47 research outputs found

    Custom-designed orthopedic implants evaluated using finite element analysis of patient-specific computed tomography data: femoral-component case study

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    <p>Abstract</p> <p>Background</p> <p>Conventional knee and hip implant systems have been in use for many years with good success. However, the custom design of implant components based on patient-specific anatomy has been attempted to overcome existing shortcomings of current designs. The longevity of cementless implant components is highly dependent on the initial fit between the bone surface and the implant. The bone-implant interface design has historically been limited by the surgical tools and cutting guides available; and the cost of fabricating custom-designed implant components has been prohibitive.</p> <p>Methods</p> <p>This paper describes an approach where the custom design is based on a Computed Tomography scan of the patient's joint. The proposed design will customize both the articulating surface and the bone-implant interface to address the most common problems found with conventional knee-implant components. Finite Element Analysis is used to evaluate and compare the proposed design of a custom femoral component with a conventional design.</p> <p>Results</p> <p>The proposed design shows a more even stress distribution on the bone-implant interface surface, which will reduce the uneven bone remodeling that can lead to premature loosening.</p> <p>Conclusion</p> <p>The proposed custom femoral component design has the following advantages compared with a conventional femoral component. (i) Since the articulating surface closely mimics the shape of the distal femur, there is no need for resurfacing of the patella or gait change. (ii) Owing to the resulting stress distribution, bone remodeling is even and the risk of premature loosening might be reduced. (iii) Because the bone-implant interface can accommodate anatomical abnormalities at the distal femur, the need for surgical interventions and fitting of filler components is reduced. (iv) Given that the bone-implant interface is customized, about 40% less bone must be removed. The primary disadvantages are the time and cost required for the design and the possible need for a surgical robot to perform the bone resection. Some of these disadvantages may be eliminated by the use of rapid prototyping technologies, especially the use of Electron Beam Melting technology for quick and economical fabrication of custom implant components.</p

    Evolution of design considerations in complex craniofacial reconstruction using patient-specific implants

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    Previously published evidence has established major clinical benefits from using Computer Aided Design (CAD), Computer Aided Manufacturing (CAM), and Additive Manufacturing (AM) to produce patient-specific devices. These include cutting guides, drilling guides, positioning guides, and implants. However, custom devices produced using these methods are still not in routine use – particularly by the UK National Health Service (NHS). Oft-cited reasons for this slow uptake include: a higher up-front cost than conventionally-fabricated devices, material-choice uncertainty, and a lack of long-term follow-up due to their relatively recent introduction. This paper identifies a further gap in current knowledge – that of design rules, or key specification considerations for complex CAD/CAM/AM devices. This research begins to address the gap by combining a detailed review of the literature with first-hand experience of interdisciplinary collaboration on five craniofacial patient case-studies. In each patient case, bony lesions in the orbito-temporal region were segmented, excised, and reconstructed in the virtual environment. Three cases translated these digital plans into theatre via polymer surgical guides. Four cases utilised AM to fabricate titanium implants. One implant was machined from PolyEther Ether Ketone (PEEK). From the literature, articles with relevant abstracts were analysed to extract design considerations. 19 frequently-recurring design considerations were extracted from previous publications. 9 new design considerations were extracted from the case studies – on the basis of subjective clinical evaluation. These were synthesised to produce a design considerations framework to assist clinicians with prescribing and design engineers with modelling. Promising avenues for further research are proposed

    Unicompartmental knee arthroplasty in patients aged less than 65: Combined data from the Australian and Swedish Knee Registries

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    Introduction and purpose: In recent years, there has been renewed interest in using unicompartmental knee arthroplasty (UKA). Several studies have reported increasing numbers of UKAs for osteoarthritis in patients who are less than 65 years of age, with low revision rates. To describe and compare the use and outcome of UKA in this age group, we have combined data from the Australian and Swedish knee registries. Patients and methods: More than 34,000 UKA procedures carried out between 1998 and 2007 were analyzed, and we focused on over 16,000 patients younger than 65 years to determine usage and to determine differences in the revision rate. Survival analysis was used to determine outcomes of revision related to age and sex, using any reason for revision as the endpoint. Results: Both countries showed a decreasing use of UKA in recent years in terms of the proportion of knee replacements and absolute numbers undertaken per year. The 7-year cumulative risk of revision of UKA in patients younger than 65 years was similar in the two countries. Patients younger than 55 years had a statistically significantly higher cumulative risk of revision than patients aged 55 to 64 years (19% and 12%, respectively at 7 years). The risk of revision in patients less than 65 years of age was similar in both sexes. Interpretation: The results of the combined UKA data from the Australian and Swedish registries show a uniformity of outcome between countries with patients aged less than 65 having a higher rate of revision than patients who were 65 or older. Surgeons and patients should be aware of the higher risk of revision in this age group.Annette W-Dahl, Otto Robertsson, Lars Lidgren, Lisa Miller, David Davidson, Stephen Graves

    Celecoxib does not appear to affect prosthesis fixation in total knee replacement: A randomized study using radiostereometry in 50 patients

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    Background and purpose After joint replacement, a repair process starts at the interface between bone and cement. If this process is disturbed, the prosthesis may never become rigidly fixed to the bone, leading to migration—and with time, loosening. Cox-2 inhibitors are widely used as postoperative analgesics, and have adverse effects on bone healing. This could tamper prosthesis fixation. We investigated whether celecoxib, a selective Cox-2 inhibitor, increases prosthesis migration in total knee replacement (TKR)

    Using Stereolithography Models In Planning Spinal Surgery

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    CT data of two patients was used to create computer generated 3-dimensional models of portions of their spines. One of the patients suffered from scoliosis and the other patient from tortecolis. The virtual models were then used to create stereolithography models in order to assist the planning of surgery of the two patients. The models increased the surgeons understanding of the deformations of the patients spines by providing a visualization tool. Also, the surgeon was able to use the models for patient education. Copyright © 2002 by ASME
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