Robots and tools for remodeling bone

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

Computer aided process planning for multi-axis CNC machining using feature free polygonal CAD models

This dissertation provides new methods for the general area of Computer Aided Process Planning, often referred to as CAPP. It specifically focuses on 3 challenging problems in the area of multi-axis CNC machining process using feature free polygonal CAD models. The first research problem involves a new method for the rapid machining of Multi-Surface Parts. These types of parts typically have different requirements for each surface, for example, surface finish, accuracy, or functionality. The CAPP algorithms developed for this problem ensure the complete rapid machining of multi surface parts by providing better setup orientations to machine each surface. The second research problem is related to a new method for discrete multi-axis CNC machining of part models using feature free polygonal CAD models. This problem specifically considers a generic 3-axis CNC machining process for which CAPP algorithms are developed. These algorithms allow the rapid machining of a wide variety of parts with higher geometric accuracy by enabling access to visible surfaces through the choice of appropriate machine tool configurations (i.e. number of axes). The third research problem addresses challenges with geometric singularities that can occur when 2D slice models are used in process planning. The conversion from CAD to slice model results in the loss of model surface information, the consequence of which could be suboptimal or incorrect process planning. The algorithms developed here facilitate transfer of complete surface geometry information from CAD to slice models. The work of this dissertation will aid in developing the next generation of CAPP tools and result in lower cost and more accurately machined components

Design and Fabrication of a Force-Displacement Control Mechanism for Bone-Surgical Tool Testing

This project focuses on the design and fabrication of an experimental setup for orthopedic-tool testing, tailored for a surgical instrumentation company. The multifaceted project encompasses a literature review, conceptual design, prototyping, and rigorous testing, resulting in a versatile control system capable of assessing various orthopedic tools, including bone drills, saws, burrs, and power handpieces. Orthopedic surgical procedures (which include cutting and/or drilling into bone) often need to be performed on bones for faster recovery. The drilling and cutting process can cause an increase in temperature at the cutting site which can cause bone necrosis. The tools also need to be reliable and operate at optimum speeds and loading to increase success rates of surgical procedures. To optimize the cutting conditions, minimize thermal osteonecrosis and, other unwanted damage of bone during surgery; the cutting process, effect of the tool design and cutting parameters on the tool performance need to be investigated. As such, a mechanism for testing the bone-cutting tools is important. The experimental setup integrates state-of-the-art sensors and measurement devices, capturing crucial data such as force, speed, and temperature. A user-friendly control interface enhances operational efficiency, while safety features, ensure user well-being and system integrity. Calibration processes and performance criteria set the stage for comprehensive testing, with iterative feedback loops from stakeholders guiding continuous refinement and documentation finalization. Future work is outlined, including advanced sensor integration, dynamic simulation models, clinical validation studies, and collaborative research initiatives. This project sets the foundation for ongoing advancements in orthopedic tool testing, emphasizing adaptability to emerging technologies and a commitment to improving patient outcomes in bone surgery

Modeling and rendering for development of a virtual bone surgery system

A virtual bone surgery system is developed to provide the potential of a realistic, safe, and controllable environment for surgical education. It can be used for training in orthopedic surgery, as well as for planning and rehearsal of bone surgery procedures...Using the developed system, the user can perform virtual bone surgery by simultaneously seeing bone material removal through a graphic display device, feeling the force via a haptic deice, and hearing the sound of tool-bone interaction --Abstract, page iii

The Application of Zeeko Polishing Technology to Freeform Femoral Knee Replacement Component Manufacture

The purpose of this study was to develop an advanced 7-axis Computer Numerical Controlled (CNC) Polishing Machine from its successful original application of industrial optics manufacture into a process for the manufacture of femoral knee components to improve wear characteristics and prolong component lifetimes. It was indentified that the successful manufacture of optical components using a corrective polishing procedure to enhance their performance could be applied to femoral knee implant components. Current femoral knee implants mimic the natural shape of the joint and are freeform (no axis of symmetry) in nature hence an advanced CNC polishing machine that can follow the contours associated with such shapes could improve surface finish and conformity of replacement femoral knee bearing surfaces, leading to improved performance. The process involved generating machine parameters that would optimize the polishing procedure to minimize wear of materials used in femoral knee implant manufacture. Secondly a design of a Non-Uniform Refind B-Spline (NURBS) model for control of the Polishing Machine over the freeform contours of the femoral component. Completing the process involved development of a corrective polishing process that would improve form control of the components. Such developments would improve surface finish and conformity which are well documented contributors to wear and hence the lifeline of orthopaedic implants. By the means of comparison of this technique to that of a conventional finishing technique using pin-on-plate disc testing it was concluded that performance of the CNC polished components was an improvement on that of the conventional technique. In the case of form control their were slight indications through small decreases in peak to valley (PV) error that the process helped reduce form error and could increase the lifetime of femoral knee replacement components. The overall study provided results that indicate the the Zeeko process could be used in the application of polishing of hard-on-hard material combinations to improve form control without compromising surface finish hence improving lifetimes of the implant. The results have their limitations in the fact that the wear test performance was only carried out on orthopaedic implant materials using a pin-on-plate wear test rig. Due to the time limitations on the thesis it can be said that further analysis of correcting form without compromising surface finish on entire implant systems under full joint simulator testing which would provide mre realistic contitions would a more definitive answer be achieved

Unveiling the prospects of point-of-care 3D printing of Polyetheretherketone (PEEK) patient-specific implants

Additive manufacturing (AM) or three-dimensional (3D) printing is rapidly gaining acceptance in the healthcare sector. With the availability of low-cost desktop 3D printers and inexpensive materials, in-hospital or point-of-care (POC) manufacturing has gained considerable attention in personalized medicine. Material extrusion-based [Fused Filament Fabrication (FFF)] 3D printing of low-temperature thermoplastic polymer is the most commonly used 3D printing technology in hospitals due to its ease of operability and availability of low-cost machines. However, this technology has been limited to the production of anatomical biomodels, surgical guides, and prosthetic aids and has not yet been adopted into the mainstream production of patient-specific or customized implants. Polyetheretherketone (PEEK), a high-performance thermoplastic polymer, has been used mainly in reconstructive surgeries as a reliable alternative to other alloplastic materials to fabricate customized implants. With advancements in AM systems, prospects for customized 3D printed surgical implants have emerged, increasing attention for POC manufacturing. A customized implant may be manufactured within few hours using 3D printing, allowing hospitals to become manufacturers. However, manufacturing customized implants in a hospital environment is challenging due to the number of actions necessary to design and fabricate the implants. The focus of this thesis relies on material extrusion-based 3D printing of PEEK patient-specific implants (PSIs). The ambitious challenge was to bridge the performance gap between 3D printing of PEEK PSIs for reconstructive surgery and the clinical applicability at the POC by taking advantage of recent developments in AM systems. The main reached milestones of this project include: (i) assessment of the fabrication feasibility of PEEK surgical implants using material extrusion-based 3D printing technology, (ii) incorporation of a digital clinical workflow for POC manufacturing, (iii) assessment of the clinical applicability of the POC manufactured patient-specific PEEK scaphoid prosthesis, (iv) visualization and quantification of the clinical reliability of the POC manufactured patient-specific PEEK cranial implants, and (v) assessment of the clinical performance of the POC manufactured porous patient-specific PEEK orbital implants. During this research work, under the first study, we could demonstrate the prospects of FFF 3D printing technology for POC PEEK implant manufacturing. It was established that FFF 3D printing of PEEK allows the construction of complex anatomical geometries which cannot be manufactured using other technologies. With a clinical digital workflow implementation at the POC, we could further illustrate a smoother integration and faster implant production (within two hours) potential for a complex-shaped, patented PEEK patient-specific scaphoid prosthesis. Our results revealed some key challenges during the FFF printing process, exploring the applicability of POC manufactured FFF 3D printed PEEK customized implants in craniofacial reconstructions. It was demonstrated that optimal heat distribution around the cranial implants and heat management during the printing process are essential parameters that affect crystallinity, and thus the quality of the FFF 3D printed PEEK cranial implants. At this stage of the investigation, it was observed that the root mean square (RMS) values for dimensional accuracy revealed higher deviations in large-sized cranial prostheses with “horizontal lines” characteristics. Further optimization of the 3D printer, a layer-by-layer increment in the airflow temperature was done, which improved the performance of the FFF PEEK printing process for large-sized cranial implants. We then evaluated the potential clinical reliability of the POC manufactured 3D printed PEEK PSIs for cranial reconstruction by quantitative assessment of geometric, morphological, and biomechanical characteristics. It was noticed that the 3D printed customized cranial implants had high dimensional accuracy and repeatability, displaying clinically acceptable morphologic similarity concerning fit and contours continuity. However, the tested cranial implants had variable peak load values with discrete fracture patterns from a biomechanical standpoint. The implants with the highest peak load had a strong bonding with uniform PEEK fusion and interlayer connectivity, while air gaps and infill fusion lines were observed in implants with the lowest strength. The results of this preclinical study were in line with the clinical applicability of cranial implants; however, the biomechanical attribute can be further improved. It was noticed that each patient-specific reconstructive implant required a different set of manufacturing parameters. This was ascertained by manufacturing a porous PEEK patient-specific orbital implant. We evaluated the FFF 3D printed PEEK orbital mesh customized implants with a metric considering the design variants, biomechanical, and morphological parameters. We then studied the performance of the implants as a function of varying thicknesses and porous design constructs through a finite element (FE) based computational model and a decision matrix based statistical approach. The maximum stress values achieved in our results predicted the high durability of the implants. In all the implant profile configurations, the maximum deformation values were under one-tenth of a millimeter (mm) domain. The circular patterned design variant implant revealed the best performance score. The study further demonstrated that compounding multi-design computational analysis with 3D printing can be beneficial for the optimal restoration of the orbital floor. In the framework of the current thesis, the potential clinical application of material extrusion-based 3D printing for PEEK customized implants at the POC was demonstrated. We implemented clinical experience and engineering principles to generate a technical roadmap from preoperative medical imaging datasets to virtual surgical planning, computer-aided design models of various reconstructive implant variants, to the fabrication of PEEK PSIs using FFF 3D printing technology. The integration of 3D printing PEEK implants at the POC entails numerous benefits, including a collaborative team approach, quicker turnaround time of customized implants, support in pre-surgical and intraoperative planning, improved patient outcomes, and decreased overall healthcare cost. We believe that FFF 3D printing of customized PEEK implants could become an integral part of the hospitals and holds potential for various reconstructive surgery applications

Computational Techniques to Predict Orthopaedic Implant Alignment and Fit in Bone

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

Precision Machining

The work included in this book focuses on precision machining and grinding processes, including milling, laser machining and polishing on various materials for high-end applications. These processes are in the forefront of contemporary technology, with significant industrial applications. Their importance is also made clear by the important works that are included in the research that is presented in the book. Some important aspects of these processes are investigated, and process parameters are optimized. This is performed in the presented works with significant experimental and modelling work, incorporating modern tools of analysis and measurements

The application of Zeeko polishing technology to freeform femoral knee replacement component manufacture

The purpose of this study was to develop an advanced 7-axis Computer Numerical Controlled (CNC) Polishing Machine from its successful original application of industrial optics manufacture into a process for the manufacture of femoral knee components to improve wear characteristics and prolong component lifetimes. It was indentified that the successful manufacture of optical components using a corrective polishing procedure to enhance their performance could be applied to femoral knee implant components. Current femoral knee implants mimic the natural shape of the joint and are freeform (no axis of symmetry) in nature hence an advanced CNC polishing machine that can follow the contours associated with such shapes could improve surface finish and conformity of replacement femoral knee bearing surfaces, leading to improved performance. The process involved generating machine parameters that would optimize the polishing procedure to minimize wear of materials used in femoral knee implant manufacture. Secondly a design of a Non-Uniform Refind B-Spline (NURBS) model for control of the Polishing Machine over the freeform contours of the femoral component. Completing the process involved development of a corrective polishing process that would improve form control of the components. Such developments would improve surface finish and conformity which are well documented contributors to wear and hence the lifeline of orthopaedic implants. By the means of comparison of this technique to that of a conventional finishing technique using pin-on-plate disc testing it was concluded that performance of the CNC polished components was an improvement on that of the conventional technique. In the case of form control their were slight indications through small decreases in peak to valley (PV) error that the process helped reduce form error and could increase the lifetime of femoral knee replacement components. The overall study provided results that indicate the the Zeeko process could be used in the application of polishing of hard-on-hard material combinations to improve form control without compromising surface finish hence improving lifetimes of the implant. The results have their limitations in the fact that the wear test performance was only carried out on orthopaedic implant materials using a pin-on-plate wear test rig. Due to the time limitations on the thesis it can be said that further analysis of correcting form without compromising surface finish on entire implant systems under full joint simulator testing which would provide mre realistic contitions would a more definitive answer be achieved.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The selected laser melting production and subsequent post-processing of Ti-6Al-4V prosthetic acetabular

&nbsp;Processing and post processing of human prosthetic acetabular cup by using 3D printing. The results showed using 3D printers leads to fabrication customized implants with higher quality.<br /