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Hodel S, Arn-Roth T, Haug F, Carillo F, Vlachopoulos L, Fucentese SF, Fürnstahl P. The influence of the weight-bearing state on three-dimensional (3D) planning in lower extremity realignment - analysis of novel vs. state-of-the-art planning approaches. Arch Orthop Trauma Surg 2024; 144:1989-1996. [PMID: 38554205 PMCID: PMC11093806 DOI: 10.1007/s00402-024-05289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/17/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND The use of 3D planning to guide corrective osteotomies of the lower extremity is increasing in clinical practice. The use of computer-tomography (CT) data acquired in supine position neglects the weight-bearing (WB) state and the gold standard in 3D planning involves the manual adaption of the surgical plan after considering the WB state in long-leg radiographs (LLR). However, this process is subjective and dependent on the surgeons experience. A more standardized and automated method could reduce variability and decrease costs. PURPOSE The aim of the study was (1) to compare three different three-dimensional (3D) planning modalities for medial open-wedge high tibial osteotomy (MOWHTO) and (2) to describe the current practice of adapting NWB CT data after considering the WB state in LLR. The purpose of this study is to validate a new, standardized approach to include the WB state into the 3D planning and to compare this method against the current gold standard of 3D planning. Our hypothesis is that the correction is comparable to the gold standard, but shows less variability due compared to the more subjective hybrid approach. METHODS Three surgical planning modalities were retrospectively analyzed in 43 legs scheduled for MOWHTO between 2015 and 2019. The planning modalities included: (1) 3D hybrid (3D non-weight-bearing (NWB) CT models after manual adaption of the opening angle considering the WB state in LLR, (2) 3D NWB (3D NWB CT models) and (3) 3D WB (2D/3D registration of 3D NWB CT models onto LLR to simulate the WB state). The pre- and postoperative hip-knee-ankle angle (HKA) and the planned opening angle (°) were assessed and differences among modalities reported. The relationship between the reported differences and BMI, preoperative HKA (LLR), medial meniscus extrusion, Outerbridge osteoarthritis grade and joint line convergence angle (JLCA) was analyzed. RESULTS The mean (std) planned opening angle of 3D hybrid did not differ between 3D hybrid and 3D WB (0.4 ± 2.1°) (n.s.) but was higher in 3D hybrid compared to 3D NWB (1.1° ± 1.1°) (p = 0.039). 3D WB demonstrated increased preoperative varus deformity compared to 3D NWB: 6.7 ± 3.8° vs. 5.6 ± 2.7° (p = 0.029). Patients with an increased varus deformity in 3D WB compared to 3D NWB (> 2 °) demonstrated more extensive varus alignment in LLR (p = 0.009) and a higher JLCA (p = 0.013). CONCLUSION Small intermodal differences between the current practice of the reported 3D hybrid planning modality and a 3D WB approach using a 2D/3D registration algorithm were reported. In contrast, neglecting the WB state underestimates preoperative varus deformity and results in a smaller planned opening angle. This leads to potential under correction in MOWHTO, especially in patients with extensive varus deformities or JLCA. CLINICAL RELEVANCE Incorporating the WB state in 3D planning modalities has the potential to increase accuracy and lead to a more consistent and reliable planning in MOWHTO. The inclusion of the WB state in automatized surgical planning algorithms has the potential to reduce costs and time in the future.
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Affiliation(s)
- Sandro Hodel
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland.
| | - Tabitha Arn-Roth
- Balgrist University Hospital, Research in Orthopaedics Computer Science, University of Zurich, Balgrist Forchstrasse 340, Zurich, 8008, Switzerland
| | - Florian Haug
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Fabio Carillo
- Balgrist University Hospital, Research in Orthopaedics Computer Science, University of Zurich, Balgrist Forchstrasse 340, Zurich, 8008, Switzerland
| | - Lazaros Vlachopoulos
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Sandro F Fucentese
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Philipp Fürnstahl
- Balgrist University Hospital, Research in Orthopaedics Computer Science, University of Zurich, Balgrist Forchstrasse 340, Zurich, 8008, Switzerland
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Peng H, Ou A, Huang X, Wang C, Wang L, Yu T, Zhang Y, Zhang Y. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg 2021; 13:1465-1473. [PMID: 34110088 PMCID: PMC8313165 DOI: 10.1111/os.13021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 12/22/2022] Open
Abstract
Osteoarthritis causes joint pain and functional disorder, of which knee osteoarthritis is the most common. Nowadays, clinically effective treatments mainly include conservative treatment, arthroplasty, and osteotomy. However, conservative treatment only offers symptomatic relief and arthroplasty is limited to the patients with a moderate to severe degree of osteoarthritis. For relatively young patients who require greater knee preservation, a surgical treatment with low operation trauma and revision rate is needed. Osteotomy around the knee, based on the notion of “knee preservation,” has been chosen as an alternative surgical treatment. Cutting and realigning the bones corrects the mechanical line of lower limb force bearing. As such, osteotomy around the knee retains normal anatomical structure and obtains good functional recovery of the knee joint. The techniques of osteotomy around the knee includes anti‐varus deformity and anti‐valgus deformity osteotomy, aiming to reallocate the force bearing in the compartment of the knee joint. By choosing the surgical section of the lower limbs, the osteotomy around the knee can achieve the correction of mechanical axis, such as the high tibial osteotomy (HTO), proximal fibular osteotomy (PFO), and distal femur osteotomy (DFO). Numerous modified techniques have been developed to meet the demands of patients based on traditional methods. These modified osteotomy have their own advantages and indications. This paper aims to guide clinical treatment by reviewing different types of osteotomies, and their effects, that have been studied and applied widely in clinical practices.
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Affiliation(s)
- Haining Peng
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Aichun Ou
- Department of Operating Room, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaohong Huang
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, China
| | - Chen Wang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Wang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tengbo Yu
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Sports Medicine and Rehabilitation, Qingdao University, Qingdao, China
| | - Yingze Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Zhang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Sports Medicine and Rehabilitation, Qingdao University, Qingdao, China.,Shandong Institute of Traumatic Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
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Zindel C, Fürnstahl P, Hoch A, Götschi T, Schweizer A, Nagy L, Roner S. Inter-rater variability of three-dimensional fracture reduction planning according to the educational background. J Orthop Surg Res 2021; 16:159. [PMID: 33632251 PMCID: PMC7905543 DOI: 10.1186/s13018-021-02312-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Computer-assisted three-dimensional (3D) planning is increasingly delegated to biomedical engineers. So far, the described fracture reduction approaches rely strongly on the performance of the users. The goal of our study was to analyze the influence of the two different professional backgrounds (technical and medical) and skill levels regarding the reliability of the proposed planning method. Finally, a new fragment displacement measurement method was introduced due to the lack of consistent methods in the literature. Methods 3D bone models of 20 distal radius fractures were presented to nine raters with different educational backgrounds (medical and technical) and various levels of experience in 3D operation planning (0 to 10 years) and clinical experience (1.5 to 24 years). Each rater was asked to perform the fracture reduction on 3D planning software. Results No difference was demonstrated in reduction accuracy regarding rotational (p = 1.000) and translational (p = 0.263) misalignment of the fragments between biomedical engineers and senior orthopedic residents. However, a significantly more accurate planning was performed in these two groups compared with junior orthopedic residents with less clinical experience and no 3D planning experience (p < 0.05). Conclusion Experience in 3D operation planning and clinical experience are relevant factors to plan an intra-articular fragment reduction of the distal radius. However, no difference was observed regarding the educational background (medical vs. technical) between biomedical engineers and senior orthopedic residents. Therefore, our results support the further development of computer-assisted surgery planning by biomedical engineers. Additionally, the introduced fragment displacement measure proves to be a feasible and reliable method. Level of Evidence Diagnostic Level II
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Affiliation(s)
- Christoph Zindel
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland. .,Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland
| | - Armando Hoch
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland.,Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ladislav Nagy
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Simon Roner
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland.,Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Wu J, Mahfouz MR. Reconstruction of knee anatomy from single-plane fluoroscopic x-ray based on a nonlinear statistical shape model. J Med Imaging (Bellingham) 2021; 8:016001. [PMID: 33457444 PMCID: PMC7797787 DOI: 10.1117/1.jmi.8.1.016001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 10/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose: Reconstruction of patient anatomy is critical to patient-specific instrument (PSI) design in total joint replacement (TJR). Conventionally, computed tomography (CT) and magnetic resonance imaging (MRI) are used to obtain the patient anatomy as they are accurate imaging modalities. However, computing anatomical landmarks from the patient anatomy for PSIs requires either high-resolution CT, increasing time of scan and radiation exposure to the patient, or longer and more expensive MRI scans. As an alternative, reconstruction from single-plane fluoroscopic x-ray provides a cost-efficient tool to obtain patient anatomical structures while allowing capture of the patient’s joint dynamics, important clinical information for TJR. Approach: We present a three-dimensional (3D) reconstruction scheme that automatically and accurately reconstructs the 3D knee anatomy from single-plane fluoroscopic x-ray based on a nonlinear statistical shape model called kernel principal component analysis. To increase robustness, we designed a hybrid energy function that integrated feature and intensity information as a similarity measure for the 3D reconstruction. Results: We evaluated the proposed method on five subjects during deep knee bending: the root-mean-square accuracy is 1.19±0.36 mm for reconstructed femur and 1.15±0.17 mm for reconstructed tibia. Conclusions: The proposed method demonstrates reliable 3D bone model reconstruction accuracy with successful elimination of prior 3D imaging and reduction of manual labor and radiation dose on patient as well as characterizing joints in motion. This method is promising for applications in medical interventions such as patient-specific arthroplasty design, surgical planning, surgical navigation, and understanding anatomical and dynamic characteristics of joints.
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Affiliation(s)
- Jing Wu
- University of Tennessee, Department of Mechanical, Aerospace, and Biomedical Engineering, Knoxville, Tennessee, United States
| | - Mohamed R Mahfouz
- University of Tennessee, Department of Mechanical, Aerospace, and Biomedical Engineering, Knoxville, Tennessee, United States
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Yoshii Y, Teramura S, Oyama K, Ogawa T, Hara Y, Ishii T. Development of three-dimensional preoperative planning system for the osteosynthesis of distal humerus fractures. Biomed Eng Online 2020; 19:56. [PMID: 32660498 PMCID: PMC7359224 DOI: 10.1186/s12938-020-00801-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To reproduce anatomical reduction and appropriate implant placement/choices during osteosynthesis for elbow fractures, we developed a 3D preoperative planning system. To assess the utility of 3D digital preoperative planning for the osteosynthesis of distal humerus fractures, we evaluated the reproducibility of implant reduction shapes and placements in patients with distal humerus fractures. METHODS Twelve patients with distal humerus fractures who underwent osteosynthesis using 3D preoperative planning were evaluated. Reduction shapes were evaluated by the angle between the diaphysis axis and a line connecting the vertices of the medial epicondyle and the lateral epicondyle (epicondyle angle), and the angle between the diaphysis axis and the articular surface (joint angle) in the coronal plane, and the distance between the anterior diaphysis and the anterior articular surface in the sagittal plane (anterior distance) based on 3D images of the distal humerus. In addition, the implant positions were evaluated by the positions of the proximal and posterior edge of the plate, and the angle of the plate to the epicondyle line. The reproducibility was evaluated by intra-class correlation coefficients of the parameters between pre- and postoperative images. RESULTS The intra-class correlation coefficients were 0.545, 0.802, and 0.372 for the epicondyle angle, joint angle, and anterior distance, respectively. The differences in the measurements between the preoperative plan and postoperative reduction were 2.1 ± 2.1 degrees, 2.3 ± 1.8 degrees, and 2.8 ± 2.0 mm, for the epicondyle angle, joint angle, and anterior distance, respectively. The intra-class correlation coefficients were 0.983, 0.661, and 0.653 for the proximal and posterior plate positions, and the angle to the epicondyle, respectively. The differences in the measurements between the preoperative plan and postoperative reduction were 3.3 ± 2.1 mm, 2.7 ± 1.7 mm and 9.7 ± 9.8 degrees, for the plate positions of proximal and posterior edge, and the angle of the plate to the epicondyle line, respectively. There were significant correlations for the epicondyle angle, joint angle, and plate positions. CONCLUSIONS 3D preoperative planning for osteosynthesis of distal humerus fracture was reproducible for the reduction shape of the coronal view and the plate positions. It may be helpful for acquiring practical images of osteosynthesis in distal humerus fractures. LEVEL OF EVIDENCE Level III, a case-control study.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Shin Teramura
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Kazuki Oyama
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Yuki Hara
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
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Jud L, Roth T, Fürnstahl P, Vlachopoulos L, Sutter R, Fucentese SF. The impact of limb loading and the measurement modality (2D versus 3D) on the measurement of the limb loading dependent lower extremity parameters. BMC Musculoskelet Disord 2020; 21:418. [PMID: 32605616 PMCID: PMC7329436 DOI: 10.1186/s12891-020-03449-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Deformity assessment and preoperative planning of realignment surgery are conventionally based on weight-bearing (WB) radiographs. However, newer technologies such as three-dimensional (3D) preoperative planning and surgical navigation with patient-specific instruments (PSI) rely on non-weight bearing (NWB) computed tomography (CT) data. Additionally, differences between conventional two-dimensional (2D) and 3D measurements are known. The goal of the present study was to systematically analyse the influence of WB and the measurement modality (2D versus 3D) on common WB-dependent measurements used for deformity assessment. Methods 85 lower limbs could be included. Two readers measured the hip-knee-ankle angle (HKA) and the joint line convergence angle (JLCA) in 2D WB and 2D NWB radiographs, as well as in CT-reconstructed 3D models using an already established 3D measurement method for HKA, and a newly developed 3D measurement method for JLCA, respectively. Interrater and intermodality reliability was assessed. Results Significant differences between WB and NWB measurements were found for HKA (p < 0.001) and JLCA (p < 0.001). No significant difference could be observed between 2D HKA NWB and 3D HKA (p = 0.09). The difference between 2D JLCA NWB and 3D JLCA was significant (p < 0.001). The intraclass correlation coefficient (ICC) for the interrater agreement was almost perfect for all HKA and 3D JLCA measurements and substantial for 2D JLCA WB and 2D JLCA NWB. ICC for the intermodality agreement was almost perfect between 2D HKA WB and 2D HKA NWB as well as between 2D HKA NWB and 3D HKA, whereas it was moderate between 2D JLCA WB and 2D JLCA NWB and between 2D JLCA NWB and 3D JLCA. Conclusion Limb loading results in significant differences for both HKA and JLCA measurements. Furthermore, 2D projections were found to be insufficient to represent 3D joint anatomy in complex cases. With an increasing number of surgical approaches based on NWB CT-reconstructed models, research should focus on the development of 3D planning methods that consider the effects of WB on leg alignment.
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Affiliation(s)
- Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.
| | - Tabitha Roth
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.,Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
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Caiti G, Dobbe JGG, Strackee SD, Strijkers GJ, Streekstra GJ. Computer-Assisted Techniques in Corrective Distal Radius Osteotomy Procedures. IEEE Rev Biomed Eng 2020; 13:233-247. [DOI: 10.1109/rbme.2019.2928424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Soodmand E, Kluess D, Varady PA, Cichon R, Schwarze M, Gehweiler D, Niemeyer F, Pahr D, Woiczinski M. Interlaboratory comparison of femur surface reconstruction from CT data compared to reference optical 3D scan. Biomed Eng Online 2018; 17:29. [PMID: 29495963 PMCID: PMC5833145 DOI: 10.1186/s12938-018-0461-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 02/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study contrasts the accuracy of different reconstructed models with distinctive segmentation methods performed by various experts. Seven research groups reconstructed nine 3D models of one human femur based on an acquired CT image using their own computational methods. As a reference model for accuracy assessment, a 3D surface scan of the human femur was created using an optical measuring system. Prior to comparison, the femur was divided into four areas; "neck and greater trochanter", "proximal metaphysis", "diaphysis", and "distal metaphysis". The deviation analysis was carried out in GEOMAGIC studio v.2013 software. RESULTS The results revealed that the highest deviation errors occurred in "neck and greater trochanter" area and "proximal metaphysis" area with RMSE of 0.84 and 0.83 mm respectively. CONCLUSION In conclusion, this study shows that the average deviation of reconstructed models prepared by experts with various methods, skills and software from the surface 3D scan is lower than 0.79 mm, which is not a significant discrepancy.
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Affiliation(s)
- Ehsan Soodmand
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, University Medicine Rostock, Doberaner Strasse 142, 18057, Rostock, Germany.
| | - Daniel Kluess
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, University Medicine Rostock, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Patrick A Varady
- Trauma Center Murnau Institute of Biomechanics, Professor-Küntscher-Str. 882418, Murnau am Staffelsee, Germany
| | - Robert Cichon
- Chair of Mechanics and Robotics, University Duisburg-Essen, Lotharstrasse 1, 47057, Duisburg, Germany
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials of the Orthopaedic Clinic, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hannover, Germany
| | - Dominic Gehweiler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Frank Niemeyer
- Fraunhofer Research Institution for Large Structures in Production Engineering (IGP), Albert-Einstein-Str. 30, 18059, Rostock, Germany
| | - Dieter Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Vienna, Getreidemarkt 9, 1060, Vienna, Austria
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany
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Outcome reporting following navigated high tibial osteotomy of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24:3529-3555. [PMID: 27665094 DOI: 10.1007/s00167-016-4327-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/12/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE This systematic review evaluates radiographic and clinical outcome reporting following navigated high tibial osteotomy (HTO). Conventional HTO was used as a control to compare outcomes and furthermore investigate the quality of evidence in studies reporting outcomes for navigated HTO. It was hypothesized that navigated HTO will show superior clinical and radiographic outcomes compared to conventional HTO. METHODS Two independent reviewers searched PubMed, Ovid (MEDLINE), EMBASE, and Cochrane databases for studies reporting outcomes following navigated HTO. Titles, abstracts, and full-text were screened in duplicate using an a priori inclusion and exclusion criteria. Descriptive statistics were calculated using Minitab ® statistical software. Methodological Index for Nonrandomized Studies (MINORS) and Cochrane Risk of Bias Scores were used to evaluate methodological quality. RESULTS Thirty-four studies which involved 2216 HTOs were analysed in this review, 1608 (72.6 %) navigated HTOs and 608 (27.4 %) conventional HTOs. The majority of studies were of level IV evidence (16). Clinical outcomes were reported in knee and function scores or range of motion comparisons. Postoperative clinical and functional scores were improved by navigated HTO although it is not demonstrated if there is significant improvement compared to conventional HTO. Most common clinical outcome score reported was Lysholm scores (6) which report postoperative scores of 87.8 (standard deviation 5.9) and 88.8 (standard deviation 5.9) for conventional and navigation-assisted HTO, respectively. Radiographic outcomes reported commonly were weight-bearing mechanical axis, coronal plane angle, and posterior tibial slope angle in the sagittal plane. Studies have shown HTO gives significant correction of mechanical alignment and navigated HTO produces significantly less change in posterior tibial slope postoperatively compared to conventional. The mean MINORS for the 17 non-comparative studies was 9/16, and 15/24 for the 14 non-randomized comparative studies. CONCLUSION Navigation HTO results in improved mechanical axis alignment and demonstrates significantly better control over the tibial slope angle change postoperatively compared to conventional methods; however, these improvements have not yet been reflected in clinical outcome scores. Overall the studies report HTO does create significantly improved knee scores and functions compared to patients' preoperative ratings regardless of technique. Future studies on HTO outcomes need to focus on consistency of outcome reporting. LEVEL OF EVIDENCE IV.
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Abstract
Background The treatment for undisplaced scaphoid waist fractures has evolved from conventional cast immobilization to percutaneous screw insertion. Percutaneous fixation reduces some of the risks of open surgery, but can be technically demanding and carries the risk of radiation exposure. Recently, computer-assisted percutaneous scaphoid fixation (CAPSF) has been gaining interest. Materials and Methods Conventional percutaneous scaphoid fixation is performed under fluoroscopic guidance and involves insertion of a guide wire along the length of the scaphoid to facilitate placement of a cannulated screw. Adapting computer-assisted techniques for scaphoid fixation poses several unique challenges including patient tracking and registration. Results To date, five groups have successfully implemented systems for CAPSF. These systems have implemented wrist immobilization strategies to resolve the issue of patient tracking and have developed unique guidance techniques incorporating 2D fluoroscope, cone-beam CT, and ultrasound, to circumvent patient-based registration. Conclusions Computer-aided percutaneous pinning of scaphoid waist fractures can significantly reduce radiation exposure and has the potential to improve the accuracy of this procedure. This article reviews the rationale for, and the evolution of, CAPSF and describes the key principles of computer-assisted technology.
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Affiliation(s)
- Erin J. Smith
- Department of Mechanical Engineering, Queen's University, Kingston, Ontario, Canada
| | - Randy E. Ellis
- Department of Mechanical Engineering, Queen's University, Kingston, Ontario, Canada
- School of Computing, Queen's University, Kingston, Ontario, Canada
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - David R. Pichora
- Department of Mechanical Engineering, Queen's University, Kingston, Ontario, Canada
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
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Picardo NE, Khan W, Johnstone D. Computer-assisted navigation in high tibial osteotomy: a systematic review of the literature. Open Orthop J 2012; 6:305-12. [PMID: 22896778 PMCID: PMC3415684 DOI: 10.2174/1874325001206010305] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/28/2012] [Accepted: 03/10/2012] [Indexed: 12/02/2022] Open
Abstract
High tibial osteotomy (HTO) is a procedure which aims to change the mechanical axis of the lower limb, transferring the body weight across healthy articular cartilage. Several studies have shown that accurate correction is the leading predictor for success. In this article, we systematically review the computer-assisted techniques that have been used in attempts to increase the accuracy of the surgery and improve postoperative outcomes. The results of the cadaveric and clinical studies to date are presented and the benefits and pitfalls of navigation are discussed.
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Affiliation(s)
- Natasha E Picardo
- Bone Tumour Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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Lützner J, Gross AF, Günther KP, Kirschner S. Precision of navigated and conventional open-wedge high tibial osteotomy in a cadaver study. Eur J Med Res 2010; 15:117-20. [PMID: 20452896 PMCID: PMC3352217 DOI: 10.1186/2047-783x-15-3-117] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
High tibial osteotomy (HTO) is an established treatment option for isolated medial osteoarthritis in young and active patients. One important factor for success of this procedure is the degree of correction of the weight-bearing line. Computer-assisted navigation systems are believed to improve the precision of axis correction through intraoperative real-time monitoring. This study investigates the precision of correction of the weight-bearing line in open-wedge HTO with and without a navigation system. Nineteen legs of well-preserved human cadaver were randomly assigned to navigated (n = 10) or conventional (n = 9) HTO. In order to achieve a sufficient amount of correction in all legs the weight-bearing line was aimed at 80 percent of the width of the tibial plateau. The mean deviation of the weight-bearing line from the desired 80 percent was 1 percent in the navigated and 8.6 percent in the conventional operated legs (p = 0.002). The weight-bearing line of all navigated but only 5 of the 9 conventional operated legs was within a ± 5 percent tolerance level (p = 0.33). Navigated open-wedge HTO achieved better correction of the weight-bearing line than the conventional method in human cadaver legs. Future studies have to prove this advantage in a clinical setting and it's effect on patient outcome.
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Affiliation(s)
- J Lützner
- Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Germany.
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13
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Ellis R. From scans to sutures: computer-assisted orthopedic surgery in the twenty-first century. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2005:7234-7. [PMID: 17281949 DOI: 10.1109/iembs.2005.1616180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Computer-assisted surgery is the process of using medical images, such as CT scans, X-ray fluoroscopy, or 3D ultrasound, to improve patient care. A typical surgical procedure begins by acquiring and processing a CT scan with specially developed image-analysis software. A surgeon then performs a "virtual surgery" on the patient to develop a preoperative plan. In the operating room the medical image is registered to the patient's anatomy by finding an optimal rigid-body transformation. This transformation allows an object or motion in one coordinate frame to be represented in the other frame, and thus a surgeon can visualize the location of an instrument deep within concealed anatomy while avoiding structures at risk. The operating surgeon can also use computer-tracked fluoroscopy or ultrasound for 3D guidance. For the past seven years, our interdisciplinary research group has been investigating fundamental problems in orthopedic surgery of bones and joints. This paper is an overview of the problems and solutions that have been tested in a set of pilot clinical trials in which we have treated more than 250 patients for early or advanced arthritis, poorly healed bone fractures, and treatment of deep bone tumors.
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Affiliation(s)
- R Ellis
- Dept. of Surg., Queen's Univ., Kingston, Ont
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14
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Jenny JY. [The history and development of computer assisted orthopaedic surgery]. DER ORTHOPADE 2007; 35:1038-42. [PMID: 16933124 DOI: 10.1007/s00132-006-0994-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Computer assisted orthopaedic surgery (CAOS) was developed to improve the accuracy of surgical procedures. It has improved dramatically over the last years, being transformed from an experimental, laboratory procedure into a routine procedure theoretically available to every orthopaedic surgeon. The first field of application of computer assistance was neurosurgery. After the application of computer guided spinal surgery, the navigation of total hip and knee joints became available. Currently, several applications for computer assisted surgery are available. At the beginning of navigation, a preoperative CT-scan or several fluoroscopic images were necessary. The imageless systems allow the surgeon to digitize patient anatomy at the beginning of surgery without any preoperative imaging. The future of CAOS remains unknown, but there is no doubt that its importance will grow in the next 10 years, and that this technology will probably modify the conventional practice of orthopaedic surgery.
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Affiliation(s)
- J-Y Jenny
- Centre de Traumatologie et d'Orthopédie, 10 Avenue Baumann, F-67400, Illkirch, Fankreich.
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15
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Barratt DC, Penney GP, Chan CSK, Slomczykowski M, Carter TJ, Edwards PJ, Hawkes DJ. Self-calibrating 3D-ultrasound-based bone registration for minimally invasive orthopedic surgery. IEEE TRANSACTIONS ON MEDICAL IMAGING 2006; 25:312-23. [PMID: 16524087 DOI: 10.1109/tmi.2005.862736] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Intraoperative freehand three-dimensional (3-D) ultrasound (3D-US) has been proposed as a noninvasive method for registering bones to a preoperative computed tomography image or computer-generated bone model during computer-aided orthopedic surgery (CAOS). In this technique, an US probe is tracked by a 3-D position sensor and acts as a percutaneous device for localizing the bone surface. However, variations in the acoustic properties of soft tissue, such as the average speed of sound, can introduce significant errors in the bone depth estimated from US images, which limits registration accuracy. We describe a new self-calibrating approach to US-based bone registration that addresses this problem, and demonstrate its application within a standard registration scheme. Using realistic US image data acquired from 6 femurs and 3 pelves of intact human cadavers, and accurate Gold Standard registration transformations calculated using bone-implanted fiducial markers, we show that self-calibrating registration is significantly more accurate than a standard method, yielding an average root mean squared target registration error of 1.6 mm. We conclude that self-calibrating registration results in significant improvements in registration accuracy for CAOS applications over conventional approaches where calibration parameters of the 3D-US system remain fixed to values determined using a preoperative phantom-based calibration.
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Affiliation(s)
- Dean C Barratt
- Department of Imaging Sciences, Guy's Hospital, GKT School of Medicine, King's College London, UK.
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16
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Menetrey J, Paul M. [Possibilities of computer-assisted navitation in knee para-articular osteotomies]. DER ORTHOPADE 2004; 33:224-8. [PMID: 14872315 DOI: 10.1007/s00132-003-0598-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Osteotomies in the knee region for incipient osteoarthritis in active patients have become increasingly popular in recent years. A computer-guided navigation system should help increase the surgeon's accuracy and lower the risk of intraoperative complications for this technically demanding type of surgery. Furthermore, computer navigation might be a powerful research and educational tool. The technical principles and the clinical implications of this system for knee osteotomies are described in the following article.
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Affiliation(s)
- J Menetrey
- Clinique et policlinique de chirurgie orthopédique et de traumatologie de l'appareil moteur, Hôpitaux Universitaires de Genève, Switzerland.
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17
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Kawasaki Y, Ino F, Mizutani Y, Fujimoto N, Sasama T, Sato Y, Sugano N, Tamura S, Hagihara K. High-performance computing service over the internet for intraoperative image processing. ACTA ACUST UNITED AC 2004; 8:36-46. [PMID: 15055800 DOI: 10.1109/titb.2004.824740] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents a framework for a cluster system that is suited for high-resolution image processing over the Internet during surgery. The system realizes high-performance computing (HPC) assisted surgery, which allows surgeons to utilize HPC resources remote from the operating room. One application available in the system is an intraoperative estimator for the range of motion (ROM) adjustment in total hip replacement (THR) surgery. In order to perform this computation-intensive estimation during surgery, we parallelize the ROM estimator on a cluster of 64 PCs, each with two CPUs. Acceleration techniques such as dynamic load balancing and data compression methods are incorporated into the system. The system also provides a remote-access service over the Internet with a secure execution environment. We applied the system to an actual THR surgery performed at Osaka University Hospital and confirmed that it realizes intraoperative ROM estimation without degrading the resolution of images and limiting the area for estimations.
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MESH Headings
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/methods
- Computing Methodologies
- Hip Joint/diagnostic imaging
- Hip Joint/surgery
- Humans
- Imaging, Three-Dimensional/methods
- Internet
- Monitoring, Intraoperative/instrumentation
- Monitoring, Intraoperative/methods
- Online Systems
- Radiographic Image Enhancement/instrumentation
- Radiographic Image Enhancement/methods
- Radiographic Image Interpretation, Computer-Assisted/methods
- Surgery, Computer-Assisted/instrumentation
- Surgery, Computer-Assisted/methods
- Telemedicine/instrumentation
- Telemedicine/methods
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Affiliation(s)
- Yasuhiro Kawasaki
- Department of Computer Science, Graduate School of Information Science and Technology, Osaka University, Osaka 560-8531, Japan
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Abstract
Medical imaging has been used primarily for diagnosis. In the past 15 years there has been an emergence of the use of images for the guidance of therapy. This process requires three-dimensional localization devices, the ability to register medical images to physical space, and the ability to display position and trajectory on those images. This paper examines the development and state of the art in those processes.
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Affiliation(s)
- R L Galloway
- Department of Biomedical Engineering, Center for Technology Guided Therapy, Vanderbilt University, Nashville, Tennessee 37235, USA.
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