablation, which is a similar technique. CONCLUSION CT-guided PBRD is a therapeutic option in case of osteoid osteoma of the proximal femur. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- S Raux
- Service d'orthopédie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - K Abelin-Genevois
- Service d'orthopédie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - I Canterino
- Service d'imagerie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - F Chotel
- Service d'orthopédie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - R Kohler
- Service d'orthopédie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France.
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Cheng EY, Naranje SM, Ritenour ER. Radiation dosimetry of intraoperative cone-beam compared with conventional CT for radiofrequency ablation of osteoid osteoma. J Bone Joint Surg Am 2014; 96:735-42. [PMID: 24806010 DOI: 10.2106/jbjs.m.00874] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radiofrequency (RF) ablation is the standard of care for the surgical treatment of non-spinal osteoid osteoma and has greatly reduced morbidity associated with surgical excision. Precise placement of the RF ablation probe is necessary to avoid incomplete ablation. Limiting radiation exposure is especially advantageous in the pediatric population in whom osteoid osteoma frequently occurs. The aim of this study was to compare the radiation dosimetry and clinical outcomes among patients treated with RF ablation using three different localization techniques. METHODS Case-control methods were used to analyze sixty-six cases. Patients were categorized into three treatment groups: (1) intraoperative three-dimensional cone-beam CT (computed tomography) imaging (O-Arm) with surgical navigation (StealthStation S7), (2) intraoperative three-dimensional imaging (O-Arm) only, and (3) radiology suite-based diagnostic CT imaging. Radiation dosimetry and clinical outcome were analyzed with use of the dose-length product and local-relapse-free survival, respectively. RESULTS Mean age was nineteen years for the twenty-three patients in group 1, twenty years for the seven patients in group 2, and nineteen years for the thirty-six patients in group 3. Mean follow-up was fifty-three months. The mean radiation dose for groups 1, 2, and 3 was 446.62, 379.78, and 1058.83 mGy-cm, respectively. Significant (p < 0.05) differences in the radiation dose existed between groups 1 and 3 and between groups 2 and 3, whereas no difference was found between groups 1 and 2. Local-remission-free survival at three years for groups 1, 2, and 3 was 84.7% (95% confidence interval [CI], 64.5% to 100%), 100% (95% CI, 100% to 100%), and 90.7% (95% CI, 80.7% to 100%), respectively. Fifty-eight (92%) of the sixty-three followed patients were asymptomatic at the latest follow-up visit. CONCLUSIONS RF ablation using intraoperative cone-beam CT imaging, with or without surgical navigation, was associated with a significantly lower radiation dose compared with ablation using a radiology suite-based CT technique. Ablation using each of the three imaging techniques was equally effective in treating osteoid osteomas with a similar risk of relapse.
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Affiliation(s)
- Edward Y Cheng
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, R200, Minneapolis, MN 55454. E-mail address for E.Y. Cheng: . E-mail address for S.M. Naranje:
| | - Sameer M Naranje
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, R200, Minneapolis, MN 55454. E-mail address for E.Y. Cheng: . E-mail address for S.M. Naranje:
| | - E Russell Ritenour
- Department of Diagnostic Radiology, University of Minnesota, MMC 292, Room B-275 Mayo, 420 Delaware Street S.E., Minneapolis, MN 55455. E-mail address:
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Abstract
Osteoid osteomas consist of a nidus with surrounding sclerotic bone. The differential diagnosis covers a wide range of conditions due to the variable presentation of osteoid osteoma. The natural history is for regression to occur within 6 to 15 years with no treatment; however, this can be reduced to 2 to 3 years with the use of aspirin and non-steroidal anti-inflammatory drugs. Computed tomography-guided percutaneous techniques, including trephine excision, cryoablation, radiofrequency ablation, and laser thermocoagulation, are described.
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Abstract
Osteoid osteoma of the acetabulum is rare and its treatment represents a challenge for the orthopedic surgeon. We report a case of a 12-year-old boy with osteoid osteoma in the acetabulum who was treated with a controlled hip dislocation and a gamma probe guide to facilitate excision. The diagnosis was confirmed by pathology. The patient was asymptomatic immediately after surgery and remained so at long-term follow-up.
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Stübig T, Jähnisch T, Petri M, Hawi N, Zeckey C, Krettek C, Citak M, Meller R. Navigated versus conventional transfixation of AC joint injuries: feasibility and accuracy. ACTA ACUST UNITED AC 2013; 18:68-75. [PMID: 23379619 DOI: 10.3109/10929088.2013.766264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Transfixation of the acromioclavicular (AC) joint is a well-established technique for treating Rockwood IV to VI lesions. However, several complications, including pin breakage or pin migration due to incorrect placement, have been reported in the literature. A cadaveric study was performed to investigate whether the use of 3D navigation might improve the accuracy of AC joint transfixation. METHODS Seventeen transfixations of the AC joint (8 non-navigated, 9 navigated) were performed minimally invasively in cadaveric shoulders. For the navigated procedures, a 3D C-arm (Ziehm Vision FD Vario 3D) and a navigation system (BrainLab VectorVision) were used. Reference markers were attached to the spina scapulae, then a 3D scan was performed and the data transferred to the navigation system. Two Kirschner wires (K-wires) were placed either freehand under fluoroscopic control (in the non-navigated group) or with the use of a navigated drill guide. Radiological analysis was performed with OsiriX software, measuring the distance of the K-wires from the center of the AC joint. For statistical analysis, Student's t-test was performed, with the significance level being set to p < 0.05. RESULTS The maximum distance of the K-wires from the center of the AC joint was 5.4 ± 1.1 mm for the freehand non-navigated group and 3.1 ± 1.6 mm for the navigated group (p = 0.0054). The minimum distance of the K-wires from the AC joint center was 3.0 ± 0.6 mm for the freehand group and 1.6 ± 0.6 mm for the navigated group (p = 0.0002). The radiation time was significant lower for the freehand group (41.25 ± 20.4 seconds versus 79.5 ± 13.3 seconds for the navigated group, p = 0.004). There was no statistical difference between the groups with respect to the time required for surgery (11.25 ± 3.6 min for the freehand group and 12.6 ± 4.6 min for the navigated group; p = 0.475). In the freehand group, the AC joint was penetrated by both K-wires in 87.5% of the procedures, compared to 100% in the navigated group. Both K-wires were placed completely intraosseously in the clavicula in 50% of the procedures in the freehand group, compared to 88% in the navigated group. CONCLUSION Three-dimensional navigation may improve the accuracy of AC joint transfixation techniques. However, the radiation time is increased when using the navigated procedure, while the overall operation time remains comparable. Nevertheless, a 3D C-arm with a variable isocentric design is recommended for the acquisition of the shoulder scans.
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Affiliation(s)
- Timo Stübig
- Trauma Department, Hannover Medical School, Hannover, Germany.
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Schai PA, Exner GU. Open Resection of a Subchondral Acetabular Osteoid Osteoma Guided by Combined CT Navigation and Hip Arthroscopy: A Case Report. JBJS Case Connect 2012; 2:e65. [PMID: 29252361 DOI: 10.2106/jbjs.cc.l.00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Pascal A Schai
- Luzerner Kantonsspital Wolhusen, Orthopädisch-Traumatologische Abteilung, CH - 6110 Wolhusen, Switzerland.
| | - G Ulrich Exner
- Orthopädie Zentrum Zürich OZZ, Seestrasse 259, CH - 8038 Zürich, Switzerland.
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Widmann G, Schullian P, Fasser M, Niederwanger C, Bale R. CT-guided stereotactic targeting accuracy of osteoid osteoma. Int J Med Robot 2012; 9:274-9. [PMID: 22539415 DOI: 10.1002/rcs.1435] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the CT-guided stereotactic targeting accuracy for radiofrequency ablation of osteoid osteoma (OO), a small, benign but painful osseous lesion. METHODS Patient and extremity were fixed in a vacuum cushion. The OO was targeted using an optical navigation system with a stereotactic targeting device. For evaluation of targeting errors, the control CT with the needle in place was fused with the planning CT. RESULTS In 16 consecutive patients, nine OOs in the femur, four in the tibia, one in the spine, one in the ulna and one in the pubic bone were successfully targeted without complications. The mean ± SD lateral targeting error was 2.6 ± 1.7 mm at the needle entry and 1.9 ± 1.2 mm at the needle tip, and the mean angular error was 2.0 ± 1.3°. CONCLUSION Stereotaxy allows for accurate and safe targeting of OOs in various bone regions.
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Affiliation(s)
- Gerlig Widmann
- Section of Microinvasive Therapy, Department of Radiology, Innsbruck Medical University, Austria
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Navigation-assisted surgery for bone and soft tissue tumors with bony extension. Clin Orthop Relat Res 2012; 470:275-83. [PMID: 22009710 PMCID: PMC3238002 DOI: 10.1007/s11999-011-2094-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 09/01/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The navigation system was introduced to orthopaedic surgery in the 1990s. More recently, CT-based navigation systems have been used more commonly in spine and joint replacement surgery because of their precision. QUESTIONS/PURPOSES The aim of our study was to evaluate the accuracy and efficacy of navigation-assisted excision of bone and soft tissue tumors. METHODS From 2006 to 2009, we performed navigation-assisted surgery in 16 patients, 11 males and five females, with a mean age of 39 years (range, 13-70 years). We diagnosed nine benign bone tumors and seven malignant bone and soft tissue tumors. In two patients, the malignant soft tissue tumors infiltrated the adjacent bones. Nine excisional biopsies for benign tumors and seven en bloc excisions for malignant tumors were performed. In all cases, the point registration method was performed using 10 skin markers, which were placed around the tumor. Each excisional difference between the preoperative and postoperative plans was evaluated histologically or by postoperative CT. RESULTS The mean accuracy of this system, which was determined using skin markers, was 0.93 mm (range, 0.6-1.2 mm). All biopsy and excision samples were evaluated by pathologic examination and postoperative CT imaging. The mean difference between the planned margin and postoperative CT or excised histologic specimen was 0 mm to 4 mm. The mean followup was 34 months (range, 10-54 months). There were no local recurrences, except for excision of skip metastases in a patient with a chordoma. CONCLUSION We report our experience with navigation-assisted surgery for bone and soft tissue tumors. Navigation-assisted surgery could be indicated for sufficiently reliable, accurate, and minimally invasive resections.
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Takao M, Yabuta K, Nishii T, Sakai T, Sugano N. Accuracy of a 3D fluoroscopic navigation system using a flat-panel detector-equipped C-arm. ACTA ACUST UNITED AC 2011; 16:234-9. [DOI: 10.3109/10929088.2011.602117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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