Surgical Treatment of Long-Bone Deformities: 3D Preoperative Planning and Patient-Specific Instrumentation

2015 ◽  
pp. 123-149 ◽  
Author(s):  
Philipp Fürnstahl ◽  
Andreas Schweizer ◽  
Matthias Graf ◽  
Lazaros Vlachopoulos ◽  
Sandro Fucentese ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Preoperative Planning ◽  
Long Bone ◽  
Patient Specific ◽  
Patient Specific Instrumentation ◽  
Bone Deformities

scholarly journals In-Hospital manufacturing of patient specific 3D-printed guides

10.29007/m81x ◽  
2019 ◽  
Author(s):  
Ignacio Aguado-Maestro ◽  
Ignacio García-Cepeda ◽  
Juan José González-Álvarez ◽  
Elisa Cebrián-Rodríguez ◽  
Javier López-Sánchez ◽  
...  
Keyword(s):  
Articular Surface ◽  
Low Cost ◽  
Region Of Interest ◽  
Long Bone ◽  
Patient Specific ◽  
Low Grade ◽  
Design Time ◽  
Articular Fractures ◽  
Patient Specific Instrumentation ◽  
Extended Curettage

IntroductionPatient specific instrumentation is a novel aid the industry has been implementing in our hospitals during the last years. However, the cost of the process and the impossibility to discuss face to face with the manufacturer the needs of the particular cases may favor the in-hospital production of these devices.We present the design and manufacturing process of three patient-specific devices to treat complex common situations in orthopaedic surgery, such as intramedular tumor resections, long bone pseudarthrosis and malunions of articular fractures.Material and MethodsCT scans of the region of interest were performed to all the patients. Horos® software was used to isolate the affected bone region, whereas Meshmixer® software was used to create the patient specific guides. An Ultimaker 2+® 3D printer was used to print the guide, in a biocompatible material (SmartFil® Medical). The printing parameters included a nozzle of 0.6 mm and a layer height of 0.1 mm.There was one case of a low-grade chondrosarcoma in which we created a guide to resect enough cortical bone to make an extended curettage of the lesion. Phenol and PMMA were used as adjuvants after the curettage. We used the same guide to obtain an exact replica of allograft which was later placed in position.We had a femur diaphyseal atrophic pseudarthrosis in a patient with achondroplasia, in which the guide permitted the resection of the affected bone with a saw and posterior osteosynthesis with an anterior LCP plate.Finally, in an intraarticular malunion of a distal radius Die-Punch fracture we used the guide to make an osteotomy of the affected articular portion and correct the articular surface. Bone autograft was added prior to the osteosynthesis with a plate.ResultsMean design time was 6.3 hours. Mean printing time was 5.2 hours. The price of the filament used for each guide was under 10 USD. The mean time from the CT-Scan and the surgery being performed was 2.7 months. In all cases the patient specific guides fitted in the bone and permitted the planned resection/osteotomy.All the surgeries fulfilled their purpose.ConclusionsPatient specific guides are easy to design in a local setting with the aid of free software. Design time still needs dedication although it permits the manufacturing of the guides following surgeon needs. The use of self-designed and printed guides is safe and accurate, with a low cost for the institutions.

scholarly journals Patient-specific instrumentation for total knee arthroplasty

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668475 ◽  
Author(s):  
Arash Nabavi ◽  
Caroline M Olwill ◽  
Mike Do ◽  
Tanya Wanasawage ◽  
Ian A Harris
Keyword(s):  
Ct Scan ◽  
Femoral Component ◽  
Tibial Component ◽  
Preoperative Planning ◽  
Coronal Plane ◽  
Patient Specific ◽  
Excellent Outcome ◽  
Patient Specific Instrumentation ◽  
Total Knee ◽  
Sagittal Orientation

Purpose: To assess the accuracy of total knee replacements (TKRs) performed using CT-based patient-specific instrumentation by postoperative CT scan. Method: Approval from the Ethics Committee was granted prior to commencement of this study. Fifty prospective and consecutive patients who had undergone TKR (Evolis, Medacta International) using CT-based patient-specific instrumentation (MY KNEE, Medacta International) were assessed postoperatively using a CT scan and the validated Perth protocol measurement technique. The hip-knee-ankle (HKA) angle of the lower limb in the coronal plane; the coronal, sagittal, and rotational orientation of the femoral component; and the coronal and sagittal orientation of the tibial component were measured. These results were then compared to each patient’s preoperative planning. The percentage of patients found to be less than or equal to 3° of planned alignment was calculated. One patient was excluded as the femoral cutting block did not fit the femur as predicted by planning and therefore underwent a conventional TKR. Results: Ninety-eight percent of patients were within 3° of planned alignment in the coronal plane reproducing the predicted HKA angle. Predicted coronal plane orientation of the tibial and femoral component was achieved in 100% and 96% of patients, respectively. The sagittal orientation of the femoral component was within 3° in 98% of patients. The planned sagittal positioning of the tibial component was achieved in 92% of patients. Furthermore, 90% of patients were found to have a femoral rotation within 3° of planning. Eighty-six percent of patients achieved good-to-excellent outcome at 12 months (Oxford Knee Score > 34). Conclusion: We have found that TKR using this patient-specific instrumentation accurately reproduces preoperative planning in all six of the parameters measured in this study.

Preoperative Planning and Patient-Specific Rods for Surgical Treatment of Thoracolumbar Sagittal Imbalance

2016 ◽  
pp. 645-662 ◽  
Author(s):  
Vincent Fiere ◽  
Xavier Armoiry ◽  
Jean Marc Vital ◽  
Virginie Lafage ◽  
Julien Berthiller ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Preoperative Planning ◽  
Patient Specific ◽  
Sagittal Imbalance

scholarly journals Simulated operation combined with patient-specific instrumentation technology is superior to conventional technology for supramalleolar osteotomy: A retrospective comparative study

2020 ◽  
Author(s):  
Hua Liu ◽  
Chenggong Wang ◽  
Can Xu ◽  
Yusheng Li ◽  
Mingqing Li ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Preoperative Planning ◽  
Patient Specific ◽  
Aofas Score ◽  
Curative Effect ◽  
Vas Score ◽  
Supramalleolar Osteotomy ◽  
Patient Specific Instrumentation ◽  
Conventional Technology

Abstract Background Over the past seven years, our team has designed a simulated operation combined with patient-specific instrumentation (SO-PSI) assisted supramalleolar osteotomy (SMOT) method and applied it in the clinic. This study aimed to evaluate the differences between SO-PSI technology and conventional operation (CO) technology for SMOT in preoperative planning, intraoperative application, and postoperative curative effect. Methods We retrospectively analyzed SMOT data collected from our hospital between October 2014 and December 2018. Patients (n = 28) were enrolled and divided into CO (n = 17) and SO-PSI (n = 11) groups; mean follow-up time was 33.4 (range, 13 to 59) months. We statistically analyzed and compared perioperative data, accuracy of preoperative planning, and intraoperative application; difference between pre- and post-operative radiologic ankle angles; and changes in American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of ankle motion, and Takakura stage after surgery. Results All ankle alignments and positions were recovered for both groups. Compared with the CO group, the SO-PSI group had a shorter mean operating time and postoperative hospital stay, a decreased number of fluoroscopy examinations, lower albumin reduction, longer preoperative planning time and preoperative hospital stay, and increased hospitalization expenses. In the SO-PSI group, comparison of ankle angles at preoperative planning and postoperatively revealed good correlation, while this was not the case in the CO group. Mean tibial ankle center discrepancy for the SO-PSI group was 1.86 ± 1.06 mm. On follow-up, all radiologic parameters for the two groups improved significantly; however, the improvement of the tibial anterior surface angle and tibiotalar tilt angle for the SO-PSI group were more obvious than those for the CO group; AOFAS score, VAS score, ankle range of motion, and Takakura stage improved after surgery in both groups; however, the improvements in the SO-PSI group were greater than those in the CO group overall. Conclusions SO-PSI technology can facilitate accurate and rapid preoperative planning for SMOT. In general, compared with conventional technology, SO-PSI has advantages for preoperative planning, intraoperative application, and postoperative curative effect.

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