scholarly journals Computer-assisted femoral head reduction osteotomies: an approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
P. Fürnstahl ◽  
F. A. Casari ◽  
J. Ackermann ◽  
M. Marcon ◽  
M. Leunig ◽  
...  
Keyword(s):  
Pilot Study ◽  
Femoral Head ◽  
Periacetabular Osteotomy ◽  
3D Models ◽  
Contralateral Side ◽  
Anatomic Reconstruction ◽  
Patient Specific ◽  
Rank Test ◽  
Computer Assisted ◽  
Sphericity Index

Abstract Background Legg–Calvé–Perthes (LCP) is a common orthopedic childhood disease that causes a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration that requires total hip arthroplasty. In 2002, Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The purpose of this study was to report the first results in the treatment of 6 patients to investigate whether our approach is feasible and safe. Methods In this retrospective pilot study, 6 LCP patients were treated with FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D-models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific instruments tailored for FHRO were designed, 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically [diameter index, sphericity index, Stulberg classification, extrusion index, LCE-, Tönnis-, CCD-angle and Shenton line] and the time and costs were recorded. Radiologic values were tested for normal distribution using the Shapiro–Wilk test and for significance using Wilcoxon signed-rank test. Results The sphericity index improved postoperatively by 20% (p = 0.028). The postoperative diameter of the femoral head differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg grading improved from poor coxarthrosis outcome to good outcome (p = 0.026). All patients underwent acetabular reorientation by periacetabular osteotomy. The average time (in minutes) for preliminary analysis, computer simulation and patient-specific instrument design was 63 (±48), 156 (±64) and 105 (±68.5), respectively. Conclusion The clinical feasibility of our approach to FHRO has been demonstrated. The results showed significant improvement compared to the preoperative situation. All operations were performed by experienced surgeons; nevertheless, three complications occurred, showing that FHRO remains one of the most complex hip surgeries even with computer assistance. However, none of the complications were directly related to the simulation or the navigation technique.

scholarly journals Computer-Assisted femoral head reduction osteotomies: An approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

2020 ◽  
Author(s):  
Philipp Fürnstahl ◽  
Fabio A. Casari ◽  
Joëlle Ackermann ◽  
Magda Marcon ◽  
Michael Leunig ◽  
...  
Keyword(s):  
Pilot Study ◽  
Femoral Head ◽  
Periacetabular Osteotomy ◽  
3D Models ◽  
Contralateral Side ◽  
Anatomic Reconstruction ◽  
Patient Specific ◽  
Rank Test ◽  
Computer Assisted ◽  
Sphericity Index

Abstract Background Legg–Calvé–Perthes (LCP) is a common orthopedic childhood disease that causes a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration that requires total hip arthroplasty. In 2002, Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The purpose of this study was to report the first results in the treatment of 6 patients to investigate whether our approach is feasible and safe.Methods In this retrospective pilot study, 6 LCP patients were treated with FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D-models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific instruments tailored for FHRO were designed, 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically [diameter index, sphericity index, Stulberg classification, extrusion index, LCE-, Tönnis-, CCD-angle and Shenton line] and the time and costs were recorded. Radiologic values were tested for normal distribution using the Shapiro–Wilk test and for significance using Wilcoxon signed-rank test.Results The sphericity index improved postoperatively by 20% (p = 0.028). The postoperative diameter of the femoral head differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg grading improved from poor coxarthrosis outcome to good outcome (p = 0.026). All patients underwent acetabular reorientation by periacetabular osteotomy. The average time (in minutes) for preliminary analysis, computer simulation and patient-specific instrument design was 63 (±48), 156 (±64) and 105 (±68.5), respectively.Conclusion The clinical feasibility of our approach to FHRO has been demonstrated. The results showed significant improvement compared to the preoperative situation. All operations were performed by experienced surgeons; nevertheless, three complications occurred, showing that FHRO remains one of the most complex hip surgeries even with computer assistance. However, none of the complications were directly related to the simulation or the navigation technique.

scholarly journals Computer-Assisted femoral head reduction osteotomies: An approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

2020 ◽  
Author(s):  
Philipp Fürnstahl ◽  
Fabio A. Casari ◽  
Joëlle Ackermann ◽  
Magda Marcon ◽  
Michael Leunig ◽  
...  
Keyword(s):  
Pilot Study ◽  
Femoral Head ◽  
Periacetabular Osteotomy ◽  
3D Models ◽  
Contralateral Side ◽  
Anatomic Reconstruction ◽  
Patient Specific ◽  
Rank Test ◽  
Computer Assisted ◽  
Sphericity Index

Abstract Background Legg–Calvé–Perthes (LCP) is a common orthopedic childhood disease that causes a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration that requires total hip arthroplasty. In 2002, Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The purpose of this study was to report the first results in the treatment of 6 patients to investigate whether our approach is feasible and safe.Methods In this retrospective pilot study, 6 LCP patients were treated with FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D-models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific instruments tailored for FHRO were designed, 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically [diameter index, sphericity index, Stulberg classification, extrusion index, LCE-, Tönnis-, CCD-angle and Shenton line] and the time and costs were recorded. Radiologic values were tested for normal distribution using the Shapiro–Wilk test and for significance using Wilcoxon signed-rank test.Results The sphericity index improved postoperatively by 20% (p = 0.028). The postoperative diameter of the femoral head differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg grading improved from poor coxarthrosis outcome to good outcome (p = 0.026). All patients underwent acetabular reorientation by periacetabular osteotomy. The average time (in minutes) for preliminary analysis, computer simulation and patient-specific instrument design was 63 (±48), 156 (±64) and 105 (±68.5), respectively.Conclusion The clinical feasibility of our approach to FHRO has been demonstrated. The results showed significant improvement compared to the preoperative situation. All operations were performed by experienced surgeons; nevertheless, three complications occurred, showing that FHRO remains one of the most complex hip surgeries even with computer assistance. However, none of the complications were directly related to the simulation or the navigation technique.

scholarly journals Computer-assisted femoral head reduction osteotomies an approach for anatomic reconstruction of severely deformed Legg-Calvè-Perthes hips

2020 ◽  
Author(s):  
Philipp Fürnstahl ◽  
Fabio A. Casari ◽  
Joëlle Ackermann ◽  
Magda Marcon ◽  
Michael Leunig ◽  
...  
Keyword(s):  
Femoral Head ◽  
3D Models ◽  
Contralateral Side ◽  
Anatomic Reconstruction ◽  
Patient Specific ◽  
Computer Assisted ◽  
Joint Biomechanics ◽  
Analysis Computer ◽  
Computer Based ◽  
3D Printed

Abstract Background: Legg–Calvé–Perthes (LCP) is a common orthopedic childhood disease leading to a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration requiring total hip arthroplasty. In 2002 Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The goal of this study was to evaluate the feasibility and anatomic reconstruction of such an approach for FHRO. Methods: In this pilot study 6 LCP patients were treated by FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific intstruments tailored to FHRO were designed 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically and time and costs recorded. Results and Interpretation: The clinical feasibility of our approach for FHRO surgery has been demonstrated. The results showed significant improvement compared to the preoperative situation. The sphericity index improved postoperatively by 20% (p=0.028), the postoperative head diameter differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg classification improved from 4.33 poor coxathrosis outcome to 1.5 good outcome (p = 0.026). The average time (minutes) for preliminary analysis, computer simulation, and patient-specific instrument design was 63 (±48), 156 (±64), and 105 (±68.5), respectively. All operations were performed by experienced surgeons, still three complications occurred, showing that FHRO remains one of the most complex hip surgeries, even with computer assistance; however none was directly related to simulation or navigation technique.

scholarly journals Morphological symmetry of the radius and ulna—Can contralateral forearm bones utilize as a reliable template for the opposite side?

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258232
Author(s):  
Eunah Hong ◽  
Dai-Soon Kwak ◽  
In-Beom Kim
Keyword(s):  
Proximal Part ◽  
3D Models ◽  
Contralateral Side ◽  
Patient Specific ◽  
Computer Assisted ◽  
Dominant Hand ◽  
Lower Section ◽  
Bone Parameters ◽  
Patient Specific Instruments ◽  
Forearm Bones

The most important precondition for correction of the affected forearm using data from the contralateral side is that the left and right bone features must be similar, in order to develop patient-specific instruments (PSIs) and/or utilize computer-assisted orthopedic surgery (CAOS). The forearm has complex anatomical structure, and most people use their dominant hand more than their less dominant hand, sometimes resulting in asymmetry of the upper limbs. The aim of this study is to investigate differences of the bilateral forearm bones through a quantitative comparison of whole bone parameters including length, volume, bowing, and twisting parameters, and regional shape differences of the forearm bones. In total, 132 bilateral 3D radii and ulnae 3D models were obtained from CT images, whole bone parameters and regional shape were analyzed. Statistically significant differences in whole bone parameters were not shown. Regionally, the radius shows asymmetry in the upper section of the central part to the upper section of the distal part. The ulna shows asymmetry in the lower section of the proximal part to the lower section of the central part. Utilizing contralateral side forearm bones to correct the affected side may be feasible despite regional differences in the forearm bones of around 0.5 mm.

scholarly journals Patient-specific template and electromagnetic navigation assisted bilateral periacetabular osteotomy for staged correction of bilateral injury-induced hip dysplasia: a case report

2021 ◽  
Author(s):  
Peter Brumat ◽  
Rene Mihalič ◽  
Črt Benulič ◽  
Anže Kristan ◽  
Rihard Trebše
Keyword(s):  
Case Report ◽  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Patient Specific ◽  
Computer Assisted ◽  
Electromagnetic Navigation ◽  
Assisted Navigation ◽  
High Surgical Risk ◽  
Unique Method ◽  
Post Traumatic

ABSTRACT Periacetabular osteotomy (PAO) for pelvic fracture sequelae presents a challenge in hip preservation surgery due to a combination of complex conditions involving post-traumatic altered anatomy and technically demanding procedure, with high surgical risk involved. To address these challenging conditions and evade potential devastating complications, a combination of patient-specific template (PST) and electromagnetic navigation (EMN) guidance can be used to increase the safety of the procedure and the accuracy of the acetabular reorientation. Herein we report our experience utilizing a combined PST- and EMN-assisted bilateral PAO for staged correction of bilateral severe, injury-induced hip dysplasia. The presented case report describes a unique method of successful surgical treatment of severe, bilateral injury-induced hip dysplasia with combined 3-D printing technology (PST) and intra-operative electromagnetic computer-assisted navigation (EMN) aided technically demanding surgical procedure (PAO), which emphasizes the benefits of PST and EMN use in hip preservation surgery in patients with complex pathoanatomic circumstances.

scholarly journals 3D Printed Patient-Specific Complex Hip Arthroplasty Models Streamline the Preoperative Surgical Workflow: A Pilot Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Michael Jiang ◽  
Jasamine Coles-Black ◽  
Gordon Chen ◽  
Matthew Alexander ◽  
Jason Chuen ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hip Arthroplasty ◽  
Planning Process ◽  
Cost Benefit ◽  
3D Models ◽  
Patient Specific ◽  
Risk Environment ◽  
Surgical Workflow ◽  
Operative Planning ◽  
3D Printed

Introduction: Surgical planning for complex total hip arthroplasty (THA) often presents a challenge. Definitive plans can be difficult to decide upon, requiring unnecessary equipment to be ordered and a long theatre list booked. We present a pilot study utilising patient-specific 3D printed models as a method of streamlining the pre-operative planning process.Methods: Complex patients presenting for THA were referred to the research team. Patient-specific 3D models were created from routine Computed Tomography (CT) imaging. Simulated surgery was performed to guide prosthesis selection, sizing and the surgical plan.Results: Seven patients were referred for this pilot study, presenting with complex conditions with atypical anatomy. Surgical plans provided by the 3D models were more detailed and accurate when compared to 2D CT and X ray imaging. Streamlined equipment selection was of great benefit, with augments avoided post simulation in three cases. The ability to tackle complex surgical problems outside of the operating theatre also flagged potential complications, while also providing teaching opportunities in a low risk environment.Conclusion: This study demonstrated that 3D printed models can improve the surgical plan and streamline operative logistics. Further studies investigating the optimal 3D printing material and workflow, along with cost-benefit analyses are required before this process is ready for routine use.

scholarly journals Evaluation of Constant Thickness Cartilage Models vs. Patient Specific Cartilage Models for an Optimized Computer-Assisted Planning of Periacetabular Osteotomy

PLoS ONE ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. e0146452 ◽  
Author(s):  
Li Liu ◽  
Timo Michael Ecker ◽  
Steffen Schumann ◽  
Klaus-Arno Siebenrock ◽  
Guoyan Zheng
Keyword(s):  
Periacetabular Osteotomy ◽  
Patient Specific ◽  
Constant Thickness ◽  
Computer Assisted

scholarly journals Morphometric Evaluation of Detailed Asymmetry for the Proximal Humerus in Korean Population

Symmetry ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 862
Author(s):  
Eunah Hong ◽  
Dai-Soon Kwak ◽  
In-Beom Kim
Keyword(s):  
Proximal Humerus ◽  
Contralateral Side ◽  
Patient Specific ◽  
Computer Assisted ◽  
Patient Specific Instruments ◽  
Left And Right ◽  
Ct Data ◽  
Bilateral Differences ◽  
Computer Assisted Orthopedic Surgery ◽  
Morphometric Evaluation

Computer-assisted orthopedic surgery and patient-specific instruments are widely used in orthopedic fields that utilize contralateral side bone data as a template to restore the affected side bone. The essential precondition for these techniques is that the left and right bone features are similar. Although proximal humerus fracture accounts for 4% to 8% of all fractures, the bilateral asymmetry of the proximal humerus is not fully understood. The aim of this study is to investigate anthropometric differences of the bilateral proximal humerus. One hundred one pairs of Korean humerus CT data from 51 females and 50 males were selected for this research. To investigate bilateral shape differences, we divided the proximal humerus into three regions and the proximal humerus further into five sections in each region. The distance from the centroid to the cortical outline at every 10 degrees was measured in each section. Differences were detected in all regions of the left and right proximal humerus; however, males had a larger number of significant differences than females. Large bilateral differences were measured in the greater tubercle. Nevertheless, using contralateral data as a template for repairing an affected proximal humerus might be possible.

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