240 research outputs found

    Computational Techniques to Predict Orthopaedic Implant Alignment and Fit in Bone

    Get PDF
    Among the broad palette of surgical techniques employed in the current orthopaedic practice, joint replacement represents one of the most difficult and costliest surgical procedures. While numerous recent advances suggest that computer assistance can dramatically improve the precision and long term outcomes of joint arthroplasty even in the hands of experienced surgeons, many of the joint replacement protocols continue to rely almost exclusively on an empirical basis that often entail a succession of trial and error maneuvers that can only be performed intraoperatively. Although the surgeon is generally unable to accurately and reliably predict a priori what the final malalignment will be or even what implant size should be used for a certain patient, the overarching goal of all arthroplastic procedures is to ensure that an appropriate match exists between the native and prosthetic axes of the articulation. To address this relative lack of knowledge, the main objective of this thesis was to develop a comprehensive library of numerical techniques capable to: 1) accurately reconstruct the outer and inner geometry of the bone to be implanted; 2) determine the location of the native articular axis to be replicated by the implant; 3) assess the insertability of a certain implant within the endosteal canal of the bone to be implanted; 4) propose customized implant geometries capable to ensure minimal malalignments between native and prosthetic axes. The accuracy of the developed algorithms was validated through comparisons performed against conventional methods involving either contact-acquired data or navigated implantation approaches, while various customized implant designs proposed were tested with an original numerical implantation method. It is anticipated that the proposed computer-based approaches will eliminate or at least diminish the need for undesirable trial and error implantation procedures in a sense that present error-prone intraoperative implant insertion decisions will be at least augmented if not even replaced by optimal computer-based solutions to offer reliable virtual “previews” of the future surgical procedure. While the entire thesis is focused on the elbow as the most challenging joint replacement surgery, many of the developed approaches are equally applicable to other upper or lower limb articulations

    3D Innovations in Personalized Surgery

    Get PDF
    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

    Desktop 3D Printing: Key for Surgical Navigation in Acral Tumors?

    Get PDF
    Surgical navigation techniques have shown potential benefits in orthopedic oncologic surgery. However, the translation of these results to acral tumor resection surgeries is challenging due to the large number of joints with complex movements of the affected areas (located in distal extremities). This study proposes a surgical workflow that combines an intraoperative open-source navigation software, based on a multi-camera tracking, with desktop three-dimensional (3D) printing for accurate navigation of these tumors. Desktop 3D printing was used to fabricate patient-specific 3D printed molds to ensure that the distal extremity is in the same position both in preoperative images and during image-guided surgery (IGS). The feasibility of the proposed workflow was evaluated in two clinical cases (soft-tissue sarcomas in hand and foot). The validation involved deformation analysis of the 3D-printed mold after sterilization, accuracy of the system in patient-specific 3D-printed phantoms, and feasibility of the workflow during the surgical intervention. The sterilization process did not lead to significant deformations of the mold (mean error below 0.20 mm). The overall accuracy of the system was 1.88 mm evaluated on the phantoms. IGS guidance was feasible during both surgeries, allowing surgeons to verify enough margin during tumor resection. The results obtained have demonstrated the viability of combining open-source navigation and desktop 3D printing for acral tumor surgeries. The suggested framework can be easily personalized to any patient and could be adapted to other surgical scenarios.This work was supported by projects TEC2013-48251-C2-1-R (Ministerio de Economía y Competitividad); PI18/01625 and PI15/02121 (Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III and European Regional Development Fund “Una manera de hacer Europa”) and IND2018/TIC-9753 (Comunidad de Madrid).Publicad

    The importance of biomechanical restoration for total hip arthroplasty

    Get PDF
    Total hip arthroplasty (THA) has become a safe and very successful surgical intervention. A vast majority of patients get their expectations met. Improvement of materials, implant designs, and surgical techniques, have extended prosthetic survival. However, inferior placement and sizing of a hip prosthesis are known to increase the risk of mechanical failure, wear, and early loosening as well as patient dissatisfaction. The main objective of this thesis was to evaluate the importance of improved biomechanical restoration for the function and survival of THA, as well as finding ways of achieving this improvement. We used radiostereometry (RSA), low dose computer tomography (CT) for 3D measurements, 3D templating, prosthetic modularity, and 3D gait analysis, together with patient-reported outcomes. We found a strong correlation between initial postoperative femoral neck anteversion (FNA) and subsequent posterior rotation and loosening of cemented stems. Our 3D measurement techniques showed near-perfect inter- and intraobserver agreements regarding our femoral offset (FO), acetabular offset (AO), and global offset (GO) measurements. We did not see any differences in RSA migration between uncemented modular and standard stem types, both stabilised well with good migration pattern. Postoperative FNA and FO/AO quota had no impact on uncemented stem migration, maybe due to the study being underpowered. The standard stem tended to result in insufficient GO, whereas the modular stem did not. 3D templating was superior in the correct prediction of the final stem size and neck, but 2D templating overestimated stem-size and underestimated neck-length. There was no statistically significant difference regarding cup size predictions. We found an unexpected progressive varus deformation, with concomitant corrosion-related cobalt ion release, from the modular stem-neck junction. However, the ion-concentrations did not correlate with adverse local tissue reaction (ALTR) as measured with MRI up to 8 years. Biomechanical restoration during THA does positively impact the quality of postoperative overall gait pattern, with faster walking speed and with less trunk lean over the affected side. Increased FNA was associated with increased internal hip rotation during walking. An increase in external hip adduction moments was, on the other hand, not associated with a change in FO/AO quota but with a more upright walking position and increased walking speed.Biomechanical restoration is important for THA and our studies confirm the need for precise measuring- and evaluation-tools for this kind of research

    Spine Surgery

    Get PDF
    We are very excited to introduce this new book on spinal surgery, which follows the curriculum of the EUROSPINE basic and advanced diploma courses. The approach we take is a purely case-based one, in which each case illustrates the concepts surrounding the treatment of a given pathology, including the uncertainties and problems in decision-making. The readers will notice that in many instances a lack of evidence for a given treatment exists. So decisions taken are usually not a clearcut matter of black or white, but merely different shades of gray. Probably in a lot of cases, there is often more than one option to treat the patient. The authors were asked to convey this message to the reader, giving him a guidance as what would be accepted within the mainstream. In addition, the reader is provided with the most updated literature and evidence on the topic. Most of the authors are teachers in the courses of EUROSPINE or other national societies with often vast clinical experience and have given their own perspective and reasoning. We believe that the readers will profit very much from this variety and bandwidth of knowledge provided for them in the individual chapters. We have given the authors extensive liberty as to what they consider the best solution for their case. It is thus a representative picture of what is considered standard of care for spine pathologies in Europe. We hope that this book will be an ideal complement for trainees to the courses they take. Munich, Germany Bernhard Meyer Offenbach, Germany Michael Rauschman

    Advancement in total elbow arthroplasty care

    Get PDF

    PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

    Get PDF
    The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

    A total hip replacement toolbox : from CT-scan to patient-specific FE analysis

    Get PDF

    Advancement in total elbow arthroplasty care

    Get PDF
    • …
    corecore