3D Innovations in Personalized Surgery

Current practice involves the use of 3D surgical planning and patient-specific solutions in multiple surgical areas of expertise. Patient-specific solutions have been endorsed for several years in numerous publications due to their associated benefits around accuracy, safety, and predictability of surgical outcome. The basis of 3D surgical planning is the use of high-quality medical images (e.g., CT, MRI, or PET-scans). The translation from 3D digital planning toward surgical applications was developed hand in hand with a rise in 3D printing applications of multiple biocompatible materials. These technical aspects of medical care require engineers’ or technical physicians’ expertise for optimal safe and effective implementation in daily clinical routines.The aim and scope of this Special Issue is high-tech solutions in personalized surgery, based on 3D technology and, more specifically, bone-related surgery. Full-papers or highly innovative technical notes or (systematic) reviews that relate to innovative personalized surgery are invited. This can include optimization of imaging for 3D VSP, optimization of 3D VSP workflow and its translation toward the surgical procedure, or optimization of personalized implants or devices in relation to bone surgery

Patient-Specific Implants in Musculoskeletal (Orthopedic) Surgery

Most of the treatments in medicine are patient specific, aren’t they? So why should we bother with individualizing implants if we adapt our therapy to patients anyway? Looking at the neighboring field of oncologic treatment, you would not question the fact that individualization of tumor therapy with personalized antibodies has led to the thriving of this field in terms of success in patient survival and positive responses to alternatives for conventional treatments. Regarding the latest cutting-edge developments in orthopedic surgery and biotechnology, including new imaging techniques and 3D-printing of bone substitutes as well as implants, we do have an armamentarium available to stimulate the race for innovation in medicine. This Special Issue of Journal of Personalized Medicine will gather all relevant new and developed techniques already in clinical practice. Examples include the developments in revision arthroplasty and tumor (pelvic replacement) surgery to recreate individual defects, individualized implants for primary arthroplasty to establish physiological joint kinematics, and personalized implants in fracture treatment, to name but a few

Effectiveness of total knee arthroplasty using three-dimensional printing technology for knee osteoarthritis accompanied with extra-articular deformity

目的探讨3D打印技术辅助人工全膝关节置换术(total knee arthroplasty,TKA)治疗合并关节外畸形的膝骨关节炎(knee; osteoarthritis,KOA)的临床疗效。方法2013年3月2015年12月,收治15例(18膝)合并关节外畸形的KOA患者。男6例(6; 膝),女9例(12膝);年龄55~70岁,平均60.2岁;病程7~15年,平均10.8年。单膝12例,双膝3例。膝关节学会评分系统(KSS)临床; 评分为(57.441.06)分,功能评分为(60.881.26)分。膝关节活动度为(72.220.18)°。下肢力线偏移(18.890.92)°; 。合并股骨侧畸形8例(10膝),胫骨侧畸形5例(5膝),股骨侧及胫骨侧畸形2例(3膝)。术前3D打印骨骼模型、截骨导航模板并设计手术方案,选择合; 适的膝关节假体后实施TKA。结果手术时间65~100 min,平均75.6 min;术中出血量50~150 mL,平均90.2; mL。术后均未出现切口愈合不良、感染、血栓等并发症。患者均获随访,随访时间12~30个月,平均22个月。末次随访时,X线片示假体位置均良好,未发; 现松动、下沉;下肢力线偏移(2.000.29)°,与术前比较差异有统计学意义(t=13.120,P=0.007);KSS临床评分为(87.500; .88)分、功能评分为(81.941.41)分,与术前比较差异有统计学意义(t=27.553,P=0.000;t=35.551,P=0.000); ;膝关节活动度为(101.941.42)°,与术前比较差异有统计学意义(t=31.633,P=0.000)。结论对于合并关节外畸形的KOA,采用; 3D打印技术辅助TKA,可达到个体化治疗、降低手术难度,有效矫正畸形,恢复患者膝关节功能的目的。Objective To evaluate the effectiveness of total knee arthroplasty (TKA); using three-dimensional (3D) printing technology for knee osteoarthritis; (KOA) accompanied with extra-articular deformity. Methods Between March; 2013 and December 2015, 15 patients (18 knees) with extra-articular; deformity and KOA underwent TKA. There were 6 males (6 knees) and 9; females (12 knees), aged 55-70 years (mean, 60.2 years). The mean; disease duration was 10.8 years (range, 7-15 years). The unilateral knee; was involved in 12 cases and bilateral knees in 3 cases. The clinical; score was 57.441.06 and the functional score was 60.881.26 of Knee; Society Score (KSS). The range of motion of the knee joint was; (72.220.18)°. The deviation of mechanical axis of lower limb was; (18.890.92)° preoperatively. There were 8 cases (10 knees) with; extra-articular femoral deformity, 5 cases (5 knees) with; extra-articular tibial deformity, and 2 cases (3 knees) with; extra-articular femoral and tibial deformities. Bone models and the; navigation templates were printed and the operation plans were designed; using 3D printing technology. The right knee joint prostheses were; chosen. Results The operation time was 65-100 minutes (mean, 75.6; minutes). The bleeding volume was 50-150 mL (mean, 90.2 mL). There was; no poor incision healing, infection, or deep venous thrombosis after; operation. All patients were followed up 12- 30 months (mean, 22; months). Prostheses were located in the right place, and no sign of; loosening or subsidence was observed by X-ray examination. At last; follow-up, the deviation of mechanical axis of lower limb was; (2.000.29)°, showing significant difference when compared with; preoperative one (t=13.120, P=0.007). The KSS clinical score was; 87.500.88 and function score was 81.941.41, showing significant; differences when compared with preoperative ones (t=27.553, P=0.000;; t=35.551, P=0.000). The range of motion of knee was (101.941.42)°,; showing significant difference when compared with preoperative one; (t=31.633, P=0.000). Conclusion For KOA accompanied with extra-articular; deformity, TKA using 3D printing technology has advantages such as; individualized treatment, reducing the difficulty of operation, and; achieving the satisfactory function

Personalized Hip and Knee Joint Replacement

This open access book describes and illustrates the surgical techniques, implants, and technologies used for the purpose of personalized implantation of hip and knee components. This new and flourishing treatment philosophy offers important benefits over conventional systematic techniques, including component positioning appropriate to individual anatomy, improved surgical reproducibility and prosthetic performance, and a reduction in complications. The techniques described in the book aim to reproduce patients’ native anatomy and physiological joint laxity, thereby improving the prosthetic hip/knee kinematics and functional outcomes in the quest of the forgotten joint. They include kinematically aligned total knee/total hip arthroplasty, partial knee replacement, and hip resurfacing. The relevance of available and emerging technological tools for these personalized approaches is also explained, with coverage of, for example, robotics, computer-assisted surgery, and augmented reality. Contributions from surgeons who are considered world leaders in diverse fields of this novel surgical philosophy make this open access book will invaluable to a wide readership, from trainees at all levels to consultants practicing lower limb surger

Arthrokinematics of the Distal Radioulnar Joint in the Normal Wrist and Following Distal Radius Malunion

Contact patterns in the distal radioulnar joint (DRUJ) are not well understood for normal anatomy or with distal radius deformity. This thesis presents three studies which investigate the arthrokinematics of the DRUJ for these conditions. The first study compared casting and Tekscan, two standard methods for contact measurement, with a novel technique of proximity mapping termed Inter-cartilage Distance (ICD). The relative benefits, limitations and role for ICD in DRUJ contact assessment were examined and discussed. The second study used ICD to characterize contact patterns in the native DRUJ. Contact was found to be maximal in 10 degrees of supination and the contact centroid moved volar and proximal with supination. The third and final study evaluated the effect of dorsal angulation deformity on DRUJ arthrokinematics. The contact centroid moved volarly, while simulated TFCC rupture reduced DRUJ contact area and caused the centroid position to become more variable in its pathway

The of Application of 3D-Printing to Lumbar Spine Surgery

Rapid prototyping refers to the manufacturing process in which a three-dimensional (3D) digital model can be transformed into a physical model by layering material in the shape of successive cross sections atop of previously layers. Rapid prototyping has been increasing in popularity in the field of medicine and surgery due to the ability to personalize various aspects of patient care. The thesis will explore the use of rapid prototyping in lumbar spine surgery, aim to quantify the accuracy of medical imaging when relating to imaged structures and their corresponding models produced by rapid prototyping, and determine if complex patient-specific guides are accurate and safe