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

X-ray computed tomography and additive manufacturing in medicine: a review

The use of X-ray computed tomography (XCT) with additive manufacture (AM) within a medical context is examined in this review. The seven AM process families and various XCT scanning techniques are explained in brief, and the use of these technologies together is detailed over time. The transition of these technologies from a simple method of medical modelling to a robust method of customised implant manufacture is described, and the state-of-the-art for XCT and AM is examined in detail. XCT and AM are identified as having the potential to improve gold standards in both modelling and implant production, and in the conclusions of this review, primary barriers to the increased adoption ofAMand XCT technologies are identified in reference to the main applications of XCT and AM technologies. The primary prohibitive factors generally relate to the cost of production across all of the examined applications, as well as the need for further clinical trials in surgical guidance and applications involving implantation

A parametric modeling concept for predicting biomechanical compatibility in total hip arthroplasty

This work attempts to predict the long-term outcome of total hip arthroplasty based on available patient-specific information and possible installation positions of the prosthesis. For this purpose, a holistic modeling approach for the numerical simulation of osseointegration and long-term stability of endoprostheses, including possible prosthesis positions, is developed. In addition, new, efficient, and reliable methods for the numerical description of adaptive bone remodeling and osseointegration are proposed: The adaptive bone remodeling is described as a geometric-linear, material-nonlinear finite element model, following thermodynamically consistent material modeling guidelines. The resulting constitutive equations are expanded to describe osseointegration and transferred into a contact interface between bone and prosthesis. Finally, the results are projected to an imaging format that is easier to interpret for medical professionals, using a newly developed simulation for X-ray images. The inclusion of possible prosthesis positions spans an infinite-dimensional event space. Therefore, the model is reduced to a finite-dimensional surrogate model sampled with an adaptive sparse-grid collocation method. Without clinical validation, reliable statements cannot be made, and therefore the numerical examples given in this thesis can be regarded as proof of correct implementation and feasibility studies. This dissertation thus provides an answer to how much computational effort is required to provide a real digital decision aid in orthopedic surgery

1st EFORT European Consensus: Medical & Scientific Research Requirements for the Clinical Introduction of Artificial Joint Arthroplasty Devices

Innovations in Orthopaedics and Traumatology have contributed to the achievement of a high-quality level of care in musculoskeletal disorders and injuries over the past decades. The applications of new implants as well as diagnostic and therapeutic techniques in addition to implementation of clinical research, have significantly improved patient outcomes, reduced complication rates and length of hospital stay in many areas. However, the regulatory framework is extensive, and there is a lack of understanding and clarity in daily practice what the meaning of clinical & pre‐clinical evidence as required by the MDR is. Thus, understanding and clarity are of utmost importance for introduction of new implants and implant-related instrumentation in combination with surgical technique to ensure a safe use of implants and treatment of patients. Therefore EFORT launched IPSI, The Implant and Patient Safety Initiative, which starting from an inaugural workshop in 2021 issued a set of recommendations, notably through a subsequent Delphi Process involving the National Member Societies of EFORT, European Specialty Societies as well as International Experts. These recommendations provide surgeons, researchers, implant manufacturers as well as patients and health authorities with a consensus of the development, implementation, and dissemination of innovation in the field of arthroplasty. The intended key outcomes of this 1st EFORT European Consensus on “Medical & Scientific Research Requirements for the Clinical Introduction of Artificial Joint Arthroplasty Devices”are consented, practical pathways to maintain innovation and optimisation of orthopaedic products and workflows within the boundaries of MDR 2017/745. Open Access practical guidelines based on adequate, state of the art pre-clinical and clinical evaluation methodologies for the introduction of joint replacements and implant-related instrumentation shall provide hands-on orientation for orthopaedic surgeons, research institutes and laboratories, orthopaedic device manufacturers, Notified Bodies but also for National Institutes and authorities, patient representatives and further stakeholders. We would like to acknowledge and thank the Scientific Committee members, all International Expert Delegates, the Delegates from European National & Specialty Societies and the Editorial Team for their outstanding contributions and support during this EFORT European Consensus

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): Guidelines for medical 3D printing and appropriateness for clinical scenarios

Este número da revista Cadernos de Estudos Sociais estava em organização quando fomos colhidos pela morte do sociólogo Ernesto Laclau. Seu falecimento em 13 de abril de 2014 surpreendeu a todos, e particularmente ao editor Joanildo Burity, que foi seu orientando de doutorado na University of Essex, Inglaterra, e que recentemente o trouxe à Fundação Joaquim Nabuco para uma palestra, permitindo que muitos pudessem dialogar com um dos grandes intelectuais latinoamericanos contemporâneos. Assim, buscamos fazer uma homenagem ao sociólogo argentino publicando uma entrevista inédita concedida durante a sua passagem pelo Recife, em 2013, encerrando essa revista com uma sessão especial sobre a sua trajetória

Interface micromotion in cementless hip prostheses.

The most commonly reported failure modes of cementless hip stems are loosening and thigh pain both are attributed to the relative motion at the bone-implant interface due to failure to achieve sufficient primary fixation. The main aim of the current study is to investigate, using Finite Element Analysis, various factors that could affect micromotion and could compromise the stability of cementless femoral stems. We propose a novel technique for predicting hip stem instability to analyse these problems. The designs of cementless hip stems are crucial to its success. We first categorize them into three major types based on the overall geometry and they are all found to be stable under physiological loadings. Tsoelastic' stems are found to increase interface micromotion, but if tight fit is achieved distally, the stem would still be stable. Having shorter stems for primary arthroplasty is beneficial if revision surgery is required, but these produce larger relative motion. The results from this study show that if sufficient cortical contact is achieved distally, stability is not impaired. Two types of hip stems' fixation are also compared the proximal fixation design is found to be less stable than the distal fixation design, but stability can be improved with the use of proximal macrofeatures. The strength of primary fixation also depends on surgical parameters imprecise surgical procedures can cause interfacial gaps, implant undersizing and implant malalignment. The FE results show that undersizing should be avoided because it increases micromotion and instability, especially in stems with cylindrical design. Hip stems with varus malalignment are found to be relatively stable compared to the normally aligned undersized stem. Interfacial gaps due to surgical error are not found to impair the stem's fixation as long as maximum press-fit is achieved. Successful implant fixation also depends on the quality of the bone. Bone with skeletal diseases of osteoporosis and osteoarthritis are analysed and compared with the results from a normal healthy bone. The hip stem in the osteoporotic bone is found to have the largest micromotion and is the most unstable, especially during stair-climbing activity

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios

Abstract Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.https://deepblue.lib.umich.edu/bitstream/2027.42/146524/1/41205_2018_Article_30.pd

Book of Abstracts 15th International Symposium on Computer Methods in Biomechanics and Biomedical Engineering and 3rd Conference on Imaging and Visualization

In this edition, the two events will run together as a single conference, highlighting the strong connection with the Taylor & Francis journals: Computer Methods in Biomechanics and Biomedical Engineering (John Middleton and Christopher Jacobs, Eds.) and Computer Methods in Biomechanics and Biomedical Engineering: Imaging and Visualization (JoãoManuel R.S. Tavares, Ed.). The conference has become a major international meeting on computational biomechanics, imaging andvisualization. In this edition, the main program includes 212 presentations. In addition, sixteen renowned researchers will give plenary keynotes, addressing current challenges in computational biomechanics and biomedical imaging. In Lisbon, for the first time, a session dedicated to award the winner of the Best Paper in CMBBE Journal will take place. We believe that CMBBE2018 will have a strong impact on the development of computational biomechanics and biomedical imaging and visualization, identifying emerging areas of research and promoting the collaboration and networking between participants. This impact is evidenced through the well-known research groups, commercial companies and scientific organizations, who continue to support and sponsor the CMBBE meeting series. In fact, the conference is enriched with five workshops on specific scientific topics and commercial software.info:eu-repo/semantics/draf