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 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.

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-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 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 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 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 Computer-Assisted Planning and Patient-Specific Instruments for Bone Tumor Resection within the Pelvis: A Series of 11 Patients

Sarcoma ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
François Gouin ◽  
Laurent Paul ◽  
Guillaume Anthony Odri ◽  
Olivier Cartiaux
Keyword(s):  
Computed Tomography ◽  
Bone Tumor ◽  
Tumor Resection ◽  
Pelvic Bone ◽  
Patient Specific ◽  
Computer Assisted ◽  
Minimal Distance ◽  
Location Accuracy ◽  
Patient Specific Instruments ◽  
Bone Tumor Resection

Pelvic bone tumor resection is challenging due to complex geometry, limited visibility, and restricted workspace. Accurate resection including a safe margin is required to decrease the risk of local recurrence. This clinical study reports 11 cases of pelvic bone tumor resected by using patient-specific instruments. Magnetic resonance imaging was used to delineate the tumor and computerized tomography to localize it in 3D. Resection planning consisted in desired cutting planes around the tumor including a safe margin. The instruments were designed to fit into unique position on the bony structure and to indicate the desired resection planes. Intraoperatively, instruments were positioned freehand by the surgeon and bone cutting was performed with an oscillating saw. Histopathological analysis of resected specimens showed tumor-free bone resection margins for all cases. Available postoperative computed tomography was registered to preoperative computed tomography to measure location accuracy (minimal distance between an achieved and desired cut planes) and errors on safe margin (minimal distance between the achieved cut planes and the tumor boundary). The location accuracy averaged 2.5 mm. Errors in safe margin averaged −0.8 mm. Instruments described in this study may improve bone tumor surgery within the pelvis by providing good cutting accuracy and clinically acceptable margins.

scholarly journals Computer Assisted Surgery and 3D Printing in Orthopaedic Oncology: A Lesson Learned by Cranio-Maxillo-Facial Surgery

2021 ◽  
Vol 11 (18) ◽  
pp. 8584
Author(s):  
Giuseppe Bianchi ◽  
Tommaso Frisoni ◽  
Benedetta Spazzoli ◽  
Alessandra Lucchese ◽  
Davide Donati
Keyword(s):  
3D Printing ◽  
Pelvic Surgery ◽  
Patient Specific ◽  
Computer Assisted ◽  
Mechanical Complication ◽  
Orthopaedic Oncology ◽  
Custom Made ◽  
Patient Specific Instruments ◽  
Primary Bone ◽  
Custom Made Prostheses

Primary bone sarcomas are rare tumors and surgical resection in combination with chemo and radiation therapy is the mainstay of treatment. Some specific anatomical sites still represent a reconstructive challenge due to their complex three-dimensional anatomy. In recent years, patient specific instruments along with 3D printing technology has come to represent innovative techniques in orthopaedic oncology. We retrospectively reviewed 23 patients affected by primary bone sarcoma treated with patient-specific instruments and 3D printing custom made prostheses. At follow up after approximately two years, the infection rate was 26%, mechanical complication rate 13%, and local recurrence rate 13% (with a five-years implant survival rate of 74%). Based on our experience, patient-specific instruments and 3D custom-made prostheses represents a reliable and safe technique for improving the accuracy of resection of primary bone tumour, with a particular use in pelvic surgery ameliorating functional results.

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