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Ishifuro M, Yoshida N, Yokomachi K, Fujioka C, Adachi N. Development of an Original Three-Dimensional Computed Tomography Scan Method and Imaging Process for Surgical Support of the Anterior Cruciate Ligament. Cureus 2024; 16:e59307. [PMID: 38813334 PMCID: PMC11134476 DOI: 10.7759/cureus.59307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/31/2024] Open
Abstract
Three-dimensional computed tomography (3D CT) scan images are useful as they can provide information essential for surgical support, particularly in orthopedic surgery. In the case of anterior cruciate ligament (ACL) reconstruction, a 3D CT scan is important in preoperative simulation. Furthermore, it is associated with a reduced risk of revision surgery because the angle of the foramen magnum changes with the femoral muscle mass. However, the CT scan system geometry has several limitations. For example, the patient's posture is limited during the procedure. Herein, we report an original CT scan method and 3D imaging process for surgical support of the ACL.
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Affiliation(s)
- Minoru Ishifuro
- Department of Radiological Technology, Niigata University of Health and Welfare, Niigata, JPN
| | - Nobukiyo Yoshida
- Department of Radiological Technology, Niigata University of Health and Welfare, Niigata, JPN
| | - Kazushi Yokomachi
- Department of Clinical Support, Hiroshima University Hospital, Hiroshima, JPN
| | - Chikao Fujioka
- Department of Clinical Support, Hiroshima University Hospital, Hiroshima, JPN
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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Sakellariou E, Alevrogiannis P, Alevrogianni F, Galanis A, Vavourakis M, Karampinas P, Gavriil P, Vlamis J, Alevrogiannis S. Single-center experience with Knee+™ augmented reality navigation system in primary total knee arthroplasty. World J Orthop 2024; 15:247-256. [PMID: 38596188 PMCID: PMC10999969 DOI: 10.5312/wjo.v15.i3.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/15/2024] [Accepted: 03/04/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years, as they enhance precision compared to conventional hardware. The expansion of computer assistance is evolving with the employment of augmented reality. Yet, the accuracy of augmented reality navigation systems has not been determined. AIM To examine the accuracy of component alignment and restoration of the affected limb's mechanical axis in primary total knee arthroplasty (TKA), utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon. METHODS From May 2021 to December 2021, 30 patients, 25 women and five men, underwent a primary unilateral TKA. Revision cases were excluded. A preoperative radiographic procedure was performed to evaluate the limb's axial alignment. All patients were operated on by the same team, without a tourniquet, utilizing three distinct prostheses with the assistance of the Knee+™ augmented reality navigation system in every operation. Postoperatively, the same radiographic exam protocol was executed to evaluate the implants' position, orientation and coronal plane alignment. We recorded measurements in 3 stages regarding femoral varus and flexion, tibial varus and posterior slope. Firstly, the expected values from the Augmented Reality system were documented. Then we calculated the same values after each cut and finally, the same measurements were recorded radiologically after the operations. Concerning statistical analysis, Lin's concordance correlation coefficient was estimated, while Wilcoxon Signed Rank Test was performed when needed. RESULTS A statistically significant difference was observed regarding mean expected values and radiographic measurements for femoral flexion measurements only (Z score = 2.67, P value = 0.01). Nonetheless, this difference was statistically significantly lower than 1 degree (Z score = -4.21, P value < 0.01). In terms of discrepancies in the calculations of expected values and controlled measurements, a statistically significant difference between tibial varus values was detected (Z score = -2.33, P value = 0.02), which was also statistically significantly lower than 1 degree (Z score = -4.99, P value < 0.01). CONCLUSION The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized. Augmented reality navigation systems can bolster orthopaedic surgeons' accuracy in achieving precise axial alignment. However, further research is required to further evaluate their efficacy and potential.
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Affiliation(s)
- Evangelos Sakellariou
- The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
| | - Panagiotis Alevrogiannis
- The 1st Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, Attikon General Hospital, Athens 14561, Greece
| | - Fani Alevrogianni
- Department of Anesthesiology, KAT General Hospital, Athens 14561, Greece
| | - Athanasios Galanis
- The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
| | - Michail Vavourakis
- The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
| | - Panagiotis Karampinas
- The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
| | - Panagiotis Gavriil
- The 1st Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, Attikon General Hospital, Athens 14561, Greece
| | - John Vlamis
- The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
| | - Stavros Alevrogiannis
- Department of Robotic Hip & Knee Orthopaedic Surgery, Metropolitan General Hospital, Athens 14561, Greece
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Xu Z, Zhang X, Wang Y, Hao X, Liu M, Sun J, Zhao Z. Comparison of Bone-setting Robots and Conventional Reduction in the Treatment of Intertrochanteric Fracture: A Retrospective Study. Orthop Surg 2024; 16:312-319. [PMID: 38086603 PMCID: PMC10834210 DOI: 10.1111/os.13954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE Intertrochanteric fracture of the femur is a common fracture in older people. Due to the poor systemic condition and prognosis of elderly patients, it is prone to more complications. We introduce the bone-setting concept in the design of the robots, which are used for intertrochanteric fracture of the femur reduction. The purpose of this study is to compare the effect of bone-setting robots and conventional reduction in the treatment of intertrochanteric fracture of the femur (IFF). METHODS From June 2021 to January 2023, 60 patients with IFF who were treated surgically were assigned to bone-setting robots group and conventional reduction methods group in this retrospective study. The reduction time, operation time, total time, intraoperative blood loss, incision length, fluoroscopy time, and the follow-up time were reviewed. The visual analogue scale (VAS) and Harris scores were used for functional assessment. For continuous variables, independent t-tests were applied; for categorical data, the chi-square test was applied. The significance level as p < 0.05. RESULTS Among the 60 patients with IFF, 31 were assigned to the bone-setting robots group, and 29 were assigned to the conventional reduction methods group. Both groups with a similar baseline in the number, gender, age, and classification (p > 0.05). The reduction time, operation time, total time, intraoperative blood loss, and fluoroscopy time were less than those in the bone-setting robots reduction group compared to the conventional reduction group. In the bone-setting robots reduction group, the preoperative VAS score was 6.2 ± 1.3, the Harris score was 35.3 ± 3.1, 1 week after surgery VAS score was 3.3 ± 1.2, the Harris score was 57.3 ± 3.7, and at the last follow-up VAS score was 2.4 ± 0.8, and the Harris score was 88.7 ± 3.4. While in the conventional reduction group, the preoperative VAS score was 6.3 ± 1.3, the Harris score was 35.9 ± 2.9, 1 week after surgery VAS score was 4.8 ± 1.4, the Harris score was 46.8 ± 2.8, and at the last follow-up VAS score was 2.6 ± 0.8, and the Harris score was 87.3 ± 3.3. There were no significant differences between the two groups at the preoperative and 6-month postoperative follow-ups in VAS score and Harris score (p > 0.05, p > 0.05, respectively). But the difference was statistically significant at the one-week postoperative follow-up in VAS and Harris scores (p < 0.001). CONCLUSION The bone-setting robots can better protect the "fracture environment" and have the advantages of being precise, minimally invasive, simple, short time, low radiation, and rapid fracture recovery. The clinical effect of closed repair of IFF is ideal.
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Affiliation(s)
- Zhanmin Xu
- Tianjin Fourth Centre HospitalTianjinChina
| | - Xinan Zhang
- Tianjin University of Traditional Chinese MedicineTianjinChina
| | | | | | - Meiyue Liu
- Tianjin Fourth Centre HospitalTianjinChina
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Bai H, Wang R, Dai Y, Xue Y. Optimizing milling parameters based on full factorial experiment and backpropagation artificial neural network of lamina milling temperature prediction model. Technol Health Care 2024; 32:201-214. [PMID: 37302049 DOI: 10.3233/thc-220812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Milling operations of laminae in spinal surgery generate high temperatures, which can lead to thermal injury and osteonecrosis and affect the biomechanical effects of implants, ultimately leading to surgical failure. OBJECTIVE In this paper, a backpropagation artificial neural network (Bp-ANN) temperature prediction model was developed based on full factorial experimental data of laminae milling to optimize the milling motion parameters and to improve the safety of robot-assisted spine surgery. METHODS A full factorial experiment design were used to analyze the parameters affecting the milling temperature of laminae. The experimental matrixes were established by collecting the corresponding cutter temperature Tc and bone surface temperature Tb for the milling depth, feed speed and different bone densities. The Bp-ANN lamina milling temperature prediction model was constructed from experiment data. RESULTS Increasing milling depth increases bone surface and cutter temperature. Increasing feed speed had little effect on cutter temperature, but decreased bone surface temperature. Increasing bone density of laminae increased cutter temperature. The Bp-ANN temperature prediction model had best training results in the 10th epoch, and there is no overfitting (training set R= 0.99661, validation set R= 0.85003, testing set R= 0.90421, all temperature data set R= 0.93807). The goodness of fit R of Bp-ANN was close to 1, indicating that the predicted temperature was in good agreement with the experiment measurements. CONCLUSION This study can help spinal surgery-assisted robot to select appropriate motion parameters at different density bones to improve lamina milling safety.
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Affiliation(s)
- He Bai
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Wang
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Dai
- Institute of Robotics and Automatic Information System, Tianjin Key Laboratory of Intelligent Robotics, College of Artificial Intelligence, Nankai University, Tianjin, China
| | - Yuan Xue
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
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Chen H. Application progress of artificial intelligence and augmented reality in orthopaedic arthroscopy surgery. J Orthop Surg Res 2023; 18:775. [PMID: 37838695 PMCID: PMC10576364 DOI: 10.1186/s13018-023-04280-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023] Open
Abstract
In today's rapidly developing technological era, the technological revolution triggered by the rapid iteration of artificial intelligence and augmented reality has provided brand-new digital intelligent empowerment for orthopaedic clinical operation. Although traditional arthroscopy has been widely promoted globally due to its advantages such as minimally invasive, safety and early functional exercise, it still has deficiencies in precision and personalization. The assistance of artificial intelligence and augmented reality enables precise positioning and navigation in arthroscopic surgery, as well as personalized operations based on patient conditions, which lifts the objective limitations of traditional sports medicine surgery. The integration of artificial intelligence and augmented reality with orthopaedic arthroscopy surgery is still in infancy, even though there are still some insufficient to be solved, but its prospect is bright.
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Affiliation(s)
- Haojie Chen
- Department of Orthopaedics, The First People's Hospital of Xiaoshan District, No. 199, Shixin South Road, Chengxiang Street, Xiaoshan District, Hangzhou, China.
- Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
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Wei X, Zheng J, Bu L, Luo Y, Qiu Y, Yang C. Digital template-guided genioplasty for patients with jaw deformity resulting from temporomandibular joint ankylosis: A comparison between single- and double-layer genioplasty. Int J Oral Maxillofac Surg 2023; 52:1057-1063. [PMID: 36990830 DOI: 10.1016/j.ijom.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
The aim of this study was to compare single- and double-layer digital template-assisted genioplasty for the correction of jaw deformity resulting from temporomandibular joint ankylosis (TMJA). Thirteen patients with jaw deformity resulting from TMJA who underwent lateral arthroplasty, costochondral graft, or total joint replacement combined with single- or double-layer digital template-assisted genioplasty were included. Computed tomography data were obtained for the preoperative design. Digital templates were designed and manufactured using three-dimensional printing to assist with the chin osteotomy and repositioning in single- or double-layer genioplasty. Of the 13 patients included, seven underwent single-layer genioplasty and six underwent double-layer genioplasty. The digital templates precisely reflected the osteotomy planes and repositioning of the chin segments intraoperatively. The radiographic evaluation showed that the patients who underwent double-layer genioplasty exhibited more chin advancement (11.95 ± 0.92 mm vs 7.50 ± 0.89 mm; P < 0.001) with a slightly larger mean surface error (1.19 ± 0.14 mm vs 0.75 ± 0.15 mm; P < 0.001) than those who underwent single-layer genioplasty. This indicates that double-layer genioplasty better promoted chin advancement and improved the facial shape, but was accompanied by more surgical error compared with the preoperative design. Furthermore, hardly any nerve damage was observed. Digital templates are useful for assisting in surgical procedures.
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Affiliation(s)
- X Wei
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China
| | - J Zheng
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China
| | - L Bu
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China
| | - Y Luo
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China
| | - Y Qiu
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China
| | - C Yang
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China.
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Ackermann J, Hoch A, Snedeker JG, Zingg PO, Esfandiari H, Fürnstahl P. Automatic 3D Postoperative Evaluation of Complex Orthopaedic Interventions. J Imaging 2023; 9:180. [PMID: 37754944 PMCID: PMC10532700 DOI: 10.3390/jimaging9090180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023] Open
Abstract
In clinical practice, image-based postoperative evaluation is still performed without state-of-the-art computer methods, as these are not sufficiently automated. In this study we propose a fully automatic 3D postoperative outcome quantification method for the relevant steps of orthopaedic interventions on the example of Periacetabular Osteotomy of Ganz (PAO). A typical orthopaedic intervention involves cutting bone, anatomy manipulation and repositioning as well as implant placement. Our method includes a segmentation based deep learning approach for detection and quantification of the cuts. Furthermore, anatomy repositioning was quantified through a multi-step registration method, which entailed a coarse alignment of the pre- and postoperative CT images followed by a fine fragment alignment of the repositioned anatomy. Implant (i.e., screw) position was identified by 3D Hough transform for line detection combined with fast voxel traversal based on ray tracing. The feasibility of our approach was investigated on 27 interventions and compared against manually performed 3D outcome evaluations. The results show that our method can accurately assess the quality and accuracy of the surgery. Our evaluation of the fragment repositioning showed a cumulative error for the coarse and fine alignment of 2.1 mm. Our evaluation of screw placement accuracy resulted in a distance error of 1.32 mm for screw head location and an angular deviation of 1.1° for screw axis. As a next step we will explore generalisation capabilities by applying the method to different interventions.
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Affiliation(s)
- Joëlle Ackermann
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Laboratory for Orthopaedic Biomechanics, ETH Zurich, 8093 Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jess Gerrit Snedeker
- Laboratory for Orthopaedic Biomechanics, ETH Zurich, 8093 Zurich, Switzerland
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Patrick Oliver Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Hooman Esfandiari
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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Ling W, Chen L. Research hotspots and trends in internal fixation of femoral neck fractures from 2010 to 2022: A 12-year bibliometric analysis. Medicine (Baltimore) 2023; 102:e34003. [PMID: 37335643 PMCID: PMC10256364 DOI: 10.1097/md.0000000000034003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND This study endeavors to scrutinize the hotspots and trends in the literature concerning the internal fixation of femoral neck fractures (INFNF) through a comprehensive bibliometric analysis. Notably, this analytical process encompasses both qualitative and quantitative components. METHODS The present study has utilized the Science Citation Index-Expanded from the Web of Science Core Collection to extract datasets ranging from January 1, 2010, to August 31, 2022. Quantitative analysis was carried out using sophisticated analytical tools such as the Bibliographic Item Co-Occurrence Matrix Builder, the Online Analysis Platform of Literature Metrology, and CiteSpace software. Further, the major Medical Subject Headings terms and their subheading counterparts associated with INFNF were extracted from the PubMed2XL website using the corresponding PMIDs. These Medical Subject Headings terms were employed in conducting a co-word clustering analysis. Ultimately, the Graphical CLUstering TOolkit program was utilized to execute a co-word biclustering analysis to discern the prevailing hotspots in this domain. RESULTS Between January 1, 2010, and August 31, 2022, a total of 463 publications were issued on INFNF. The INJURY-INTERNAL JOURNAL OF THE CARE OF THE INJURED stood out as the most extensively perused journal in this area. Notably, China emerged as the foremost contributor to publishing articles within the last 12 years, followed by the United States and Canada. McMaster University was identified as the leading institution in INFNF research, while Bhandari M emerged as the most prolific author in this field. Moreover, the study identified five notable research hotspots within the domain of INFNF. CONCLUSIONS This study has identified five critical areas of research in the field of INFNF. It suggests that the primary focus of future research is likely to center on advancing internal fixation methods and robot-assisted instrumentation for femoral neck fractures. As such, this study provides valuable insights into future research directions and ideas for those working in this field.
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Affiliation(s)
- Wenkang Ling
- Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Leilei Chen
- Department of Orthopaedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
- Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
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Yoshii Y, Iwabuchi S, Ikumi A, Kohyama S, Ogawa T, Ishii T. Correlations between 3D preoperative planning and postoperative reduction in the osteosynthesis of distal humeral fractures. J Orthop Surg Res 2023; 18:283. [PMID: 37031170 PMCID: PMC10082491 DOI: 10.1186/s13018-023-03772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/01/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Three-dimensional preoperative planning has been applied to the osteosynthesis of distal humerus fractures. The present study investigated the correlations between 3D preoperative planning and postoperative reduction for the osteosynthesis of distal humerus fractures using 3D parameters. METHODS Twenty-three elbows of 23 distal humerus fracture patients who underwent osteosynthesis with three-dimensional preoperative planning were evaluated. 3D images of the distal humerus were created after taking preoperative CT scans of the injured elbow. Fracture reduction, implant selection, and placement simulations were performed based on 3D images. Postoperative CT images were taken 1 month after surgery. Correlations were evaluated with preoperative plans and postoperative 3D images. The longitudinal axis and coordinates of the humerus were defined on the 3D images. The coronal angle (CA) was defined as the angle formed by the long axis and the line connecting the medial and lateral margins of the trochlea of the humerus on a coronal plane image. The sagittal angle (SA) was defined as the angle formed by the long axis and the line connecting the top of the lateral epicondyle and the center of the humeral capitellum on a sagittal plane image. The axial angle (AA) was defined as the angle between the sagittal plane and the line connecting the medial and lateral margins behind the trochlea of the humerus. The intraclass correlation coefficients (ICC) of each measurement value were assessed between preoperative planning and postoperative images. RESULTS Preoperative planning and postoperative measurement values were CA: 85.6 ± 5.9°/85.8 ± 5.9°, SA: 140.9 ± 8.5°/139.4 ± 7.9°, and AA: 84.0 ± 3.1°/82.6 ± 4.9°, respectively. ICCs were CA: 0.75 (P < 0.01), SA: 0.78 (P < 0.01), and AA: 0.34 (P < 0.05), respectively. CONCLUSIONS The 3D preoperative planning of distal humeral fractures achieved the good correlations of coronal and sagittal angles, but the relatively poor correlation of the axial angle. This may be attributed to an inability to assess the rotation angle during surgery. We propose the measurement indices shown in the present study as a three-dimensional evaluation index for distal humerus fractures. TRIAL REGISTRATION Registered as NCT04349319 at ClinicalTrials.gov.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Sho Iwabuchi
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Akira Ikumi
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Sho Kohyama
- Department of Orthopaedic Surgery, Kikkoman General Hospital, Noda, Chiba, 278-0005, Japan
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery, Mito Medical Center Hospital, Ibaraki, Ibaraki, 311-3193, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
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Benda V, Kubicek J, Madeja R, Oczka D, Cerny M, Dostalova K. Design of Proposed Software System for Prediction of Iliosacral Screw Placement for Iliosacral Joint Injuries Based on X-ray and CT Images. J Clin Med 2023; 12:jcm12062138. [PMID: 36983141 PMCID: PMC10054889 DOI: 10.3390/jcm12062138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
One of the crucial tasks for the planning of surgery of the iliosacral joint is placing an iliosacral screw with the goal of fixing broken parts of the pelvis. Tracking of proper screw trajectory is usually done in the preoperative phase by the acquisition of X-ray images under different angles, which guide the surgeons to perform surgery. This approach is standardly complicated due to the investigation of 2D X-ray images not showing spatial perspective. Therefore, in this pilot study, we propose complex software tools which are aimed at making a simulation model of reconstructed CT (DDR) images with a virtual iliosacral screw to guide the surgery process. This pilot study presents the testing for two clinical cases to reveal the initial performance and usability of this software in clinical conditions. This model is consequently used for a multiregional registration with reference intraoperative X-ray images to select the slide from the 3D dataset which best fits with reference X-ray. The proposed software solution utilizes input CT slices of the pelvis area to create a segmentation model of individual bone components. Consequently, a model of an iliosacral screw is inserted into this model. In the next step, we propose the software CT2DDR which makes DDR projections with the iliosacral screw. In the last step, we propose a multimodal registration procedure, which performs registration of a selected number of slices with reference X-ray, and based on the Structural Similarity Index (SSIM) and index of correlation, the procedure finds the best match of DDR with X-ray images. In this pilot study, we also provide a comparative analysis of the computational costs of the multimodal registration upon various numbers of DDR slices to show the complex software performance. The proposed complex model has versatile usage for modeling and surgery planning of the pelvis area in fractures of iliosacral joints.
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Affiliation(s)
- Vojtech Benda
- Department of Cybernetics and Biomedical Engineering, VŠB-Technical University of Ostrava, 17. listopadu 2172/15, Poruba, 708 00 Ostrava, Czech Republic
| | - Jan Kubicek
- Department of Cybernetics and Biomedical Engineering, VŠB-Technical University of Ostrava, 17. listopadu 2172/15, Poruba, 708 00 Ostrava, Czech Republic
| | - Roman Madeja
- Trauma Center, University Hospital Ostrava, 17. listopadu 1790, Poruba, 708 52 Ostrava, Czech Republic
| | - David Oczka
- Department of Cybernetics and Biomedical Engineering, VŠB-Technical University of Ostrava, 17. listopadu 2172/15, Poruba, 708 00 Ostrava, Czech Republic
| | - Martin Cerny
- Department of Cybernetics and Biomedical Engineering, VŠB-Technical University of Ostrava, 17. listopadu 2172/15, Poruba, 708 00 Ostrava, Czech Republic
| | - Kamila Dostalova
- Department of Cybernetics and Biomedical Engineering, VŠB-Technical University of Ostrava, 17. listopadu 2172/15, Poruba, 708 00 Ostrava, Czech Republic
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Figueroa F, Figueroa D, Guiloff R, Putnis S, Fritsch B, Itriago M. Navigation in anterior cruciate ligament reconstruction: State of the art. J ISAKOS 2023; 8:47-53. [PMID: 36179977 DOI: 10.1016/j.jisako.2022.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/15/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022]
Abstract
Computer navigation (CN) for anterior cruciate ligament (ACL) surgery has been used mainly for two purposes: to enhance the accuracy of tunnel position and to evaluate the kinematics of the ACL reconstruction (ACLR) and the stability achieved by different surgical techniques. Many studies have shown that navigation may improve the accuracy of anatomical tunnel orientation and position during ACL reconstructive surgery compared with normal arthroscopic tunnel placement, especially regarding the femoral side. At the same time, it has become the gold-standard method for intraoperative knee kinematic assessment, as it permits a quantitative multidirectional knee joint laxity evaluation. CN in ACL surgery has been associated with diverse problems. First, in most optic systems additional skin incisions and drill holes in the femoral bone are required for fixation of a reference frame to the femur. Second, additional radiation exposure and extra medical cost to the patient for preoperative planning are usually needed. Third, CN, due to additional steps, has more opportunities for error during preoperative planning, intraoperative registration, and operation. Fourth, soft tissues, including the skin and subcutaneous tissues, are usually not considered during the preoperative planning, which can be a problem for kinematic and stability assessment. Many studies have concluded that ACLR using a CN system is more expensive than conventional surgery, it adds extra time to the surgery and it is not mitigated by better clinical outcomes. This, combined with costs and invasiveness, has limited the use of CN to research-related cases. Future technology should prioritize less invasive intra-operative surgical navigation.
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Affiliation(s)
- Francisco Figueroa
- Clinica Alemana-Universidad del Desarrollo, Av Vitacura 5951, Vitacura, Santiago, 7650568, Chile; Hospital Sotero del Rio, Avenida Concha y Toro 3459, Puente Alto, Santiago, 8207257, Chile.
| | - David Figueroa
- Clinica Alemana-Universidad del Desarrollo, Av Vitacura 5951, Vitacura, Santiago, 7650568, Chile.
| | - Rodrigo Guiloff
- Clinica Alemana-Universidad del Desarrollo, Av Vitacura 5951, Vitacura, Santiago, 7650568, Chile; Hospital Sotero del Rio, Avenida Concha y Toro 3459, Puente Alto, Santiago, 8207257, Chile.
| | - Sven Putnis
- Southmead Hospital, Southmead Rd, Bristol, BS10 5NB, UK.
| | - Brett Fritsch
- Sydney Orthopaedic Research Institute, The Gallery, Level 1/445 Victoria Ave, Chatswood, NSW, 2067, Australia.
| | - Minerva Itriago
- Clinica Alemana-Universidad del Desarrollo, Av Vitacura 5951, Vitacura, Santiago, 7650568, Chile.
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12
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Stauffer TP, Kim BI, Grant C, Adams SB, Anastasio AT. Robotic Technology in Foot and Ankle Surgery: A Comprehensive Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:686. [PMID: 36679483 PMCID: PMC9864483 DOI: 10.3390/s23020686] [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: 11/11/2022] [Revised: 12/11/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Recent developments in robotic technologies in the field of orthopaedic surgery have largely been focused on higher volume arthroplasty procedures, with a paucity of attention paid to robotic potential for foot and ankle surgery. The aim of this paper is to summarize past and present developments foot and ankle robotics and describe outcomes associated with these interventions, with specific emphasis on the following topics: translational and preclinical utilization of robotics, deep learning and artificial intelligence modeling in foot and ankle, current applications for robotics in foot and ankle surgery, and therapeutic and orthotic-related utilizations of robotics related to the foot and ankle. Herein, we describe numerous recent robotic advancements across foot and ankle surgery, geared towards optimizing intra-operative performance, improving detection of foot and ankle pathology, understanding ankle kinematics, and rehabilitating post-surgically. Future research should work to incorporate robotics specifically into surgical procedures as other specialties within orthopaedics have done, and to further individualize machinery to patients, with the ultimate goal to improve perioperative and post-operative outcomes.
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Affiliation(s)
| | - Billy I. Kim
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Caitlin Grant
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Samuel B. Adams
- Departmen of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA
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13
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Zimmermann F, Franke J, Vetter SY, Grützner PA. [Computer-assisted procedures in orthopedics and trauma surgery-Where do we stand?]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:292-298. [PMID: 36600030 DOI: 10.1007/s00104-022-01789-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/06/2023]
Abstract
Computer-assisted procedures are becoming increasingly more relevant in orthopedics and trauma surgery. The data situation on these systems has improved in recent years but still has a low level of evidence. In particular, data on short-term or medium-term results on the use of these procedures are currently available. These could show that improved precision and reproducibility of the surgical procedures can be achieved by the use of computer-assisted procedures. Nevertheless, there is still no recommendation in the current guidelines for routine use.
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Affiliation(s)
- Felix Zimmermann
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland.
| | - Jochen Franke
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Sven Y Vetter
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Paul A Grützner
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
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14
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Liu J, Yan Y, Xu K, Zhao C, Wang Y, Wu X, Tian W. Biomechanical analysis of pelvic holding pathways and strategies for use of the steinmann pin in pelvic fracture reduction. Comput Biol Med 2023; 152:106310. [PMID: 36462368 DOI: 10.1016/j.compbiomed.2022.106310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/06/2022] [Accepted: 11/13/2022] [Indexed: 11/29/2022]
Abstract
Pelvic fracture is the most serious bone trauma and has the highest mortality and disability rate. Surgical treatment of pelvic fracture is very challenging for surgeons. Minimally invasive close reduction of pelvic fracture is considered the most difficult operation due to the complex pelvic morphology and abundant soft tissue anatomy, both of which increase the difficulty of pelvic fracture reduction. The most challenging aspect of such surgery is how to hold the pelvic bone and effectively transmit the reduction force to the bone. Therefore, a safe and effective pelvic holding pathway for reduction is necessary for pelvic fracture operations. Existing research on the pelvic holding pathway addresses anatomical position and dimension. Few studies have focused on biomechanical properties or on surgical techniques related to these pathways. This paper studies the three holding pathways that are most commonly used in clinical practice. The most effective force direction for each holding pathway is identified through finite element modeling. Pathway 1 is suitable for internal rotation operation and open/close-book operation of the pelvis; Pathway 2 is suitable for translation of the fractured pelvis toward the sacrum and internal pelvic rotation operations; Pathway 3 is suitable for pulling and lifting of the fractured pelvis against gravity and open/close-book operation of the pelvis. In addition, we find through our simulation that the use of a combined holding strategy can reduce the reduction force during the reduction process. We compared the performances of the 2-pin combined holding strategy (2P-CH) and the 3-pin combined strategy (3P-CH). During translational reduction, 2P-CH and 3P-CH showed little difference in pelvic reduction force. However, in rotational reduction, 3P-CH shows advantages. It has less reduction force and the least combined muscle resistance. It can also maximize the displacement of the iliac crest under the same conditions. The results of this study can be applied to surgical planning and to the development of robot-assisted surgery systems in selecting holding pathways and operation strategies for fractured pelvis.
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Affiliation(s)
- Jixuan Liu
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Yadong Yan
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Ke Xu
- Beijing Rossumrobot Ltd., Beijing, China
| | | | - Yu Wang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.
| | - Xinbao Wu
- Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Beijing Jishuitan Hospital, Beijing, China
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15
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Pivazyan G, Sandhu FA, Beaufort AR, Cunningham BW. Basis for error in stereotactic and computer-assisted surgery in neurosurgical applications: literature review. Neurosurg Rev 2022; 46:20. [PMID: 36536143 DOI: 10.1007/s10143-022-01928-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Technological advancements in optoelectronic motion capture systems have allowed for the development of high-precision computer-assisted surgery (CAS) used in cranial and spinal surgical procedures. Errors generated sequentially throughout the chain of components of CAS may have cumulative effect on the accuracy of implant and instrumentation placement - potentially affecting patient outcomes. Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of CAS. Error reporting measures vary between studies. Understanding error generation, mechanisms of propagation, and how they relate to workflow can assist clinicians in error mitigation and improve accuracy during navigation in neurosurgical procedures. Diligence in planning, fiducial positioning, system registration, and intra-operative workflow have the potential to improve accuracy and decrease disparity between planned and final instrumentation and implant position. This study reviews the potential errors associated with each step in computer-assisted surgery and provides a basis for disparity in intrinsic accuracy versus achieved accuracy in the clinical operative environment.
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Affiliation(s)
- Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | | | - Bryan W Cunningham
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Kuris EO, Anderson GM, Osorio C, Basques B, Alsoof D, Daniels AH. Development of a Robotic Spine Surgery Program: Rationale, Strategy, Challenges, and Monitoring of Outcomes After Implementation. J Bone Joint Surg Am 2022; 104:e83. [PMID: 36197328 DOI: 10.2106/jbjs.22.00022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Surgical robots were invented in the 1980s, and since then, robotic-assisted surgery has become commonplace. In the field of spine surgery, robotic assistance is utilized mainly to place pedicle screws, and multiple studies have demonstrated that robots can increase the accuracy of screw placement and reduce radiation exposure to the patient and the surgeon. However, this may be at the cost of longer operative times, complications, and the risk of errors in mapping the patient's anatomy.
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Affiliation(s)
- Eren O Kuris
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - George M Anderson
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Camilo Osorio
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bryce Basques
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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17
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Xia G, Liu W, Bai H, Xue Y, Dai Y, Lei P, Zhang J. Surgical Tool Handle Vibration-Based Drilling State Recognition During Hip Fracture Fixation. Orthop Surg 2022; 14:2964-2978. [PMID: 36177881 PMCID: PMC9627077 DOI: 10.1111/os.13507] [Citation(s) in RCA: 2] [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: 05/05/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Traditional manual drilling during hip fracture fixation can easily lead to unstable fixation and vascular damage. This study aimed to investigate a safe and easy‐to‐use robot‐assisted method to automatically drill bone and distinguish critical bone drilling states with high accuracy in real‐time for the bone hole‐making process during hip fracture fixation. Methods A bone‐drilling robotic system was designed to automatically create holes in the femoral neck. Four fresh pig femurs were drilled at the posterosuperior femoral neck using three modes: “all‐in” (AI), “in‐out‐in” (IOI), and “percutaneous fixation” (PF). A high‐frequency accelerometer captured the generated vibrations of the drill handle, which were then transferred to a personal computer using a data acquisition card. Five bone drilling states are defined, including: “drill idling,” “initial drilling,” “in the cancellous bone,” “out the femoral neck,” and “in the cortical bone.” The harmonic distribution of the vibration signal was extracted by fast Fourier transform (FFT) and used as a critical feature to identify different drilling states. To prove the difference in the harmonic distribution at different drilling states, an independent sample t‐test was used to compare the percentage of the first harmonic amplitude in the first 10 harmonics at each drilling state. A neural network classifier was trained with the frequency spectrum as the input and the drilled state as the output to distinguish the critical bone drilling states with high accuracy in real‐time. The classifier was trained and tested on four specimens to ensure that the surgical robot could accurately identify the five drilling states. Results In each specimen, the harmonic distributions of the drilling vibration at different drilling modes were significantly different (p < 0.05). The average recognition accuracies of the drilling state for the four specimens were all higher than 84%. The three defined modes were distinguished with extremely high accuracies. The recognition accuracies of “in the cancellous bone” for specimens 1 to 4 were 83.2%, 84.8%, 92.9%, and 84.7%. The recognition accuracies of “in out the femoral neck” from specimens 1 to 4 are 98.2%, 88.4%, 95.8%, and 88.8%. The recognition accuracies of “in the cortical bone” for specimens 1 to 4 were 94.6%, 80.8%, 95.5%, and 85.8%. Conclusions The proposed robot‐assisted method can automatically distinguish five critical bone‐drilling states with high accuracy in real‐time to avoid weak fixation and damage to the lateral epiphyseal artery.
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Affiliation(s)
- Guangming Xia
- Institute of Robotics and Automatic Information System, Tianjin, China
| | - Wei Liu
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Department of Orthopaedic Surgery, Tianjin Baodi Hospital, Tianjin, China
| | - He Bai
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Xue
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Dai
- Institute of Robotics and Automatic Information System, Tianjin, China
| | - Ping Lei
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jianxun Zhang
- Institute of Robotics and Automatic Information System, Tianjin, China
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18
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Yoshii Y, Iwahashi Y, Sashida S, Shrestha P, Shishido H, Kitahara I, Ishii T. An Experimental Study of a 3D Bone Position Estimation System Based on Fluoroscopic Images. Diagnostics (Basel) 2022; 12:diagnostics12092237. [PMID: 36140638 PMCID: PMC9497817 DOI: 10.3390/diagnostics12092237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/01/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
To compare a 3D preoperative planning image and fluoroscopic image, a 3D bone position estimation system that displays 3D images in response to changes in the position of fluoroscopic images was developed. The objective of the present study was to evaluate the accuracy of the estimated position of 3D bone images with reference to fluoroscopic images. Bone positions were estimated from reference points on a fluoroscopic image compared with those on a 3D image. The four reference markers positional relationships on the fluoroscopic image were compared with those on the 3D image to evaluate whether a 3D image may be drawn by tracking positional changes in the radius model. Intra-class correlations coefficients for reference marker distances between the fluoroscopic image and 3D image were 0.98–0.99. Average differences between measured values on the fluoroscopic image and 3D bone image for each marker corresponding to the direction of the bone model were 1.1 ± 0.7 mm, 2.4 ± 1.8 mm, 1.4 ± 0.8 mm, and 2.0 ± 1.6 mm in the anterior-posterior view, ulnar side lateral view, posterior-anterior view, and radial side lateral view, respectively. Marker positions were more accurate in the anterior-posterior and posterior-anterior views than in the radial and ulnar side lateral views. This system helps in real-time comparison of dynamic changes in preoperative 3D and intraoperative fluoroscopy images.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki 300-0398, Japan
- Correspondence: ; Tel.: +81-298871161
| | | | | | - Pragyan Shrestha
- Center for Computational Sciences, Tsukuba University, Tsukuba, Ibaraki 305-8577, Japan
| | - Hidehiko Shishido
- Center for Computational Sciences, Tsukuba University, Tsukuba, Ibaraki 305-8577, Japan
| | - Itaru Kitahara
- Center for Computational Sciences, Tsukuba University, Tsukuba, Ibaraki 305-8577, Japan
| | - Tomoo Ishii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki 300-0398, Japan
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Wang XY, Liu L, Guan MS, Liu Q, Zhao T, Li HB. The accuracy and learning curves of active and passive dynamic navigation-guided dental implant surgery: An in vitro study. J Dent 2022; 124:104240. [PMID: 35872224 DOI: 10.1016/j.jdent.2022.104240] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Infrared dynamic navigation principles can be categorized into active and passive navigation systems based on whether the surgical instruments can emit or only reflect light, respectively. This in vitro study aimed to compare the accuracy of implant placement and the learning curves of both active and passive dynamic navigation systems using different registration methods. METHODS Implants (n=704) were placed in 64 sets of models and divided into active (Yizhime, DCARER, Suzhou, China) and passive (Iris-Clinic, EPED, Kaohsiung, China) dynamic navigation groups. Both marker point-based registration (M-PBR) and feature point-based registration (F-PBR) were employed by two groups mentioned above. Based on preoperative and postoperative cone-beam computed tomography imaging, the coronal, midpoint, apical, and angular deviations were analyzed from 2D and 3D views. The operation time was recorded for each group. RESULTS The active dynamic navigation group exhibited significantly greater accuracy than the passive dynamic navigation group for outcome variables (angular deviation, 4.13 ± 2.39° and 4.62 ± 3.32°; coronal global deviation, 1.48 ± 0.60 and 1.86 ± 1.12 mm; apical global deviation, 1.75 ± 0.81 and 2.20 ± 1.68 mm, respectively). Significant interaction effects were observed for both registration methods and four quadrants with different dynamic navigation systems. Learning curves for the two dynamic navigation groups approached each other after 12 procedures, and finally converged after 27 procedures. CONCLUSIONS The accuracy of active dynamic navigation system was superior to that of passive dynamic navigation system. Different combinations of dynamic navigation systems, registration methods, and implanted quadrants displayed various interactions. CLINICAL SIGNIFICANCE Our findings could provide guidance for surgeons in choosing an appropriate navigation system use in various implant surgeries. Furthermore, the time required by surgeons to master the technique was calculated for reference. Nevertheless, there are certain limitations to this in vitro study, and therefore further research is required.
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Affiliation(s)
- Xiao-Yu Wang
- Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Stomatology, The Strategic Support Force Medical Center, PLA, Beijing, China
| | - Lin Liu
- Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Miao-Sheng Guan
- Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Research, PLA Rocket Force Characteristic Medical Center, PLA, Beijing, China
| | - Qian Liu
- Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tong Zhao
- School of Mathematical Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Hong-Bo Li
- Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
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20
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Zhang H, Xu D, Wang C, Zhu K, Guo J, Zhao C, Han J, Liu H, Ma X, Zhou C. Application of electromagnetic navigation in endoscopic transforaminal lumbar interbody fusion: a cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2597-2606. [PMID: 35748953 DOI: 10.1007/s00586-022-07280-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/22/2022] [Accepted: 05/27/2022] [Indexed: 10/17/2022]
Abstract
STUDY DESIGN Clinical retrospective cohort study. OBJECTIVES To explore the application of the electromagnetic navigation system in Endo-TLIF. MATERIALS AND METHODS From May 2019 to March 2020, 76 patients with single-segment lumbar spondylolisthesis treated by electromagnetic navigation-assisted Endo-TLIF (NE group) and conventional Endo-TLIF (CE group) were enrolled in the study. Time of pedicle screw implantation, entire operation time, the number of intraoperative X-ray fluoroscopy exposures, total blood loss, incision length, ambulation time, accuracy of pedicle screws, complications, visual analog scale for back and leg pain, Oswestry Disability Index, Japanese Orthopedic Association score and postoperative fusion rates were recorded, respectively. RESULTS There were no significant differences in preoperative demographics between the NE and CE groups (P > 0.05). The mean number of intraoperative X-ray fluoroscopy exposures, guidewires insertion, entire operation time, total blood loss and adjustment rate of screws in the NE group were significantly less compared with the CE group (P < 0.05, respectively). There were no significant differences in clinical parameters between the two groups at different time points in the follow-up period (P > 0.05). There was no statistical difference in fusion rates between the two groups. In addition, one case of cage subsidence was observed after surgery in the CE group. CONCLUSION Electromagnetic navigation systems could be applied throughout the entire surgical course and ameliorate the shortcomings of the conventional Endo-TLIF technique to reduce radiation exposure, improve accuracy, avoid repetitive operations and shorten surgery time and the required learning curve of the procedure. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Hao Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Derong Xu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Chao Wang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Kai Zhu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Jianwei Guo
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Chong Zhao
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Jialuo Han
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Houchen Liu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Xuexiao Ma
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China.
| | - Chuanli Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China.
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Vivarelli L, Govoni M, Attala D, Zoccali C, Biagini R, Dallari D. Custom Massive Allograft in a Case of Pelvic Bone Tumour: Simulation of Processing with Computerised Numerical Control vs. Robotic Machining. J Clin Med 2022; 11:jcm11102781. [PMID: 35628908 PMCID: PMC9143408 DOI: 10.3390/jcm11102781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
The use of massive bone allografts after the resection of bone tumours is still a challenging process. However, to overcome some issues related to the processing procedures and guarantee the best three-dimensional matching between donor and recipient, some tissue banks have developed a virtual tissue database based on the scanning of the available allografts for using their 3D shape during virtual surgical planning (VSP) procedures. To promote the use of future VSP bone-shaping protocols useful for machining applications within a cleanroom environment, in our work, we simulate a massive bone allograft machining with two different machines: a four-axes (computer numerical control, CNC) vs. a five-axes (robot) milling machine. The allograft design was based on a real case of allograft reconstruction after pelvic tumour resection and obtained with 3D Slicer and Rhinoceros software. Machining simulations were performed with RhinoCAM and graphically and mathematically analysed with CloudCompare and R, respectively. In this case, the geometrical differences of the allograft design are not clinically relevant; however, the mathematical analysis showed that the robot performed better than the four-axes machine. The proof-of-concept presented here paves the way towards massive bone allograft cleanroom machining. Nevertheless, further studies, such as the simulation of different types of allografts and real machining on massive bone allografts, are needed.
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Affiliation(s)
- Leonardo Vivarelli
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
- Correspondence: (L.V.); (M.G.)
| | - Marco Govoni
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
- Correspondence: (L.V.); (M.G.)
| | - Dario Attala
- Department of Oncological Orthopaedics—Musculoskeletal Tissue Bank, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Carmine Zoccali
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Roberto Biagini
- Department of Oncological Orthopaedics, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
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On the Necessity of a Customized Knee Spacer in Peri-Prosthetic Joint Infection Treatment: 3D Numerical Simulation Results. J Pers Med 2021; 11:jpm11101039. [PMID: 34683181 PMCID: PMC8538359 DOI: 10.3390/jpm11101039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 02/07/2023] Open
Abstract
Peri-prosthetic joint infections (PJIs) dramatically affect human health, as they are associated with high morbidity and mortality rates. Two-stage revision arthroplasty is currently the gold standard treatment for PJI and consists of infected implant removal, an accurate debridement, and placement of antimicrobial impregnated poly-methyl-metha-acrylate (PMMA) spacer. The use of antibiotic-loaded PMMA (ALPMMA) spacers have showed a success rate that ranges from 85% to 100%. ALPMMA spacers, currently available on the market, demonstrate a series of disadvantages, closely linked to a low propensity to customize, seen as the ability to adapt to the patients’ anatomical characteristics, with consequential increase of surgical complexity, surgery duration, and post-operative complications. Conventionally, ALPMMA spacers are available only in three or four standard sizes, with the impossibility of guaranteeing the perfect matching of ALPMMA spacers with residual bone (no further bone loss) and gap filling. In this paper, a 3D model of an ALPMMA spacer is introduced to evaluate the cause- effect link between the geometric characteristics and the correlated clinical improvements. The result is a multivariable-oriented design able to effectively manage the size, alignment, stability, and the patients’ anatomical matching. The preliminary numerical results, obtained by using an “ad hoc” 3D virtual planning simulator, clearly point out that to restore the joint line, the mechanical and rotational alignment and the surgeon’s control on the thicknesses (distal and posterior thicknesses) of the ALPMMA spacer is mandatory. The numerical simulations campaign involved nineteen patients grouped in three different scenarios (Case N° 1, Case N° 2 and Case N° 3) whose 3D bone models were obtained through an appropriate data management strategy. Each scenario is characterized by a different incidence rate. In particular, the observed rates of occurrence are, respectively, equal to 17% (Case N° 1), 74% (Case N° 2), and 10% (Case N° 3).
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Hong E, Kwak DS, Kim IB. Morphological symmetry of the radius and ulna-Can contralateral forearm bones utilize as a reliable template for the opposite side? PLoS One 2021; 16:e0258232. [PMID: 34613996 PMCID: PMC8494372 DOI: 10.1371/journal.pone.0258232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
The most important precondition for correction of the affected forearm using data from the contralateral side is that the left and right bone features must be similar, in order to develop patient-specific instruments (PSIs) and/or utilize computer-assisted orthopedic surgery (CAOS). The forearm has complex anatomical structure, and most people use their dominant hand more than their less dominant hand, sometimes resulting in asymmetry of the upper limbs. The aim of this study is to investigate differences of the bilateral forearm bones through a quantitative comparison of whole bone parameters including length, volume, bowing, and twisting parameters, and regional shape differences of the forearm bones. In total, 132 bilateral 3D radii and ulnae 3D models were obtained from CT images, whole bone parameters and regional shape were analyzed. Statistically significant differences in whole bone parameters were not shown. Regionally, the radius shows asymmetry in the upper section of the central part to the upper section of the distal part. The ulna shows asymmetry in the lower section of the proximal part to the lower section of the central part. Utilizing contralateral side forearm bones to correct the affected side may be feasible despite regional differences in the forearm bones of around 0.5 mm.
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Affiliation(s)
- Eunah Hong
- Department of Biomedicine & Health Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dai-Soon Kwak
- Department of Anatomy / Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail: (IBK); (DSK)
| | - In-Beom Kim
- Department of Biomedicine & Health Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Anatomy / Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail: (IBK); (DSK)
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Carlson SR, Bukowiec LG, Hasley HL, Megalla M. Letter to the Editor on: Online educational resources for orthopaedic residency-a narrative review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2755-2756. [PMID: 34462792 PMCID: PMC8405386 DOI: 10.1007/s00264-021-05205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/23/2021] [Indexed: 12/05/2022]
Affiliation(s)
- Steven R. Carlson
- Hackensack Meridian School of Medicine, 340 Kingsland Street, Nutley, NJ USA
| | - Lainey G. Bukowiec
- Hackensack Meridian School of Medicine, 340 Kingsland Street, Nutley, NJ USA
| | - Hunter L. Hasley
- Hackensack Meridian School of Medicine, 340 Kingsland Street, Nutley, NJ USA
| | - Martinus Megalla
- Hackensack Meridian School of Medicine, 340 Kingsland Street, Nutley, NJ USA
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Iñiguez M, Negrín R, Duboy J, Reyes NO, Díaz R. Robot-Assisted Unicompartmental Knee Arthroplasty: Increasing Surgical Accuracy? A Cadaveric Study. J Knee Surg 2021; 34:628-634. [PMID: 31639849 DOI: 10.1055/s-0039-1698771] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Unicompartmental knee arthroplasty (UKA) represents 10% of knee arthroplasties. Advantages are better functional results, quicker recovery, shorter hospitalization time, and lower blood loss, among others. However, revision rates are larger than total knee arthroplasty. Among the most important factors that explain this are the implant position and alignment, and the correct surgical indication. Greater accuracy in the implant placement may improve clinical results and increase the rate of implant survival. The objective of this study is to evaluate the precision of the Navio robot-assisted system in the position and alignment of medial UKA compared with the conventional technique. This is an experimental pilot study. Twenty-six cadaveric models were randomized into 2 groups: Robot-Assisted surgery (R) and Conventional Surgery (C). Radiological study was performed pre- and post-surgery, evaluating the medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), tibial slope, tibiofemoral angle (TFA), sagittal femoral angle (SFA), and size of the femoral and tibial components. The main result measurement was the change in postoperative angulation. The results of this study are MDFA median of 1.07° (0.19-4.5) for group R and 0.12° (0.03-10.4) with a significant difference in variances; a Welch t-test of p = 0.013; and an MPTA of 1.28° (0.05-5.87) for R and 1.3°(0.08-14.1) for C with significantly different variances (p = 0.0064). Size of the femoral component has a difference of p < 0.05 between groups. No differences for dispersion of TFA nor for the size of the tibial component were observed. In conclusion, using robot-assisted UKA allows for greater accuracy in the positioning of the implants and in the prediction of the size of the femoral component.
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Affiliation(s)
- Magaly Iñiguez
- Department of Orthopedics and Traumatology, Clinica Las Condes, Santiago, Chile
| | - Roberto Negrín
- Department of Orthopedics and Traumatology, Clinica Las Condes, Santiago, Chile
| | - Jaime Duboy
- Department of Orthopedics and Traumatology, Clinica Las Condes, Santiago, Chile
| | - Nicolás O Reyes
- Department of Orthopedics and Traumatology, Clinica Las Condes, Santiago, Chile
| | - Rodrigo Díaz
- Department of Orthopedics and Traumatology, Clinica Las Condes, Santiago, Chile
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Casari FA, Navab N, Hruby LA, Kriechling P, Nakamura R, Tori R, de Lourdes Dos Santos Nunes F, Queiroz MC, Fürnstahl P, Farshad M. Augmented Reality in Orthopedic Surgery Is Emerging from Proof of Concept Towards Clinical Studies: a Literature Review Explaining the Technology and Current State of the Art. Curr Rev Musculoskelet Med 2021; 14:192-203. [PMID: 33544367 PMCID: PMC7990993 DOI: 10.1007/s12178-021-09699-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Augmented reality (AR) is becoming increasingly popular in modern-day medicine. Computer-driven tools are progressively integrated into clinical and surgical procedures. The purpose of this review was to provide a comprehensive overview of the current technology and its challenges based on recent literature mainly focusing on clinical, cadaver, and innovative sawbone studies in the field of orthopedic surgery. The most relevant literature was selected according to clinical and innovational relevance and is summarized. RECENT FINDINGS Augmented reality applications in orthopedic surgery are increasingly reported. In this review, we summarize basic principles of AR including data preparation, visualization, and registration/tracking and present recently published clinical applications in the area of spine, osteotomies, arthroplasty, trauma, and orthopedic oncology. Higher accuracy in surgical execution, reduction of radiation exposure, and decreased surgery time are major findings presented in the literature. In light of the tremendous progress of technological developments in modern-day medicine and emerging numbers of research groups working on the implementation of AR in routine clinical procedures, we expect the AR technology soon to be implemented as standard devices in orthopedic surgery.
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Affiliation(s)
- Fabio A Casari
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
- ROCS, Research in Orthopedic Computer Science, Balgrist Campus, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.
| | - Nassir Navab
- Computer Aided Medical Procedures (CAMP), Technische Universität München, Munich, Germany
- Computer Aided Medical Procedures (CAMP), Johns Hopkins University, Baltimore, MD, USA
| | - Laura A Hruby
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Kriechling
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ricardo Nakamura
- Computer Engineering and Digital Systems Department, Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Romero Tori
- Computer Engineering and Digital Systems Department, Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Marcelo C Queiroz
- Orthopedics and Traumatology Department, Faculty of Medical Sciences of Santa Casa de Sao Paulo, Sao Paulo, SP, Brazil
| | - Philipp Fürnstahl
- ROCS, Research in Orthopedic Computer Science, Balgrist Campus, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Seibold M, Maurer S, Hoch A, Zingg P, Farshad M, Navab N, Fürnstahl P. Real-time acoustic sensing and artificial intelligence for error prevention in orthopedic surgery. Sci Rep 2021; 11:3993. [PMID: 33597615 PMCID: PMC7889943 DOI: 10.1038/s41598-021-83506-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
In this work, we developed and validated a computer method capable of robustly detecting drill breakthrough events and show the potential of deep learning-based acoustic sensing for surgical error prevention. Bone drilling is an essential part of orthopedic surgery and has a high risk of injuring vital structures when over-drilling into adjacent soft tissue. We acquired a dataset consisting of structure-borne audio recordings of drill breakthrough sequences with custom piezo contact microphones in an experimental setup using six human cadaveric hip specimens. In the following step, we developed a deep learning-based method for the automated detection of drill breakthrough events in a fast and accurate fashion. We evaluated the proposed network regarding breakthrough detection sensitivity and latency. The best performing variant yields a sensitivity of \documentclass[12pt]{minimal}
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\begin{document}$$93.64 \pm 2.42$$\end{document}93.64±2.42% for drill breakthrough detection in a total execution time of 139.29\documentclass[12pt]{minimal}
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\begin{document}$${\hbox { ms}}$$\end{document}ms. The validation and performance evaluation of our solution demonstrates promising results for surgical error prevention by automated acoustic-based drill breakthrough detection in a realistic experiment while being multiple times faster than a surgeon’s reaction time. Furthermore, our proposed method represents an important step for the translation of acoustic-based breakthrough detection towards surgical use.
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Affiliation(s)
- Matthias Seibold
- Computer Aided Medical Procedures (CAMP), Technical University of Munich, 85748, Munich, Germany. .,Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Balgrist Campus, 8008, Zurich, Switzerland.
| | - Steven Maurer
- Balgrist University Hospital, 8008, Zurich, Switzerland
| | - Armando Hoch
- Balgrist University Hospital, 8008, Zurich, Switzerland
| | - Patrick Zingg
- Balgrist University Hospital, 8008, Zurich, Switzerland
| | - Mazda Farshad
- Balgrist University Hospital, 8008, Zurich, Switzerland
| | - Nassir Navab
- Computer Aided Medical Procedures (CAMP), Technical University of Munich, 85748, Munich, Germany
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Balgrist Campus, 8008, Zurich, Switzerland.,Balgrist University Hospital, 8008, Zurich, Switzerland
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Yoshii Y, Ogawa T, Shigi A, Oka K, Murase T, Ishii T. Three-dimensional evaluations of preoperative planning reproducibility for the osteosynthesis of distal radius fractures. J Orthop Surg Res 2021; 16:131. [PMID: 33579338 PMCID: PMC7879530 DOI: 10.1186/s13018-021-02278-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/03/2021] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Three-dimensional preoperative planning was applied for the osteosynthesis of distal radius fractures. The objective of this study was to evaluate the reproducibility of three-dimensional preoperative planning for the osteosynthesis of distal radius fractures with three-dimensional reference points. METHODS Sixty-three wrists of 63 distal radius fracture patients who underwent osteosynthesis with three-dimensional preoperative planning were evaluated. After taking preoperative CT scans of the injured wrists, 3D images of the distal radius were created. Fracture reduction, implants choices, and placements simulation were performed based on the 3D images. One month after the surgery, postoperative CT images were taken. The reproducibility was evaluated with preoperative plan and postoperative 3D images. The images were compared with the three-dimensional coordinates of radial styloid process, volar and dorsal edges of sigmoid notch, and the barycentric coordinates of the three reference points. The reproducibility of the preoperative plan was evaluated by the distance of the coordinates between the plan and postoperative images for the reference points. The reproducibility of radial inclination and volar tilt on three-dimensional images were evaluated by intra-class correlation coefficient (ICC). RESULTS The distances between the preoperative plan and the postoperative reduction for each reference point were (1) 2.1±1.3 mm, (2) 1.9±1.2 mm, and (3) 1.9±1.2 mm, respectively. The distance between the preoperative plan and postoperative reduction for the barycentric coordinate was 1.3±0.8 mm. ICCs were 0.54 and 0.54 for the volar tilt and radial inclination, respectively (P<0.01). CONCLUSIONS Three-dimensional preoperative planning for the osteosynthesis of distal radius fracture was reproducible with an error of about 2 mm for each reference point and the correlations of reduction shapes were moderate. The analysis method and reference points may be helpful to understand the accuracy of reductions for the three-dimensional preoperative planning in the osteosynthesis of distal radius fractures. TRIAL REGISTRATION Registered as NCT02909647 at ClinicalTrials.gov.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Atsuo Shigi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
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29
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Li DX, Ead MS, Duke KK, Jaremko JL, Westover L. Quantitative analysis of regional specific pelvic symmetry. Med Biol Eng Comput 2021; 59:369-381. [PMID: 33452611 DOI: 10.1007/s11517-020-02296-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022]
Abstract
Understanding bilateral pelvic symmetry can be useful for analyzing complex pelvis anatomy and simplifying difficult procedures for pelvic fractures. This paper aims to quantify the degree of regional pelvic symmetry using computer-based methods. CT scans of 30 intact pelvises were digitized into 3D models and regions were defined: the ilium, acetabulum, pubis, and ischium. The right hemipelvis was aligned with the left, and deviations between the two models were quantified using method 1 (global registration) and method 2 (local registration). Symmetry was evaluated using the root mean square (RMS) of the deviations and the percentage of points within preset thresholds of ± 2 mm and ± 1 mm. The results showed that > 86% of points are within the ± 2 mm deviation threshold and average RMS are < 1.33 mm. For all regions, method 2 showed lower deviations than method 1. The pubis and ischium regions showed a large difference in symmetry between the two methods indicating high local symmetry, but a degree of global asymmetry. Conversely, the acetabular and iliac regions showed similar levels of symmetry with the two methods. When evaluated locally, the pelvic regions can be considered highly symmetric; the acetabulum is highly symmetric globally as well. These findings can be used in future studies to assess the feasibility of patient-specific implants using the mirrored contralateral hemipelvis as a template for unilateral pelvic fracture fixation. The left image shows the "cut planes" used to define four pelvic regions: the ilium, acetabulum, pubis, and ischium. The right image shows a deviation color map (DCM) used to quantify bilateral pelvic symmetry. The scale and color illustrate the degree of deviation of the left hemipelvis with the right hemipelvis with the units in millimeters (mm).
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Affiliation(s)
- David Xinzheyang Li
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
| | - Maha S Ead
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Kajsa K Duke
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 2R3, Canada
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Faux I, Hall JL, Schwarz T, Clements DN, Ryan J. Comparing the accuracy of freehand, fluoroscopically guided and aiming device-assisted drilling in veterinary orthopaedic surgery. Vet Rec 2020; 187:e126. [PMID: 33033104 DOI: 10.1136/vr.105834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/15/2020] [Accepted: 08/06/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Drilling accuracy is essential in the correct positioning of implants and avoidance of iatrogenic damage to surrounding tissues. The use of augmented drilling methods has been documented as an approach to improving the accuracy of drilling. The aim of this study was to compare the accuracy of two augmented drilling methods (fluoroscopically guided and aiming device) to freehand (FH) drilling. METHODS Three experienced specialist surgeons and three veterinary surgeons without primary orthopaedic experience drilled into synthetic bone towards a target using the three different methods at three different angles (0°, 10° and 20°). The duration of drilling was recorded, and the accuracy of drilling was measured using photographs before and after drilling. RESULTS The two augmented methods were more accurate than FH drilling in synthetic bone, with the aiming device producing the greatest accuracy. Increased angulation of drilling decreased the drilling accuracy. Surgeon experience did not impact on drilling accuracy. Surgeon inexperience and augmented drilling methods both increased the time taken to drill. CONCLUSION The use of augmented drilling methods improved the accuracy of drilling, and surgeons should consider their use when drilling in anatomical regions where the margin of error is small.
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Affiliation(s)
- Ian Faux
- R(D)SVS, The University of Edinburgh, Edinburgh, UK
| | - Jon L Hall
- VetEd Specialists, VetEd Specialists Ltd, Quothquan, South Lanarkshire, UK
| | - Tobias Schwarz
- Clinical Veterinary Studies, The University of Edinburgh, Roslin, UK
| | | | - John Ryan
- R(D)SVS, The University of Edinburgh, Edinburgh, UK
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Russo R, Guastafierro A, Rotonda GD, Viglione S, Ciccarelli M, Mortellaro M, Minopoli P, Fiorentino F, Pietroluongo LR. A new classification of impacted proximal humerus fractures based on the morpho-volumetric evaluation of humeral head bone loss with a 3D model. J Shoulder Elbow Surg 2020; 29:e374-e385. [PMID: 32573449 DOI: 10.1016/j.jse.2020.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to classify the pathomorphology of impacted proximal humeral fractures according to the control volume theory, with the intention to introduce a severity index to support surgeons in decision making. METHODS In total, 50 proximal humeral fractures were randomly selected from 200 medical records of adult patients treated from 2009 to 2016. Four nonindependent observers used 2 different imaging modalities (computed tomography scans plus volume rendering; 3D model) to test the classification reliability. A fracture classification system was created according to the control volume theory to provide simple and understandable patterns that would help surgeons make quick assessments. The impacted fractures table was generated based on an evaluation of the calcar condition, determined by the impairment of a defined volumetric area under the cephalic cup and the humeral head malposition. In addition to the main fracture pattern, the comminution degree (low, medium, high), providing important information on fracture severity, could also be evaluated. RESULTS From 3D imaging, the inter- and intraobserver reliability revealed a k value (95% confidence interval) of 0.55 (0.50-0.60) and 0.91 (0.79-1.00), respectively, for the pattern code, and 0.52 (0.43-0.76) and 0.91 (0.56-0.96), respectively, for the comminution degree. CONCLUSIONS The new classification provides a useful synoptic framework for identifying complex fracture patterns. It can provide the surgeon with useful information for fracture analysis and may represent a good starting point for an automated system.
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Affiliation(s)
- Raffaele Russo
- Department of Orthopedic Surgery, Pineta Grande Hospital, Caserta, Italy.
| | | | | | - Stefano Viglione
- Department of Orthopedic Surgery, Pineta Grande Hospital, Caserta, Italy
| | - Michele Ciccarelli
- Department of Orthopedic Surgery, Pineta Grande Hospital, Caserta, Italy
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Abstract
Virtual Reality (VR) in orthopedic surgery has significantly increased in popularity in the areas of preoperative planning, intraoperative usage, and for education and training; however, its utilization lags behind other surgical disciplines and industries. The use of VR in orthopedics is largely focused on education and is currently endorsed by North American and European training committees. The use of VR in shoulder and elbow surgery has varying levels of evidence, from I to IV, and typically involves educational randomized controlled trials. To date, however, the terms and definitions surrounding VR technology used in the literature are often redundant, confusing, or outdated. The purpose of this review, therefore, was to characterize previous uses of VR in shoulder and elbow surgery in preoperative, intraoperative, and educational domains including trauma and elective surgery. Secondary objectives were to provide recommendations for updated terminology of immersive VR (iVR) as well as provide a framework for standardized reporting of research surrounding iVR in shoulder and elbow surgery.
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Affiliation(s)
- Ryan Lohre
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Jon J P Warner
- The Harvard Shoulder Service, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Danny P Goel
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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Du W, Sun T, Ding Y, Jiang C, Qu W, Zhang S. Robot-assisted treatment of unstable pelvic fractures with a percutaneous iliac lumbar double rod fixation combined with a percutaneous pelvic anterior ring INFIX fixation. INTERNATIONAL ORTHOPAEDICS 2020; 44:1223-1232. [PMID: 32318753 PMCID: PMC7260149 DOI: 10.1007/s00264-020-04522-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Abstract
Objective To investigate the clinical effect of robot-assisted treatment of unstable pelvic fractures through a percutaneous iliac lumbar double rod fixation combined with a percutaneous pelvic anterior ring INFIX (internal fixator) fixation. Methods This was a retrospective analysis of 17 cases of unstable anterior and posterior pelvic ring fractures treated between April 2016 and October 2018 by the third Ti-robot system produced in China. The posterior ring was supported with an iliac lumbar double rod fixation and the anterior ring with an INFIX fixation. Operation time and peri-operative bleeding were recorded. The reduction of pelvic fracture displacement was evaluated by Matta score, the post-operative results were evaluated according to Majeed score, and the complications were recorded. Results Twelve males and five females, aged 21–71 years (mean 40.1 ± 3.8 years) were followed up for three to 12 months, (median 6.7 months). Tile typing showed seven B1 type, two B2 type, and eight C1 type cases. Operation time was 90–160 minutes (mean 112.9 ± 16.8 minutes), bleeding was 80–150 mL (mean 105.9 ± 20.6 mL). X-ray three to five days after operation was evaluated by Matta score as excellent in 15 and good in two cases. Majeed score at last follow-up was 85–98 points, excellent in 17 cases. Two cases of lower extremity deep vein thrombosis received an inferior vena cava filter. The filters were removed after two weeks. One case showed incision fat liquefaction healing and the wound healed three weeks after surgery. Conclusion Orthopedic robot-assisted treatment of unstable pelvic fractures by a percutaneous iliac lumbar double rod fixation and a percutaneous pelvic anterior ring INFIX fixator was minimally invasive and feasible. A prospective study is needed.
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Affiliation(s)
- Wei Du
- Department of Spine, Yantaishan Hospital, Yantai, 264000, Shandong, China
| | - Tao Sun
- Department of Traumatology, Yantaishan Hospital, Yantai, 264000, Shandong, China
| | - Yan Ding
- Department of Spine, Yantaishan Hospital, Yantai, 264000, Shandong, China
| | - Chuanqiang Jiang
- Department of Traumatology, Yantaishan Hospital, Yantai, 264000, Shandong, China
| | - Wenqing Qu
- Department of Traumatology, Yantaishan Hospital, Yantai, 264000, Shandong, China
| | - Shudong Zhang
- Department of Joint, Yantaishan Hospital, No. 91, Jiefang Road, Yantai, 264000, Shandong, China.
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Virtual reconstruction of unilateral pelvic fractures by using pelvic symmetry. Int J Comput Assist Radiol Surg 2020; 15:1267-1277. [PMID: 32249403 DOI: 10.1007/s11548-020-02140-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/25/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Pelvic fractures are known to be one of the most difficult injuries to treat. The objective of this study is to introduce a novel technique for virtual unilateral pelvic fracture reconstruction. Since the pelvis exhibits remarkable left-right symmetry, the contralateral hemipelvis can be used as a template for rebuilding the fractured hemipelvis. METHODS CT scan data of the pelvic region of eight subjects with acute unilateral pelvic fractures were involved in this study. Computer-aided design software was used to create 3D models of these pelvises. The contralateral hemipelvis of each subject was then reflected across the sagittal plane, and the fractured hemipelvis was rebuilt by aligning the bone fragments with their equivalent location on the reflected side. To evaluate the quality of this reduction process, a 3D deviation analysis was conducted to calculate the differences between the reflected intact hemipelvis and the reconstructed hemipelvis. RESULTS Results showed that the average root mean square (RMS) of deviations and average percentage of points within a ± 2 mm predefined threshold was 1.32 ± 0.22 mm and 88.4 ± 3.78%, respectively. The deviation color maps obtained indicated that the largest differences were along the fracture lines and on the non-articular surfaces of the pelvises. CONCLUSION These results allowed us to conclude the validity of this procedure, since the average RMS difference was below 2 mm and the average percentage of points within ± 2 mm was high. The proposed technique will allow surgeons to provide their patients with more accurate reconstruction procedures which can potentially improve surgical outcomes.
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Hazratwala K, Brereton SG, Grant A, Dlaska CE. Computer-Assisted Technologies in Arthroplasty: Navigating Your Way Today. JBJS Rev 2020; 8:e0157. [PMID: 32224641 DOI: 10.2106/jbjs.rvw.19.00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Computer-assisted technologies that are used in arthroplasty include navigation, image-derived instrumentation (IDI), and robotics. Computer-assisted navigation improves accuracy and allows for real-time assessment of component positioning and soft-tissue tension. It is not clear whether the implementation of these technologies improves the clinical outcome of surgery. High cost and time demands have prevented the global implementation of computer-assisted technologies.
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Affiliation(s)
- Kaushik Hazratwala
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mater Health Services North Queensland, Townsville, Queensland, Australia.,Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Sarah G Brereton
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mater Health Services North Queensland, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
| | - Constantin E Dlaska
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mackay Hospital and Health Services, Mackay, Queensland, Australia
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Vadalà G, De Salvatore S, Ambrosio L, Russo F, Papalia R, Denaro V. Robotic Spine Surgery and Augmented Reality Systems: A State of the Art. Neurospine 2020; 17:88-100. [PMID: 32252158 PMCID: PMC7136092 DOI: 10.14245/ns.2040060.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022] Open
Abstract
Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.
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Affiliation(s)
- Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Chen X, Wang Y, Zhu G, Zhang W, Zhou G, Fan Y. Influence of multi-angle input of intraoperative fluoroscopic images on the spatial positioning accuracy of the C-arm calibration-based algorithm of a CAOS system. Med Biol Eng Comput 2020; 58:559-572. [PMID: 31919719 DOI: 10.1007/s11517-019-02112-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/24/2019] [Indexed: 11/26/2022]
Abstract
Intraoperative fluoroscopic images, as one of the most important input data for computer-assisted orthopedic surgery (CAOS) systems, have a significant influence on the positioning accuracy of CAOS system. In this study, we proposed to use multi-angle intraoperative fluoroscopy images as input based on real clinical scenario, and the aim was to analyze the positioning accuracy and the error propagation rules with multi-angle input images compared with traditional two input images. In the experiment, the positioning accuracy of the C-arm calibration-based algorithm was studied, respectively, using two, three, four, five, and six intraoperative fluoroscopic images as input data. Moreover, the error propagation rules of the positioning error were analyzed by the Monte Carlo method. The experiment result showed that increasing the number of multi-angle input fluoroscopic images could reduce the positioning error of CAOS system, which has dropped from 1.01 to 0.61 mm. The Monte Carlo simulation analysis showed that for random input errors subject to normal distribution (μ = 0, σ = 1), the image positioning error dropped from 0.29 to 0.23 mm, and the staff gauge positioning error dropped from 1.36 to 1.19 mm, while the tracking device positioning error dropped from 3.41 to 2.13 mm. In addition, the results showed that image positioning error and staff gauge positioning error were all nonlinear error for the whole system, but tracker device positioning error was a strictly linear error. In conclusion, using multi-angle fluoroscopy images was helpful for clinic, which could improve the positioning accuracy of the CAOS system by nearly 30%. Graphical abstract The experiment process and Monte Carlo analysis of spatial positioning accuracy (A: Setup for the experiment; B: The process of Monte Carlo analysis; C: Results).
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Affiliation(s)
- Xiangqian Chen
- School of Biological Science and Medical Engineering, Beihang University, 37# Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, 37# Xueyuan Road, Haidian District, Beijing, 100191, China.
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, 37# Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Gang Zhu
- School of Biological Science and Medical Engineering, Beihang University, 37# Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Weijun Zhang
- Beijing TINAVI Medical Technology Co., Ltd, 66# Xixiaokou Road, Haidian District, Beijing, 100192, China
| | - Gang Zhou
- School of Biological Science and Medical Engineering, Beihang University, 37# Xueyuan Road, Haidian District, Beijing, 100191, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, 37# Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yubo Fan
- School of Biological Science and Medical Engineering, Beihang University, 37# Xueyuan Road, Haidian District, Beijing, 100191, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, 37# Xueyuan Road, Haidian District, Beijing, 100191, China
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Recent Trends, Technical Concepts and Components of Computer-Assisted Orthopedic Surgery Systems: A Comprehensive Review. SENSORS 2019; 19:s19235199. [PMID: 31783631 PMCID: PMC6929084 DOI: 10.3390/s19235199] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Abstract
Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.
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Yoshii Y, Totoki Y, Sashida S, Sakai S, Ishii T. Utility of an image fusion system for 3D preoperative planning and fluoroscopy in the osteosynthesis of distal radius fractures. J Orthop Surg Res 2019; 14:342. [PMID: 31694677 PMCID: PMC6836429 DOI: 10.1186/s13018-019-1370-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Recently, computerized virtual surgery planning has been increasingly applied in various orthopedic procedures. In this study, we developed an image fusion system for 3D preoperative planning and fluoroscopy for the osteosynthesis. To assess the utility of image fusion system, we evaluated the reproducibility of preoperative planning in the osteosynthesis of distal radius fractures with using the image fusion system, and compared with the reproducibility of the patients without using the image fusion system. Methods Forty-two wrists of 42 distal radius fracture patients who underwent osteosynthesis using volar locking plates were evaluated. The patients were divided into two groups. Image fusion group utilized three-dimensional (3D) preoperative planning and image fusion system. Control group utilized only 3D preoperative planning. In both groups, 3D preoperative planning was performed in order to determine reduction, placement, and choice of implants. In the image fusion group, the outline of planned image was displayed on a monitor overlapping with fluoroscopy images during surgery. Reductions were evaluated by volar tilt and radial inclination of 3D images. Plate positions were evaluated with distance to joint surface, plate center axis position, and inclination relative to the radius axis. Screw choices were recorded for the plan and actual choices for each screw hole. Differences in the parameters between pre- and postoperative images were evaluated. Differences in reduction shape, plate positions, and screw choices were compared between groups. Results The differences in the distance from plate to joint surface were significantly smaller in the image fusion group compared to the control group (P < 0.01). The differences in the distal screw choices were significantly smaller in the image fusion group compared to the control group (P < 0.01). Conclusions The image fusion system was useful to reproduce the planned plate position and distal screw choices in the osteosynthesis of distal radius fractures. Trial registration ClinicalTrials.gov, NCT03764501
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Yasukazu Totoki
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | | | - Shinsuke Sakai
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
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Abstract
The field of robotic surgery has progressed from small teams of researchers repurposing industrial robots, to a competitive and highly innovative subsection of the medical device industry. Surgical robots allow surgeons to perform tasks with greater ease, accuracy, or safety, and fall under one of four levels of autonomy; active, semi-active, passive, and remote manipulator. The increased accuracy afforded by surgical robots has allowed for cementless hip arthroplasty, improved postoperative alignment following knee arthroplasty, and reduced duration of intraoperative fluoroscopy among other benefits. Cutting of bone has historically used tools such as hand saws and drills, with other elaborate cutting tools now used routinely to remodel bone. Improvements in cutting accuracy and additional options for safety and monitoring during surgery give robotic surgeries some advantages over conventional techniques. This article aims to provide an overview of current robots and tools with a common target tissue of bone, proposes a new process for defining the level of autonomy for a surgical robot, and examines future directions in robotic surgery.
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Chytas D, Malahias MA, Nikolaou VS. Augmented Reality in Orthopedics: Current State and Future Directions. Front Surg 2019; 6:38. [PMID: 31316995 PMCID: PMC6610425 DOI: 10.3389/fsurg.2019.00038] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/12/2019] [Indexed: 12/29/2022] Open
Abstract
Augmented reality (AR) comprises special hardware and software, which is used in order to offer computer-processed imaging data to the surgeon in real time, so that real-life objects are combined with computer-generated images. AR technology has recently gained increasing interest in the surgical practice. Preclinical research has provided substantial evidence that AR might be a useful tool for intra-operative guidance and decision-making. AR has been applied to a wide spectrum of orthopedic procedures, such as tumor resection, fracture fixation, arthroscopy, and component's alignment in total joint arthroplasty. The present study aimed to summarize the current state of the application of AR in orthopedics, in preclinical and clinical level, providing future directions and perspectives concerning potential further benefits from this technology.
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Affiliation(s)
- Dimitrios Chytas
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Computer-assisted virtual surgical technology in pre-operative design for the reconstruction of calcaneal fracture malunion. INTERNATIONAL ORTHOPAEDICS 2019; 43:1669-1677. [DOI: 10.1007/s00264-019-04328-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
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43
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Bishop ES, Hall JL, Handel I, Clements DN, Ryan J. Sequential drilling and drill angulation reduce the accuracy of drill hole start location in a synthetic bone model. Vet Rec 2019; 184:383. [DOI: 10.1136/vr.104897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 11/13/2018] [Accepted: 12/28/2018] [Indexed: 11/03/2022]
Affiliation(s)
| | - Jon L Hall
- Hospital for Small Animals, University of Edinburgh; Edinburgh UK
| | - Ian Handel
- Royal Dick School of Veterinary Studies, University of Edinburgh; Edinburgh UK
| | | | - John Ryan
- Hospital for Small Animals, University of Edinburgh; Edinburgh UK
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Peng Y, Zhang W, Zhang G, Wang X, Zhang S, Ma X, Tang P, Zhang L. Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury. J Orthop Surg Res 2019; 14:29. [PMID: 30683121 PMCID: PMC6347760 DOI: 10.1186/s13018-018-1040-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022] Open
Abstract
Background Sacral fracture and sacral nerve injury remain problems in orthopedics, especially in a sacral fracture combined with an anterior sacral nerve injury. Treating a sacral nerve injury with open reduction neurolysis or more conservative treatment cannot meet the clinical needs. Open reduction sacral nerve neurolysis will increase the number of severe, life-threatening injuries, regardless of whether the anterior or posterior approach is used. In recent years, computer- and robot-assisted orthopedic surgery has emerged as part of many clinical treatments. Methods For an unstable pelvic fracture with an anterior sacral nerve injury, we established a comprehensive and integrated solution. To achieve closed reduction, minimally invasive fixation, and minimally invasive anterior sacral nerve neurolysis, the Starr Frame, navigation robot, and Da Vinci robot were jointly applied. Results The Starr Frame is very helpful for closed reduction percutaneous fixation in complex pelvic fractures. In this study, a minimally invasive fixation technique for the navigation robot in the pelvic fracture was explored. Although the patient had delayed anterior sacral nerve compression pain after surgery, we developed an approach and surgical method using the Da Vinci robot to explore the sacral nerve by celiac decompression. The patient was relieved of nerve pressure and pain. Conclusions This treatment method could be an alternative treatment for pelvic fractures and sacral nerve injury. The application of this treatment is a safe and feasible option that can be employed to manage early and late nerve repair with sacral fractures when open surgery or conservative treatment is unsuitable.
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Affiliation(s)
- Ye Peng
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China
| | - Wei Zhang
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China
| | - Gongzi Zhang
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China
| | - Xiang Wang
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China
| | - Shuwei Zhang
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China
| | - Xin Ma
- Department of Urology Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China.
| | - Peifu Tang
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China.
| | - Lihai Zhang
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China.
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Gregory TM, Gregory J, Sledge J, Allard R, Mir O. Surgery guided by mixed reality: presentation of a proof of concept. Acta Orthop 2018; 89:480-483. [PMID: 30350756 PMCID: PMC6202760 DOI: 10.1080/17453674.2018.1506974] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Thomas M Gregory
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique—Hôpitaux de Paris, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, France; ,Moveo Institute, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, France; ,Correspondence:
| | - Jules Gregory
- Department of Radiology, Beaujon Teaching Hospital, Assistance Publique—Hôpitaux de Paris, University Paris-Diderot, Clichy, France;
| | - John Sledge
- Department of Orthopedic Surgery, Lafayette Hospital, Lafayette, LA, USA;
| | - Romain Allard
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique—Hôpitaux de Paris, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, France;
| | - Olivier Mir
- Moveo Institute, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, France; ,Department of Ambulatory Care, Gustave Roussy Cancer Campus, Villejuif, France
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Self-learning computers for surgical planning and prediction of postoperative alignment. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:123-128. [DOI: 10.1007/s00586-018-5497-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
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Ewurum CH, Guo Y, Pagnha S, Feng Z, Luo X. Surgical Navigation in Orthopedics: Workflow and System Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:47-63. [PMID: 30306471 DOI: 10.1007/978-981-13-1396-7_4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Orthopedic surgery is a widely performed clinical procedure that deals with problems in relation to the bones, joints, and ligaments of the human body, such as musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders. Surgical navigation is generally recognized as the next generation technology of orthopedic surgery. The development of orthopedic navigation systems aims to analyze pre-, intra- and/or postoperative data in multiple modalities and provide an augmented reality 3-D visualization environment to improve clinical outcomes of surgical orthopedic procedures. This chapter investigates surgical navigation techniques and systems that are currently available in orthopedic procedures. In particular, optical tracking, electromagnetic localizers and stereoscopic vision, as well as commercialized orthopedic navigation systems are thoroughly discussed. Moreover, advances and development trends in orthopedic navigation are also discussed in this chapter. While current orthopedic navigation systems enable surgeons to make precise decisions in the operating room by integrating surgical planning, instrument tracking, and intraoperative imaging, it still remains an active research field which provides orthopedists with various technical disciplines, e.g., medical imaging, computer science, sensor technology, and robotics, to further develop current orthopedic navigation methods and systems.
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Affiliation(s)
| | - Yingying Guo
- Department of Computer Science, Xiamen University, Xiamen, China
| | - Seang Pagnha
- Department of Computer Science, Xiamen University, Xiamen, China
| | - Zhao Feng
- Department of Computer Science, Xiamen University, Xiamen, China
| | - Xiongbiao Luo
- Department of Computer Science, Xiamen University, Xiamen, China.
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Affiliation(s)
- Chin Siang Ong
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Narutoshi Hibino
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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