scholarly journals A Cadaveric Comparative Study on the Surgical Accuracy of Freehand, Computer Navigation, and Patient-Specific Instruments in Joint-Preserving Bone Tumor Resections

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Sarah E. Bosma ◽  
Kwok Chuen Wong ◽  
Laurent Paul ◽  
Jasper G. Gerbers ◽  
Paul C. Jutte
Keyword(s):  
Computer Navigation ◽  
Computer Assisted Surgery ◽  
Patient Specific ◽  
Computer Assisted ◽  
Oncologic Surgery ◽  
Engineering Software ◽  
Patient Specific Instrumentation ◽  
Quality Control Tool ◽  
Patient Specific Instruments ◽  
Intraoperative Quality Control

Orthopedic oncologic surgery requires preservation of a functioning limb at the essence of achieving safe margins. With most bone sarcomas arising from the metaphyseal region, in close proximity to joints, joint-salvage surgery can be challenging. Intraoperative guidance techniques like computer-assisted surgery (CAS) and patient-specific instrumentation (PSI) could assist in achieving higher surgical accuracy. This study investigates the surgical accuracy of freehand, CAS- and PSI-assisted joint-preserving tumor resections and tests whether integration of CAS with PSI (CAS + PSI) can further improve accuracy. CT scans of 16 simulated tumors around the knee in four human cadavers were performed and imported into engineering software (MIMICS) for 3D planning of multiplanar joint-preserving resections. The planned resections were transferred to the navigation system and/or used for PSI design. Location accuracy (LA), entry and exit points of all 56 planes, and resection time were measured by postprocedural CT. Both CAS + PSI- and PSI-assisted techniques could reproduce planned resections with a mean LA of less than 2 mm. There was no statistical difference in LA between CAS + PSI and PSI resections (p=0.92), but both CAS + PSI and PSI showed a significantly higher LA compared to CAS (p=0.042 and p=0.034, respectively). PSI-assisted resections were faster compared to CAS + PSI (p<0.001) and CAS (p<0.001). Adding CAS to PSI did improve the exit points, however not significantly. In conclusion, PSI showed the best overall surgical accuracy and is fastest and easy to use. CAS could be used as an intraoperative quality control tool for PSI, and integration of CAS with PSI is possible but did not improve surgical accuracy. Both CAS and PSI seem complementary in improving surgical accuracy and are not mutually exclusive. Image-based techniques like CAS and PSI are superior over freehand resection. Surgeons should choose the technique most suitable based on the patient and tumor specifics.

scholarly journals Accuracy of Coronal Plane Mechanical Alignment in a Customized, Individually Made Total Knee Replacement with Patient-Specific Instrumentation

2017 ◽  
Vol 31 (08) ◽  
pp. 792-796 ◽  
Author(s):  
Gary Levengood ◽  
Jack Dupee
Keyword(s):  
Mechanical Axis ◽  
Computer Assisted Surgery ◽  
Coronal Plane ◽  
Patient Specific ◽  
Computer Assisted ◽  
Consecutive Series ◽  
Mechanical Alignment ◽  
Patient Specific Instrumentation ◽  
Patient Specific Instruments ◽  
Total Knee

AbstractThe objective of this study was to evaluate the accuracy of a customized individually made total knee implant used in conjunction with patient-specific cutting guides in restoring coronal plane mechanical axis alignment using computer-assisted surgery (CAS). A consecutive series of 63 total knee arthroplasty (TKA) patients were prospectively measured with intraoperative CAS. The patient-specific instruments and implants were created utilizing a preoperative CT scan. CAS system was used for all patients, to determine mechanical alignment. Bone cuts were made using the patient-specific instruments. Both bone cuts and final coronal mechanical alignment were recorded utilizing the navigation system for the assessment.The patient-specific instruments and implants provided perfect neutral coronal mechanical alignment (0°) in 53 patients. The remaining 10 patients had a postoperative alignment within ± 2° of neutral. The average preoperative deformity was 5.57° versus 0.18° postoperatively (p < 0.0001). The mean correction angle was 5.68°. No patients had postoperative extension deficits as measured with CAS (7.50° pre-op for 40/63 patients). Customized, individually made total knee implant with patient-specific cutting jigs showed results that are comparable to those of CAS systems in this study. This technology restores the neutral coronal mechanical axis very accurately, while offering unique benefits such as improved implant fit and restoration of the patient's J-curves, which require further investigation.

scholarly journals Patient Specific Instruments Can Achieve a Better Surgical Accuracy Than Navigation Assistance in Joint-Preserving Surgery of the Knee Joint: a Cadaveric Comparative Study

10.29007/qcdp ◽  
2018 ◽  
Author(s):  
Sarah Bosma ◽  
Paul Jutte ◽  
Kwok-Chuen Wong ◽  
Laurent Paul ◽  
Jasper Gerbers
Keyword(s):  
Knee Joint ◽  
Computer Navigation ◽  
Surgical Margin ◽  
Bone Sarcoma ◽  
Cadaver Study ◽  
Patient Specific ◽  
Oncologic Surgery ◽  
Joint Preserving Surgery ◽  
Patient Specific Instruments ◽  
Primary Bone Sarcoma

Orthopaedic oncologic surgery requires resection with a safe margin as inadequate surgical margin leads to unfavorable results with an increased rate of local tumor re- currence [1]. Computer Navigation Assisted Surgery (CAS) and Patient Specific In- strumentation (PSI) have been reported to increase accuracy and predictability of tumor resections [2-6]. The technically demanding joint-preserving surgery that re- tains the native joint with the better function may be benefited from the new tech- niques [7]. CAS has the advantages of real-time intraoperative guidance of the bone resections but requires bulky and costly facilities [5]. PSI is a simple option of repli- cating surgical plan but lacks intraoperative image feedback on the surgery [5,6]. As primary bone sarcoma is uncommon, clinical studies for meaningful comparison of the two techniques may not be feasible. The cadaver study was to investigate the surgical accuracy of CAS and PSI in joint-preserving tumor surgery of knee joint.

In-Vivo Alignment Comparing Patient Specific Instrumentation with both Conventional and Computer Assisted Surgery (CAS) Instrumentation in Total Knee Arthroplasty

2014 ◽  
Vol 29 (2) ◽  
pp. 343-347 ◽  
Author(s):  
William Barrett ◽  
Daniel Hoeffel ◽  
David Dalury ◽  
J. Bohannon Mason ◽  
Jeff Murphy ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Computer Assisted Surgery ◽  
Patient Specific ◽  
Computer Assisted ◽  
Patient Specific Instrumentation ◽  
Total Knee

scholarly journals Post Operative Analysis of a Novel Application of Surgical Navigation

10.29007/qmm6 ◽  
2020 ◽  
Author(s):  
Benjamin Roberts ◽  
Willy Theodore
Keyword(s):  
Surgical Navigation ◽  
Sagittal Alignment ◽  
Low Cost ◽  
Femoral Condyle ◽  
Computer Assisted Surgery ◽  
Patient Specific ◽  
Computer Assisted ◽  
Tibial Resection ◽  
Patient Specific Instrumentation ◽  
The Mean

A cohort of 84 patients underwent Total Knee Replacement surgery using Patient Specific Instrumentation fitted with an optical tracker that was monitored by a Computer Assisted Surgery system. The CAS system was low cost with small footprint in the operating theatre. The hip centre was collected and four other landmarks were recorded as rotational measures. The CAS system then reported the deviation in PSI placement against the targeted PSI placement, the surgeon then made a judgement whether to replace the guide. Post-operative analysis was done to determine the achieved alignment of the component and compared to the targeted alignment. From 45 results available for analysis the study found that the mean of rotational measures over the femur and tibia were found to be within ±30 of the targeted alignment, except for femur sagittal alignment. When a single outlier was removed from the femur sagittal alignment measures, the mean fell below ±30 of the targeted alignment. Distal femoral condyle resection measures fell below a mean of 1mm and posterior femoral condyle measures fell below a mean of 2mm. Lateral proximal tibial resection fell below a mean of 2.5mm as did medial proximal tibial resection when two outliers were removed. This shows that a CAS system incorporating the low cost, quicker time, and smaller footprint benefits of PSI with the accuracy of traditional navigation may be a feasible device.

A randomized controlled trial of tibial component migration with kinematic alignment using patient-specific instrumentation versus mechanical alignment using computer-assisted surgery in total knee arthroplasty

2019 ◽  
Vol 101-B (8) ◽  
pp. 929-940 ◽  
Author(s):  
E. K. Laende ◽  
C. G. Richardson ◽  
M. J. Dunbar
Keyword(s):  
Tibial Component ◽  
Computer Assisted Surgery ◽  
Patient Specific ◽  
Kinematic Alignment ◽  
Computer Assisted ◽  
Randomized Controlled ◽  
Patient Specific Instrumentation ◽  
Total Knee ◽  
Male Patients ◽  
Component Migration

Aims Patient-specific instrumentation of total knee arthroplasty (TKA) is a technique permitting the targeting of individual kinematic alignment, but deviation from a neutral mechanical axis may have implications on implant fixation and therefore survivorship. The primary objective of this randomized controlled study was to compare the fixation of tibial components implanted with patient-specific instrumentation targeting kinematic alignment (KA+PSI) versus components placed using computer-assisted surgery targeting neutral mechanical alignment (MA+CAS). Tibial component migration measured by radiostereometric analysis was the primary outcome measure (compared longitudinally between groups and to published acceptable thresholds). Secondary outcome measures were inducible displacement after one year and patient-reported outcome measures (PROMS) over two years. The secondary objective was to assess the relationship between alignment and both tibial component migration and inducible displacement. Patients and Methods A total of 47 patients due to undergo TKA were randomized to KA+PSI (n = 24) or MA+CAS (n = 23). In the KA+PSI group, there were 16 female and eight male patients with a mean age of 64 years (sd 8). In the MA+CAS group, there were 17 female and six male patients with a mean age of 63 years (sd 7). Surgery was performed using cemented, cruciate-retaining Triathlon total knees with patellar resurfacing, and patients were followed up for two years. The effect of alignment on tibial component migration and inducible displacement was analyzed irrespective of study group. Results There was no difference over two years in longitudinal migration of the tibial component between the KA+PSI and MA+CAS groups (reaching median maximum total point motion migration at two years of 0.40 mm for the KA+PSI group and 0.37 mm for the MA+CAS group, p = 0.82; p = 0.68 adjusted for age, sex, and body mass index (BMI) for all follow-ups). Both groups had mean migrations below acceptable thresholds. There was no difference in inducible displacement (p = 0.34) or PROMS (p = 0.61 for the Oxford Knee Score) between groups. There was no correlation between alignment and tibial component migration or alignment and inducible displacement. These findings support non-neutral alignment as a viable option with this component, with no evidence that it compromises fixation. Conclusion Kinematic alignment using patient-specific instrumentation in TKA was associated with acceptable tibial component migration, indicating stable fixation. These results are supportive of future investigations of kinematic alignment. Cite this article: Bone Joint J 2019;101-B:929–940.

Complex Pelvic Reconstruction using Patient-Specific Instrumentation and a 3D-Printed Custom Implant following Tumor Resection

2018 ◽  
Vol 02 (02) ◽  
pp. 061-067 ◽  
Author(s):  
David Hennessy ◽  
Megan Anderson ◽  
Santiago Lozano-Calderón
Keyword(s):  
Proximal Femur ◽  
Tumor Resection ◽  
Computer Assisted Surgery ◽  
Implant Design ◽  
Patient Specific ◽  
Computer Assisted ◽  
Limb Salvage Surgery ◽  
Assisted Navigation ◽  
Patient Specific Instrumentation ◽  
Custom Implant

AbstractResection of a periacetabular sarcoma is a difficult surgical problem due to the complex bony and soft tissue anatomy. The challenge of pelvic tumor resection lies in achieving clear margins while also reconstructing the defect with a durable construct. Limb salvage surgery involving these types of tumors, as well as other tumors of the pelvis, has made great progress recently due to remarkable technological innovation in the field of computer-assisted surgery and custom implant design. In this study, the authors review the case of a 9-year-old child with an osteosarcoma arising from the proximal femur with local spread into the hip joint and a skip metastasis in the ipsilateral acetabulum. They undertook limb-sparing extra-articular resection of the sarcoma with a reconstruction consisting of a 3D-custom printed pelvic implant and a proximal femur extendible prosthesis. The resection of the pelvis was performed with patient-specific cutting guides, rather than computer-assisted navigation. The resection resulted in a clear margin and the patient has had no evidence of local recurrence. These patient-specific guides closely matched the planned resection in terms of orientation in the pelvis, which allowed for straightforward implantation of the custom prosthesis at the time of surgery. The result has been a durable reconstruction that has produced an excellent functional outcome for this patient.

scholarly journals Surgical Advances in Osteosarcoma

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 388
Author(s):  
Marcus J. Brookes ◽  
Corey D. Chan ◽  
Bence Baljer ◽  
Sachin Wimalagunaratna ◽  
Timothy P. Crowley ◽  
...  
Keyword(s):  
Fluorescent Dyes ◽  
Imaging Techniques ◽  
Intraoperative Imaging ◽  
Survival Rates ◽  
Computer Navigation ◽  
Bone Cancer ◽  
Technical Difficulty ◽  
Implant Design ◽  
Patient Specific ◽  
Patient Specific Instruments

Osteosarcoma (OS) is the most common primary bone cancer in children and, unfortunately, is associated with poor survival rates. OS most commonly arises around the knee joint, and was traditionally treated with amputation until surgeons began to favour limb-preserving surgery in the 1990s. Whilst improving functional outcomes, this was not without problems, such as implant failure and limb length discrepancies. OS can also arise in areas such as the pelvis, spine, head, and neck, which creates additional technical difficulty given the anatomical complexity of the areas. We reviewed the literature and summarised the recent advances in OS surgery. Improvements have been made in many areas; developments in pre-operative imaging technology have allowed improved planning, whilst the ongoing development of intraoperative imaging techniques, such as fluorescent dyes, offer the possibility of improved surgical margins. Technological developments, such as computer navigation, patient specific instruments, and improved implant design similarly provide the opportunity to improve patient outcomes. Going forward, there are a number of promising avenues currently being pursued, such as targeted fluorescent dyes, robotics, and augmented reality, which bring the prospect of improving these outcomes further.

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