Navigation and Patient Specific Instrumentation in Shoulder Arthroplasty

The humeral head osteotomy influences shoulder arthroplasty component height, version and neck shaft angle and therefore outcomes. The purpose of this study is to develop and utilize navigation to execute the osteotomy. 3D printed models were used to develop a navigation technique, and then to execute planned osteotomies. Free hand, fixed angle guide, patient specific guides, and real time navigation osteotomies were completed. The height, neck shaft angle and version were recorded. Also collected, were the planes of the guides once they were placed. Navigation had significantly less error from the planned osteotomy in neck shaft angle versus all other groups and for version compared to free hand and fixed angle guides. Patient specific guides had statistically less error from planned version compared to the fixed angle guides. There were no statistical differences in cut height across groups. There was no difference in planned, guide placement and completed osteotomy parameters

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

Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis

We report a case of a 38 year-old engineer presented with left ankle pain for 2 years and initially treated as gouty arthritis because of high serum uric acid. A year later his left ankle become swollen and plain radiograph showed soft tissue swelling around the ankle with normal articular surface and bone. An MRI investigation reported as gouty arthritis of ankle with tophi. While on treatment for gouty arthritis, he developed pus discharge from the swelling. The ankle pain also worsen and he was unable to weight bear on the affected leg. An incision and drainage shown pus from the ankle joint which grew pseudomonas aeruginosa. He was treated with intravenous followed by oral ciprofloxacin 250 mg bd. However his condition does not improved and a month after antibiotic treatment a repeated radiograph shows narrowing of joint space with irregular cortical destruction, osteopenic bone . suggestive of worsening of his septic arthritis. During this period he deny of having any fever, cough or night sweats. However he did notice some loss of weight and loss of appetite. He has worked in Africa and Russia before in petroleum industry. After 4 months of antibiotic and no sign of improvement, a biopsy and repeat culture was taken from the ankle which reveal tuberculous arthritis and positive for AFB culture. A plain chest radiograph revealed miliary tuberculosis picture. He was started on a anti TB treatment and the wound healed after a few weeks. After 4 months of treatment he was able to walk without support with reduce ankle range of motion. This case illustrate that the diagnosis was delay because tuberculosis was not suspected in a young professionals with ankle pain and elevated serum uric acid level. Further delay in diagnosis because MRI report also suggestive of gouty tophi and the pus culture and sensitivity grew pseudomonas aeruginosa

Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

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.Web of Science1923art. no. 519

Epidemiology of injuries in high-level youth sport in Luxembourg [Abstract]

peer reviewe

The Developing of a Smart Elbow Prosthesis for Loosening Detection

Total Elbow Arthroplasty (TEA) is an effective surgical procedure for restoring elbow joint function and improve a patient's quality of life by relieving pain suffered from various musculoskeletal disorders. Despite new designs for prostheses and improved surgical procedures, TEA still suffers today from mid to-long-term complications such as aseptic loosening, infection, dislocation, and pre-prosthetic fractures. With aseptic loosening followed by infection being the most persistent reason for TEA revision, investigating methods for early diagnosis of implant loosening and differentiating between the infection and aseptic loosening is necessary to address this problem. This thesis aims to develop a novel diagnostic tool that can be embedded into the prosthetic and provide a quantitative measurement for early signs of the implant loosening without any usage of radiographs or any contact with the implant. In this study, three types of sensor configurations along with detection algorithms were developed, designed, and tested along with a functional prototype to detect the migration of the elbow prosthesis (Aseptic loosening). The detection system was validated under realistic conditions through experiments with a custom-designed mechanical testing rig. Finally, for infection detection, a biocompatible chemical sensor (Hydrogel) was synthesised and was linked with the aseptic loosening detection system to investigate the early signs of infection. Among the three sensor configurations, the single sensor configuration detected the implant migration at a resolution of 0.3 mm with a detection error of less than 3 %. The configuration was able to detect angular motion up to 3 degrees with a detection error of 5 %. The quad sensor configuration, an arrangement of four closely packed sensors, enhanced the overall detection performance by increasing system resolution to 0.15 mm in multiple axes along with increasing the signal to noise ratio, reducing root mean square error, and compensating the tilt effect of the single sensor. While the dual sensor configuration, two sensors arranged in-line but 42 mm apart, downgraded the detection performance by introducing a detection error of 30 %. The detection system showed negligible effect on the biomaterial used in TEA and was able to differentiate between different migrations types (Linear, Angular, Static and Dynamic). The difference in three fixation scenarios (grossly loose, partially loose, and fully fixed) was identified evidently by the detection system with the grossly loose fixation showed a displacement of 0.187 ± 0.061 mm on the x-axis and 0.387 ± 0.059 mm on the y-axis. The chemical sensor (Hydrogel) was able to detect the change in its surrounding pH level (highlighting the potential to detect infection) and by the amalgamation with the detection system, pH change was detected without the use of an imaging technique. Further improvement in the synthesis of the hydrogel and the optimisation of the detection system has also been suggested. The quad sensor system implies that it has the potential to be used to continually or intermittently monitor implant behaviour without hospital visitation or x-ray exposure. This could be applied more widely to other major joints such as the hips and knees, giving in-situ biomechanical insight into joint replacement behaviour over time

Función del nervio facial posterior a artroplastia de articulación temporomandibular mediante el uso del abordaje endaural vs otros abordajes quirúrgicos. Revisión sistemática

Resumen La lesión de la rama temporal del nervio facial es una de las principales complicaciones postoperatorias de la cirugía abierta de la articulación temporomandibular (ATM). Se realizó una revisión sistemática sobre la función del nervio facial posterior a artroplastia de ATM. La búsqueda de literatura se realizó en las bases de datos Medline, Embase, PubMed, LILACS y Cochrane. Este proceso identificó inicialmente un total de 649 estudios, que luego de confrontarlos con los criterios de inclusión y exclusión establecidos quedaron un total de 2 estudios los cuales evaluaban la función del nervio facial posterior a artroplastia de ATM con el abordaje endaural y comparado con el abordaje preauricular. Los textos completos de los 2 estudios fueron analizados y evaluados para obtener información sobre: autores, año de publicación y diseño de estudio; resultados de la función del nervio facial posterior a los abordajes antes descritos incluyendo variables, resultados y significancia estadística; variables sociodemográficas, método de evaluación objetiva de la función del nervio facial y tiempos de seguimiento para evidenciar la recuperación de la función facial normal. La calidad metodológica de cada uno de los estudios seleccionados fue evaluado según las guías “SIGN - Scottish Intercollegiate Guidelines Network”. Se concluye que el abordaje endaural tiene mejores resultados que el abordaje preauricular con respecto a las alteraciones neurosensoriales. Sin embargo, debido a la baja calidad metodológica de las publicaciones incluidas y la poca evidencia que hay en la literatura actual sobre éste tema, es necesario realizar futuros estudios clínicos aleatorizados, controlados y desarrollados con mayor rigurosidad científica para poder fundamentar y fortalecer las conclusiones.Abstract. Injury to the temporal branch of the facial nerve is one of the main postoperative complications of open temporomandibular joint (TMJ) surgery. A systematic review was carried out on the function of the facial nerve after TMJ arthroplasty. The literature search was performed in the Medline, Embase, PubMed, LILACS and Cochrane databases. This process initially identified a total of 649 studies, which after comparing them with the inclusion and exclusion criteria established, there were a total of 2 studies which evaluated the function of the facial nerve after TMJ arthroplasty using the endaural approach and comparing it with the preauricular approach. The full texts of the 2 studies were analyzed and evaluated to obtain information on: authors, year of publication and study design; results of facial nerve function after the previously described approaches including variables, results and statistical significance; sociodemographic variables, objective evaluation method of facial nerve function and follow-up times to demonstrate the recovery of normal facial function. The methodological quality of each of the selected studies was evaluated according to the guidelines "SIGN - Scottish Intercollegiate Guidelines Network". It is concluded that the endaural approach has better results than the preauricular approach with respect to neurosensory alterations. However, due to the low methodological quality of the publications included and the low evidence that exists in the current literature on this subject, it is necessary to carry out future randomized, controlled and developed clinical studies with greater scientific rigor to be able to base and strengthen the conclusions.Otr

Osteoarthritis

Osteoarthritis is one of the most debilitating diseases affecting millions of people worldwide. However, there is no FDA approved disease modifying drug specifically for OA. Surgery remains an effective last resort to restore the function of the joints. As the aging populations increase worldwide, the number of OA patients increases dramatically in recent years and is expected to increase in many years to come. This is a book that summarizes recent advance in OA diagnosis, treatment, and surgery. It includes wide ranging topics from the cutting edge gene therapy to alternative medicine. Such multifaceted approaches are necessary to develop novel and effective therapy to cure OA in the future. In this book, different surgical methods are described to restore the function of the joints. In addition, various treatment options are presented, mainly to reduce the pain and enhance the life quality of the OA patients