A 3D computed tomography based tool for orthopedic surgery planning

Series : Lecture notes in computational vision and biomechanics, vol. 19The preparation of a plan is essential for a surgery to take place in the best way possible and also for shortening patient’s recovery times. In the orthopedic case, planning has an accentuated significance due to the close relation between the degree of success of the surgery and the patient recovering time. It is important that surgeons are provided with tools that help them in the planning task, in order to make it more reliable and less time consuming. In this paper, we present a 3D Computed Tomography based solution and its implementation as an OsiriX plugin for orthopedic surgery planning. With the developed plugin, the surgeon is able to manipulate a three-dimensional isosurface rendered from the selected imaging study (a CT scan). It is possible to add digital representations of physical implants (surgical templates), in order to evaluate the feasibility of a plan. These templates are STL files generated from CAD models. There is also the feature to extract new isosurfaces of different voxel values and slice the final 3D model according to a predefined plane, enabling a 2D analysis of the planned solution. Finally, we discuss how the proposed application assists the surgeon in the planning process in an alternative way, where it is possible to three-dimensionally analyze the impact of a surgical intervention on the patient.(undefined

Hierarchically Structured Lipid Systems (Part of 2nd Edition)

No abstract available

What questions do patients undergoing lower extremity joint replacement surgery have?

BACKGROUND: The value of the Internet to deliver preoperative education would increase if there was variability in questions patients want answered. This study's goal was to have patients consulting an orthopedic surgeon about undergoing either a total hip arthroplasty (THA) or a total knee arthroplasty (TKA) rate the importance of different questions concerning their care. METHODS: We assembled questions patients might have about joint replacement surgery by analyzing the literature and querying a pilot group of patients and surgeons. Twenty-nine patients considering undergoing THA and 19 patients considering TKR completed a written survey asking them to rate 30 different questions, with a 5 point Likert scale from 1 (least important) – 5 (most important). RESULTS: For patients considering THA or TKR, the 4 highest rated questions were: Will the surgery affect my abilities to care for myself?, Am I going to need physical therapy?, How mobile will I be after my surgery?, When will I be able to walk normally again? The mean percentage disagreement was 42% for questions answered by TKR patients and 47% for the THA group. Some patients gave a high rating to questions lowly rated by the rest of the group. CONCLUSIONS: Although there was enough agreement to define a core set of questions that should be addressed with most patients considering THA or TKA, some of the remaining questions were also highly important to some patients. The Web may offer a flexible medium for accommodating this large variety of information needs

Efficiency of immediate postoperative inpatient physical therapy following total knee arthroplasty: an RCT

BACKGROUND: The main goal of physical therapy treatment (PT) in the clinical stage following total knee arthroplasty (TKA) is to prepare patients for discharge from the hospital as soon as possible after their operation. Although aggressive rehabilitation is believed to be important, evidence of effects of different exercise programmes following TKA is limited. This led to the question whether the intensity of PT (once versus twice daily) following TKA affects short-term recovery, measured as range of motion. METHODS: A randomised controlled trial compared an exercise regimen of two sessions per day with a similar programme administered once daily. Primary outcome measure was ROM. RESULTS: At the time of hospital discharge, there was no difference between the experimental and control groups in range of motion. CONCLUSION: This study shows that in our setting twice daily PT sessions do not produce different results as daily PT sessions. It may be questioned whether multiple daily therapy sessions are needed as an in-hospital PT regimen in OA total knee patients

Effects of clinical pathways in the joint replacement: a meta-analysis

<p>Abstract</p> <p>Background</p> <p>A meta-analysis was performed to evaluate the use of clinical pathways for hip and knee joint replacements when compared with standard medical care. The impact of clinical pathways was evaluated assessing the major outcomes of in-hospital hip and knee joint replacement processes: postoperative complications, number of patients discharged at home, length of in-hospital stay and direct costs.</p> <p>Methods</p> <p>Medline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched. The search was performed from 1975 to 2007. Each study was assessed independently by two reviewers. The assessment of methodological quality of the included studies was based on the Jadad methodological approach and on the New Castle Ottawa Scale. Data analysis abided by the guidelines set out by The Cochrane Collaboration regarding statistical methods. Meta-analyses were performed using RevMan software, version 4.2.</p> <p>Results</p> <p>Twenty-two studies met the study inclusion criteria and were included in the meta-analysis for a total sample of 6,316 patients. The aggregate overall results showed significantly fewer patients suffering postoperative complications in the clinical pathways group when compared with the standard care group. A shorter length of stay in the clinical pathway group was also observed and lower costs during hospital stay were associated with the use of the clinical pathways. No significant differences were found in the rates of discharge to home.</p> <p>Conclusion</p> <p>The results of this meta-analysis show that clinical pathways can significantly improve the quality of care even if it is not possible to conclude that the implementation of clinical pathways is a cost-effective process, because none of the included studies analysed the cost of the development and implementation of the pathways. Based on the results we assume that pathways have impact on the organisation of care if the care process is structured in a standardised way, teams critically analyse the actual organisation of the process and the multidisciplinary team is highly involved in the re-organisation. Further studies should focus on the evaluation of pathways as complex interventions to help to understand which mechanisms within the clinical pathways can really improve the quality of care. With the need for knee and hip joint replacement on the rise, the use of clinical pathways might contribute to better quality of care and cost-effectiveness.</p

Setscrew distal locking for intramedullary nails: A biomechanical study

Objective: This biomechanical study was undertaken to examine the effectivenes of setscrew distal locking id a static intramedullary (IM) femoral nail on the stability of fixation of femoral shaft fractures

Radiostratigraphy and age structure of the Greenland Ice Sheet

©2015. The Authors. Several decades of ice-penetrating radar surveys of the Greenland and Antarctic ice sheets have observed numerous widespread internal reflections. Analysis of this radiostratigraphy has produced valuable insights into ice sheet dynamics and motivates additional mapping of these reflections. Here we present a comprehensive deep radiostratigraphy of the Greenland Ice Sheet from airborne deep ice-penetrating radar data collected over Greenland by The University of Kansas between 1993 and 2013. To map this radiostratigraphy efficiently, we developed new techniques for predicting reflection slope from the phase recorded by coherent radars. When integrated along track, these slope fields predict the radiostratigraphy and simplify semiautomatic reflection tracing. Core-intersecting reflections were dated using synchronized depth-age relationships for six deep ice cores. Additional reflections were dated by matching reflections between transects and by extending reflection-inferred depth-age relationships using the local effective vertical strain rate. The oldest reflections, dating to the Eemian period, are found mostly in the northern part of the ice sheet. Within the onset regions of several fast-flowing outlet glaciers and ice streams, reflections typically do not conform to the bed topography. Disrupted radiostratigraphy is also observed in a region north of the Northeast Greenland Ice Stream that is not presently flowing rapidly. Dated reflections are used to generate a gridded age volume for most of the ice sheet and also to determine the depths of key climate transitions that were not observed directly. This radiostratigraphy provides a new constraint on the dynamics and history of the Greenland Ice Sheet

Radiostratigraphy and age structure of the Greenland Ice Sheet

©2015. The Authors. Several decades of ice-penetrating radar surveys of the Greenland and Antarctic ice sheets have observed numerous widespread internal reflections. Analysis of this radiostratigraphy has produced valuable insights into ice sheet dynamics and motivates additional mapping of these reflections. Here we present a comprehensive deep radiostratigraphy of the Greenland Ice Sheet from airborne deep ice-penetrating radar data collected over Greenland by The University of Kansas between 1993 and 2013. To map this radiostratigraphy efficiently, we developed new techniques for predicting reflection slope from the phase recorded by coherent radars. When integrated along track, these slope fields predict the radiostratigraphy and simplify semiautomatic reflection tracing. Core-intersecting reflections were dated using synchronized depth-age relationships for six deep ice cores. Additional reflections were dated by matching reflections between transects and by extending reflection-inferred depth-age relationships using the local effective vertical strain rate. The oldest reflections, dating to the Eemian period, are found mostly in the northern part of the ice sheet. Within the onset regions of several fast-flowing outlet glaciers and ice streams, reflections typically do not conform to the bed topography. Disrupted radiostratigraphy is also observed in a region north of the Northeast Greenland Ice Stream that is not presently flowing rapidly. Dated reflections are used to generate a gridded age volume for most of the ice sheet and also to determine the depths of key climate transitions that were not observed directly. This radiostratigraphy provides a new constraint on the dynamics and history of the Greenland Ice Sheet