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Favero V, Volpato A, Stefanelli F, Drago G, Favero R, Baietto F, Fusetti S, Bissolotti G. Cleft lip and palate outcomes: Multidisciplinary approach for comprehensive management. J Stomatol Oral Maxillofac Surg 2024:101899. [PMID: 38692455 DOI: 10.1016/j.jormas.2024.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024]
Abstract
In patients with cleft lip and palate the most common associated dental problem is lateral incisor agenesis, often associated with lack of support and definition of the nasal tip. In many cases, adhesions deriving from surgical procedures and skeletal discrepancy make orthognathic surgery and rhinoseptoplasty unavoidable. In the present case report a dental rehabilitation with canine substitution and prosthetic-implant treatment in a posterior area is described. The use, during rhinoseptoplasty, of a customized titanium prosthesis, which provides projection for the tip of the nose, is also introduced. The patient was administered two questionnaires in order to assess the psychological aspects related to the cleft outcomes and the influence that the treatment conveyed.
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Affiliation(s)
- Vittorio Favero
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy.
| | - Andrea Volpato
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Francesca Stefanelli
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Giampaolo Drago
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Riccardo Favero
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Federico Baietto
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Stefano Fusetti
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
| | - Guido Bissolotti
- Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35121 Padua Italy
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Franke A, Sequenc AF, Sembdner P, Seidler A, Matschke JB, Leonhardt H. Three-dimensional measurements of symmetry for the mandibular ramus. Ann Anat 2024; 253:152229. [PMID: 38367950 DOI: 10.1016/j.aanat.2024.152229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The study examines a sample of patients presenting for viscerocranial computer tomography that does not display any apparent signs of asymmetry, assesses the three-dimensional congruency of the mandibular ramus, and focuses on differences in age and gender. METHODS This cross-sectional cohort study screened viscerocranial CT data of patients without deformation or developmental anomalies. Segmentations were obtained from the left and right sides and superimposed according to the best-fit alignment. Comparisons were made to evaluate three-dimensional congruency and compared between subgroups according to age and gender. RESULTS Two hundred and sixty-eight patients were screened, and one hundred patients met the inclusion criteria. There were no statistical differences between the left and right sides of the mandibular ramus. Also, there were no differences between the subgroups. The overall root mean square was 0.75 ± 0.15 mm, and the mean absolute distance from the mean was 0.54 ± 0.10 mm. CONCLUSION The mean difference was less than one millimetre, far below the two-millimetre distance described in the literature that defines relative symmetry. Our study population displays a high degree of three-dimensional congruency. Our findings help to understand that there is sufficient three-dimensional congruency of the mandibular ramus, thus contributing to facilitating CAD-CAM-based procedures based on symmetry for this specific anatomic structure.
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Affiliation(s)
- Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany.
| | | | - Philipp Sembdner
- Chair of Virtual Product Development, Institute of Machine Elements and Machine Design, TU Dresden, Germany
| | - Alexander Seidler
- Chair of Virtual Product Development, Institute of Machine Elements and Machine Design, TU Dresden, Germany
| | - Jan Bernard Matschke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany
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Yan K, Wu Y, Xie Z, Yan S, Qiao C, Qu Y, Gao S, Shangguan W, Wu G. Endoscopic-Assisted Forehead Augmentation with Polyetheretherketone (PEEK) Patient-Specific Implant (PSI) for Aesthetic Considerations. Aesthetic Plast Surg 2024:10.1007/s00266-024-03899-1. [PMID: 38409347 DOI: 10.1007/s00266-024-03899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/30/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Forehead augmentation have become popular aesthetic procedures among Asians in recent years. However, the use of polyetheretherketone (PEEK) patient-specific implant (PSI) in the facial contouring surgery for aesthetic considerations is not well documented in the existing studies. The purpose of this study was to develop a novel method for forehead augmentation and assess the clinical outcomes and complications in patients who underwent forehead augmentation with PEEK PSI assisted by endoscopy. METHODS The PEEK PSIs were fabricated using the virtual surgical planning (VSP) and the computer-aided manufacturing (CAM) for each patient, preoperatively. The implant pockets were dissected in the subperiosteal plane, and PEEK PSIs were placed in their designed position and fixed assisting by endoscopy via small incision within the hairline. All patients were asked to complete the FACE-Q questionnaire before and 6 months after the operation. Pre- and postoperative demographics, photographs, and other clinical data of patients were collected and analyzed. RESULTS 11 patients underwent forehead augmentation were enrolled in this study. All procedures were completed successfully with the help of endoscope. The average patient age was 30.63 ± 2.54 years. The mean thickness and size of PEEK PSI were 4.44 ± 1.77 mm and 38.43 ± 22.66 cm2, respectively. The mean operative time was 83.00 ± 29.44 min, and the mean postoperative follow-up period was 11.00 ± 6.50 months. No implant exposure, extrusion or removal were reported. The FACE-Q scores of patients in satisfaction with the forehead increased from 47.64 ± 7.15 to 78.81 ± 6.35. CONCLUSIONS PEEK PSIs can be prefabricated to achieve accurate remodeling of the frontal contour with good esthetic outcomes. The endoscope provides direct and magnified vision, which allow easy access to the supraorbital rim and lateral edge of the eyebrow arch and confirming the position of the implants without damaging nerves and vessels. Endoscopic-assisted forehead augmentation with PEEK PSI is safe and effective. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Kaili Yan
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yarui Wu
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Zhiyang Xie
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Shunchao Yan
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Chongxu Qiao
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yuming Qu
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Sheng Gao
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Wensong Shangguan
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Guoping Wu
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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Assink N, Oldhoff MGE, Ten Duis K, Kraeima J, Doornberg JN, Witjes MJH, de Vries JPPM, Meesters AML, IJpma FFA. Development of patient-specific osteosynthesis including 3D-printed drilling guides for medial tibial plateau fracture surgery. Eur J Trauma Emerg Surg 2024; 50:11-19. [PMID: 37391531 PMCID: PMC10924019 DOI: 10.1007/s00068-023-02313-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE A substantial proportion of conventional tibial plateau plates have a poor fit, which may result in suboptimal fracture reduction due to applied -uncontrolled- compression on the bone. This study aimed to assess whether patient-specific osteosyntheses could facilitate proper fracture reduction in medial tibial plateau fractures. METHODS In three Thiel embalmed human cadavers, a total of six tibial plateau fractures (three Schatzker 4, and three Schatzker 6) were created and CT scans were made. A 3D surgical plan was created and a patient-specific implant was designed and fabricated for each fracture. Drilling guides that fitted on top of the customized plates were designed and 3D printed in order to assist the surgeon in positioning the plate and steering the screws in the preplanned direction. After surgery, a postoperative CT scan was obtained and outcome was compared with the preoperative planning in terms of articular reduction, plate positioning, and screw direction. RESULTS A total of six patient-specific implants including 41 screws were used to operate six tibial plateau fractures. Three fractures were treated with single plating, and three fractures with dual plating. The median intra-articular gap was reduced from 6.0 (IQR 4.5-9.5) to 0.9 mm (IQR 0.2-1.4), whereas the median step-off was reduced from 4.8 (IQR 4.1-5.3) to 1.3 mm (IQR 0.9-1.5). The median Euclidean distance between the centre of gravity of the planned and actual implant was 3.0 mm (IQR: 2.8-3.7). The lengths of the screws were according to the predetermined plan. None of the screws led to screw penetration. The median difference between the planned and actual screw direction was 3.3° (IQR: 2.5-5.1). CONCLUSION This feasibility study described the development and implementation of a patient-specific workflow for medial tibial plateau fracture surgery that facilitates proper fracture reduction, tibial alignment and accurately placed screws by using custom-made osteosynthesis plates with drilling guides.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Miriam G E Oldhoff
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Joep Kraeima
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Job N Doornberg
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Max J H Witjes
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Anne M L Meesters
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Reiss S, Kulker D, Laure B, Paré A. Reconstruction of the orbitozygomatic framework: State of the art and perspectives. J Stomatol Oral Maxillofac Surg 2024; 125:101788. [PMID: 38281701 DOI: 10.1016/j.jormas.2024.101788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 01/30/2024]
Abstract
The reconstruction of the whole orbitozygomatic framework (OZF) is complex and can be encountered in cases of congenital midface deformity, after tumor ablative surgery and in severe facial trauma. Nowadays, surgeon has a wide range of available techniques that have continually grown over the past years, optimizing the surgical management and the aesthetical outcomes. Among them, the autologous bone graft (ABG) remains one of the most suitable options : ABG is easy to harvest and has optimal biological properties for bone healing. It can be tailored to the patient anatomy thanks to the recent advances in computer-assisted surgery. However, substantial drawbacks remain such as the early resorption of the non-vascularized graft, the need of a donor site and its potential morbidity. Alloplastic reconstruction is another option that can resolve both the resorption issue and the donor site morbidity. Moreover, the 3D-printing technologies also allows the manufacturing of patient specific implants. However, alloplastic materials have a variable success, especially due to the high risk of infection or exposure. Consequently, regenerative medicine is a promising field that aims to find a procedure without the disadvantages of ABG or alloplastic based reconstructions, but displaying similar or even higher success rate. Indeed, recent tissue engineering strategies have demonstrated encouraging results for bone regeneration using natural or synthetic biomaterials, patient cells and synthetic bioactive substances. The objective of this review is to present the etiologies of OZF defect, the available reconstruction procedures as well as the current state of the research.
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Affiliation(s)
- Ségolène Reiss
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France
| | - Dimitri Kulker
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France
| | - Boris Laure
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France
| | - Arnaud Paré
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France.
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6
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Kreutzer K, Lampert P, Doll C, Voss JO, Koerdt S, Heiland M, Steffen C, Rendenbach C. Patient-specific 3D-printed mini-versus reconstruction plates for free flap fixation at the mandible: Retrospective study of clinical outcomes and complication rates. J Craniomaxillofac Surg 2023; 51:621-628. [PMID: 37852889 DOI: 10.1016/j.jcms.2023.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/15/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023] Open
Abstract
This study aimed to compare the clinical outcomes and complication rates of patient-specific 3D-printed mini- and reconstruction plates for free flap fixation in mandibular reconstruction. A retrospective monocentric study was carried out between April 2017 and December 2021 to analyze patients undergoing immediate mandibular reconstruction using fibula free flaps and osteosynthesis using patient-specific 3D-printed implants. Eighty-three patients with a mean age of 63.6 years were included. The mean follow-up period was 18.5 months. Patient-specific 3D-printed plates were designed as reconstruction plates (38 patients), miniplates (21 patients) or a combination of reconstruction- and miniplates (24 patients). With miniplates, plate removal was performed significantly more often via an intraoral approach (p < 0.001) and in an outpatient setting (p = 0.002). Univariate analysis showed a higher fistula rate with reconstruction plates (p = 0.037). Multivariate analysis showed no significant differences in complications. Case-control matching demonstrated significantly lower rates of fistula (p = 0.017) and non-union (p = 0.029) in the combined group. This retrospective study shows a tendency towards reduced complication rates with patient-specific 3D-printed miniplates in comparison to patient-specific 3D-printed reconstruction plates for immediate mandibular reconstruction with fibula free flaps.
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Affiliation(s)
- Kilian Kreutzer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Philipp Lampert
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christian Doll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jan O Voss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany
| | - Steffen Koerdt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Claudius Steffen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Carsten Rendenbach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
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van Kootwijk A, Jonker BP, Wolvius EB, Saldivar MC, Leeflang MA, Zhou J, Tümer N, Mirzaali MJ, Zadpoor AA. Biomechanical evaluation of additively manufactured patient-specific mandibular cage implants designed with a semi-automated workflow: A cadaveric and retrospective case study. J Mech Behav Biomed Mater 2023; 146:106097. [PMID: 37678107 DOI: 10.1016/j.jmbbm.2023.106097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Mandibular reconstruction using patient-specific cage implants is a promising alternative to the vascularized free flap reconstruction for nonirradiated patients with adequate soft tissues, or for patients whose clinical condition is not conducive to microsurgical reconstruction. This study aimed to assess the biomechanical performance of 3D printed patient-specific cage implants designed with a semi-automated workflow in a combined cadaveric and retrospective case series study. METHODS We designed cage implants for two human cadaveric mandibles using our previously developed design workflow. The biomechanical performance of the implants was assessed with the finite element analysis (FEA) and quasi-static biomechanical testing. Digital image correlation (DIC) was used to measure the full-field strains and validate the FE models by comparing the distribution of maximum principal strains within the bone. The retrospective study of a case series involved three patients, each of whom was treated with a cage implant of similar design. The biomechanical performance of these implants was evaluated using the experimentally validated FEA under the scenarios of both mandibular union and nonunion. RESULTS No implant or screw failure was observed prior to contralateral bone fracture during the quasi-static testing of both cadaveric mandibles. The FEA and DIC strain contour plots indicated a strong linear correlation (r = 0.92) and a low standard error (SE=29.32με), with computational models yielding higher strain values by a factor of 2.7. The overall stresses acting on the case series' implants stayed well below the yield strength of additively manufactured (AM) commercially pure titanium, when simulated under highly strenuous chewing conditions. Simulating a full union between the graft and remnant mandible yielded a substantial reduction (72.7±1.5%) in local peak stresses within the implants as compared to a non-bonded graft. CONCLUSIONS This study shows the suitability of the developed semi-automated workflow in designing patient-specific cage implants with satisfactory mechanical functioning under demanding chewing conditions. The proposed workflow can aid clinical engineers in creating reconstruction systems and streamlining pre-surgical planning. Nevertheless, more research is still needed to evaluate the osteogenic potential of bone graft insertions.
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Affiliation(s)
- A van Kootwijk
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - B P Jonker
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - M Cruz Saldivar
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - M A Leeflang
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - J Zhou
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - N Tümer
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands.
| | - M J Mirzaali
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - A A Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
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Franke A, Hofmann EC, Steinberg A, Lauer G, Kitzler H, Leonhardt H. Probing real-world Central European population midfacial skeleton symmetry for maxillofacial surgery. Clin Oral Investig 2023; 27:5637-5647. [PMID: 37535197 PMCID: PMC10492674 DOI: 10.1007/s00784-023-05185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES Symmetry is essential for computer-aided surgical (CAS) procedures in oral and maxillofacial surgery (OMFS). A critical step for successful CAS is mirroring the unaffected side to create a template for the virtual reconstruction of the injured anatomical structure. The aim was to identify specific anatomical landmarks of the midfacial skeleton, to evaluate the symmetry in a group of the real-world Central European population, and to use these landmarks to assess midfacial symmetry in CT scans. MATERIAL AND METHODS The retrospective cross-sectional study defined landmarks of the midface's bony contour using viscerocranial CT data. The distances of the skeletal landmarks (e.g., the frontozygomatic suture and temporozygomatic suture) of the left and right sides from the midline were measured and statistically compared. Midfacial symmetry for reference points was defined as a difference within 0 mm and their mean difference plus one standard deviation. RESULTS We examined a total of 101 CT scans. 75% of our population shows symmetrical proportions of the midface. The means of the differences for the left and right sides ranged from 0.8 to 1.3 mm, averaging 1.1 ± 0.2 mm for all skeletal landmarks. The standard deviations ranged from 0.6 to 1.4 mm, with a computed mean of 0.9 ± 0.3 mm. CONCLUSION We established a methodology to assess the symmetry of the bony midface. If the determined differences were equal to or lower than 2.5 mm in the mentioned midfacial skeletal landmarks, then the symmetry of the bony midface was considered present, and symmetry-based methods for CAS procedures are applicable. CLINICAL RELEVANCE Many CAS procedures require facial symmetry. We provide an easy-to-apply method to probe for symmetry of the midface. The method may be used for population-based research, to check for proper reduction of fractures after reposition or to screen for symmetry prior to CAS planning.
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Affiliation(s)
- Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany.
| | - Elisabeth Claudia Hofmann
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
| | - Anna Steinberg
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
| | - Hagen Kitzler
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
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Manekar VS, Datarkar AN, Ghormode A, Daware S, Pandilwar P, Sapkal P. Comparison of Two Types of Patient Specific Implants (PSI) and Quad Zygoma Implant (QZI) for Rehabilitation of Post-COVID Maxillary Mucormycosis Defect (PCMMD): Finite Element Analysis. J Maxillofac Oral Surg 2023; 22:688-694. [PMID: 37534346 PMCID: PMC10390377 DOI: 10.1007/s12663-023-01950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/29/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction The residual post-COVID maxillary mucormycosis defect (PCMMD) were extensive, due to unilateral or bilateral maxillectomies. The Goal of rehabilitation of PCMMD is to deliver a prosthetically driven reconstruction. FEA was to evaluate the biomechanical response of PSI struts (PSI 1), PSI Screw retained (PSI 2) and QZI to masticatory load on virtual simulation to improve accuracy and enhance the design. Aim To validate and compare the Biomechanical benefit of the PSI struts, PSI Screw retained, QZI in a case of rehabilitation of post-COVID maxillary mucormycosis defect (PCMMD) by FEA study. Methodology The result of stress to masticatory load on virtual simulation for (1) Maximum and minimum stress (Von Mises stress); (2) the Displacement (in three positions) and (3) the Deformation (Plastic strain) was compared on virtual simulation for PSI 1 and PSI 2 and QZI. Conclusion The FEA and comparative evaluation of PSI 1, PSI 2 and QZI showed a good resistance to displacement. The stress and strain values are low and acceptable. In comparison QZI shows more stress in the anterior region.
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Affiliation(s)
- Varsha Sunil Manekar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Abhay N. Datarkar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Ashlesha Ghormode
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Surendra Daware
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Prashant Pandilwar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
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Khallaf RM, Emam AN, Mostafa AA, Nassif MS, Hussein TS. Strength and bioactivity of PEEK composites containing multiwalled carbon nanotubes and bioactive glass. J Mech Behav Biomed Mater 2023; 144:105964. [PMID: 37336042 DOI: 10.1016/j.jmbbm.2023.105964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
Polyetheretherketone (PEEK) polymer is a widely accepted implantable biomaterial in the biomedical field. However, PEEK has a low elastic modulus (E-modulus) as well as a bio-inert nature which is not conductive to rapid bone cell attachment, hence, producing delayed or weak bone-implant integration. Multiwalled carbon nanotubes (MWCNTs) represent one of the strongest known materials that could be added to a polymer to improve its mechanical properties. Bioactive glasses (BGs) can form hydroxyapatite deposits on their surfaces and form a tight bond with the bone, thus, their incorporation into the PEEK matrix may improve its bioactivity. METHODS Eight groups were formulated according to the type and percentage of modification of PEEK by MWCNTs and BGs. Group 1: Pure PEEK (P), Group 2: P + 3% MWCNTs (PC3), Group 3: P + 5% MWCNTs (PC5), Group 4: P + 5% BGs (PG5), Group 5: P + 10% BGs (PG10), Group 6: P + 3% MWCNTs + 5% BGs (PC3G5), Group 7: P + 3% MWCNTs + 10% BGs (PC3G10), and Group 8: P + 5% MWCNTs + 5% BGs (PC5G5). Characterization of the vacuum-pressed PEEK and PEEK composite specimens was done using FE-SEM, EDS, FT-IR and TF-XRD. Three-point load test was done to obtain the flexural strength (F.S) and the E-modulus of the specimens. Wettability was determined by measuring the contact angle with distilled water. In-vitro bioactivity was determined after immersion of specimens in simulated body fluid (SBF). Moreover, the effect of the specimens on osteoblastic cell viability was evaluated. RESULTS Three-point load test results have shown an improvement in both F.S. and E-modulus for groups PC5, PC3G5 and PC5G5. The lowest contact angle was obtained for group PC5G5 followed by the PC3G10 group. All specimens containing BGs showed the formation of hydroxyapatite-like deposits after their immersion in SBF, as well as an improvement in osteoblastic cell viability compared to PEEK. CONCLUSION PC3G10, PC3G5 and PG10, groups are promising for the fabrication of patient-specific implants that can be used in low-stress-bearing areas.
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Affiliation(s)
- Reem Magdy Khallaf
- Ain-Shams University, Department of Dental Biomaterials, 11566, Cairo, Egypt.
| | - Ahmed N Emam
- Refractories, Ceramics & Building Materials, Advanced Materials Technology and Mineral Resources Research Institute, National Research Centre (NRC), 12622, Dokki, Cairo, Egypt; Nanomedicine & Tissue Engineering Research Lab., MRCE, National Research Centre (NRC), 12622, Dokki, Cairo, Egypt
| | - Amany A Mostafa
- Refractories, Ceramics & Building Materials, Advanced Materials Technology and Mineral Resources Research Institute, National Research Centre (NRC), 12622, Dokki, Cairo, Egypt; Nanomedicine & Tissue Engineering Research Lab., MRCE, National Research Centre (NRC), 12622, Dokki, Cairo, Egypt.
| | | | - Tarek Salah Hussein
- Ain-Shams University, Department of Dental Biomaterials, 11566, Cairo, Egypt
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Ebel F, Schön S, Sharma N, Guzman R, Mariani L, Thieringer FM, Soleman J. Clinical and patient-reported outcome after patient-specific 3D printer-assisted cranioplasty. Neurosurg Rev 2023; 46:93. [PMID: 37074490 PMCID: PMC10115682 DOI: 10.1007/s10143-023-02000-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/16/2023] [Accepted: 04/08/2023] [Indexed: 04/20/2023]
Abstract
Various cranioplasty techniques exist for the reconstruction of cranial bone defects. Patient-specific implants can be produced in-house using a recently developed 3D printer-assisted cranioplasty technique. However, the resulting cosmetic outcomes from the patient's perspective are underreported. With our case series, we aim to present the clinical outcome, morbidity rate, patient-reported cosmetic results, and cost-effectiveness of patient-specific3D printer-assisted cranioplasty technique. This is a consecutive retrospective case series of adult patients undergoing cranioplasty using the patient-specific 3D printer-assisted technique. As primary endpoint, the functional outcome based on modified Rankin scale (mRS) at discharge and follow-up was assessed. A prospective telephone survey was conducted to collect and provide patient-reported outcomes. Thirty-one patients underwent patient-specific 3D printer-assisted cranioplasty, mostly to reconstruct frontotemporoparietal (61.3%) and frontotemporal defects with orbital involvement (19.4%). Good functional outcome (mRS ≤ 2) at discharge and during the last follow-up was achieved in 54.8% (n = 17) and 58.1% (n = 18) patients. Overall, the rate of clinically relevant surgery-related complications was 35.5% (n = 11). Postoperative epidural hematoma/collection (16.1%) and infections (12.9%) were the most frequent complications. Permanent morbidity occurred in one patient (3.2%) with postoperative acute ipsilateral vision loss after frontotemporal cranioplasty with orbital involvement. No surgery-related mortality occurred. The mean patient-reported cosmetic satisfaction score was 7.8 ± 1.5, with 80% of patients reporting satisfying or very satisfying cosmetic results. No significant differences were seen between the different defect localization regarding the cosmetic outcome. The mean manufacturing costs of a patient-specific 3D printer-assisted implant ranged from 748 to 1129 USD. Based on our case series, patient-specific 3D printer-assisted cranioplasty is cost-effective and leads to satisfying cosmetic results, especially in large defects and/or defects with complex geometry.
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Affiliation(s)
- Florian Ebel
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
| | - Stephan Schön
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Neha Sharma
- Department of Oral & Cranio-Maxillo-Facial Surgery and 3D Print Lab, University Hospital of Basel, Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM/Smart Implants), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
- Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Florian M Thieringer
- Department of Oral & Cranio-Maxillo-Facial Surgery and 3D Print Lab, University Hospital of Basel, Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM/Smart Implants), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
- Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Nkhwa S, Montshiwa T, de Beer D, Booysen G, van den Heever C, Els J, Heydenrych A, Kebaetse M. Local design and manufacturing of patient-specific implant using Anatomage Medical Design Studio software: proof of concept - Botswana's 1st case report. 3D Print Med 2023; 9:7. [PMID: 36952034 PMCID: PMC10035237 DOI: 10.1186/s41205-023-00170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/17/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Botswana, like most sub-Sahara African nations, uses conventional orthopaedic implants that are sourced from major manufactures in the West. The implants are mass-produced and designed with universal configurations to fit an average patient. During surgery, surgeons thus sometimes bend the implants to match the individual bone anatomy, especially for paediatric patients and those with unique deformities, thus risking implant failure. The purpose of this project was to show the feasibility of developing safe and effective patient-specific orthopaedic implants in a low-resourced market. METHODS CT Scan slice files of a paediatric patient with Ollier's disease were used to reconstruct the lower limb anatomy. The resultant files were 3D printed into prototypes that showed severe right knee valgus deformity. The surgeon used the prototype to plan for corrective femoral osteotomy and the required implant. The implant design and planned surgery were subsequently simulated on the Medical Design Studio software for proper fitting before final implant printing. Surgery was then performed, followed by 12 weeks of physiotherapy. RESULTS Post-surgical x-rays demonstrated good implant positioning and knee joint alignment. At 18 months of post-surgical follow-up, the child was pain-free, could perform full squats, and ambulation was near-normal, without the use of an assistive device. CONCLUSIONS It is feasible to develop effective, patient-specific implants for selected orthopaedic cases in a low-resourced country. This work could improve surgical and rehabilitation outcomes for selected paediatric patients and those with severe bone deformities.
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Affiliation(s)
- Shathani Nkhwa
- Faculty of Medicine, Department of Biomedical Sciences, University of Botswana, Corner of Notwane and Mobuto Road, Pvt Bag, 00713, Gaborone, Botswana
| | - Thapelo Montshiwa
- Sidilega Private Hospital, Orthopaedic Surgery, P.O. Box 70905, Gaborone, Botswana
| | - Deon de Beer
- Free State, Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Private Bag X20539, Bloemfontein, 9300, South Africa
| | - Gerrie Booysen
- Free State, Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Private Bag X20539, Bloemfontein, 9300, South Africa
| | - Cules van den Heever
- Free State, Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Private Bag X20539, Bloemfontein, 9300, South Africa
| | - Johan Els
- Free State, Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Private Bag X20539, Bloemfontein, 9300, South Africa
| | - Andre Heydenrych
- Free State, Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Private Bag X20539, Bloemfontein, 9300, South Africa
| | - Maikutlo Kebaetse
- Faculty of Medicine, Department of Biomedical Sciences, University of Botswana, Corner of Notwane and Mobuto Road, Pvt Bag, 00713, Gaborone, Botswana.
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Arunkumar K, Prasad C, Balaji J, Rohini T, Supraja R. Familial Gigantiform Cementoma: Life-Saving Total Midface Resection and Reconstruction Using Virtual Surgical Planning and 3D Printed Patient-Specific Implant-A Clinical Study. J Maxillofac Oral Surg 2023; 22:145-150. [PMID: 37041944 PMCID: PMC10082875 DOI: 10.1007/s12663-023-01902-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Background Familial gigantiform cementoma (FGC) is a rare benign fibrocemento-osseous lesion of the jaw characterized by well-circumscribed, extensive, mixed radiolucent-radiopaque masses in the mandible and the maxilla that can cause severe facial deformity. This condition is extremely rare with less than 40 cases reported in the literature. Purpose The purpose of the paper is to highlight the importance of virtual surgical planning and patient-specific implant in the treatment of a complex lesion and reconstruction of the facial skeleton. The clinical presentations, and diagnostic challenges encountered when managing the lesion have been discussed in this article with emphasis on the treatment plan. Method/Surgical plan The sequence of treatment planned was resection of the lesion and immediate reconstruction with a patient-specific implant to improve the patient's quality of life. The management of FGC was a challenging one keeping in mind the rapid expansion of the lesion, widespread involvement of the jaws, and needs of the pediatric patient. Conclusion Virtual surgical planning (VSP) along with 3D printed implant was instrumental in reconstructing the facial form of the child where the maxilla was completely resected and rehabilitation provided support to the vital structures of the face.
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Affiliation(s)
- K. Arunkumar
- Department Of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai-3, India
| | - C. Prasad
- Department Of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai-3, India
| | - J. Balaji
- Department Of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai-3, India
| | - T. Rohini
- Department Of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai-3, India
| | - R. Supraja
- Department Of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai-3, India
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Chowdhury SKR, Padha K, Kumar R, Santra S. Scope of PSI in Maxillofacial Region: Our Experience. J Maxillofac Oral Surg 2023; 22:124-132. [PMID: 37041951 PMCID: PMC10082877 DOI: 10.1007/s12663-022-01832-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Patient-specific implants aided by 3D virtual planning and CAD-CAM technology represents the next frontier in rehabilitation of complex maxillofacial defects slowly replacing the gold standard autografts as the preferred mode of reconstruction. Methods In a first of its kind case series, we describe eight cases of complex maxillofacial defects managed by patient-specific implants at AFDC, New Delhi. All the designs went through stringent FEA analysis and GOM analysis to standardize the implant for achieving optimal functionality. We also added integrated dental implant component in the PSI to achieve immediate postoperative dental rehabilitation. Conclusion This case series adds to literature the varying scenarios in which PSI's can be used in the maxillofacial region with functional dental rehabilitation thus paving a way for a new era in reconstruction.
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Affiliation(s)
| | - Karan Padha
- Oral and Maxillofacial Surgery, AFDC, KG Marg, New Delhi, 110001 India
| | - Rahul Kumar
- Oral and Maxillofacial Surgery, MDC Delhi Cantt, New Delhi, India
| | - Soumyajit Santra
- Oral and Maxillofacial Surgery, MDC Delhi Cantt, New Delhi, India
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Matschke J, Franke A, Franke O, Bräuer C, Leonhardt H. Methodology: workflow for virtual reposition of mandibular condyle fractures. Maxillofac Plast Reconstr Surg 2023; 45:5. [PMID: 36662288 PMCID: PMC9859969 DOI: 10.1186/s40902-023-00373-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Even though mandibular condyle fractures have a high clinical relevance, their treatment remains somewhat challenging. Open reduction and internal fixation are difficult due to narrow surgical approaches, poor overview during reduction, and a possible risk of facial nerve damage. In times of technical endeavors in surgery, there is a trend towards the usage of stable CAD-CAM-implants from additive manufacturing or titanium laser sintering. Up until now, there have not been any reports of fracture treatment of the mandibular condyle using this technique. RESULTS AND CONCLUSION We present a workflow for virtual repositioning of the fractured mandibular condyle, to manufacture patient-specific implants for osteosynthesis with the intention of use of resorbable metal alloys in the future.
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Affiliation(s)
- Jan Matschke
- grid.412282.f0000 0001 1091 2917Department of Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus” Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Adrian Franke
- grid.412282.f0000 0001 1091 2917Department of Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus” Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Olufunmi Franke
- grid.412282.f0000 0001 1091 2917Department of Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus” Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Christian Bräuer
- grid.412282.f0000 0001 1091 2917Department of Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus” Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Henry Leonhardt
- grid.412282.f0000 0001 1091 2917Department of Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus” Dresden, Fetscherstr. 74, 01307 Dresden, Germany
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Anish Poorna T, Antony PG, Lokesh JR, Joshna EK, John B. Post-traumatic Actinomycotic Oro-antral Fistula Closure with Three-dimensional Stereolithographic Modeling and Patient-Specific Titanium Implant. Indian J Otolaryngol Head Neck Surg 2022; 74:6251-6254. [PMID: 36742939 PMCID: PMC9895694 DOI: 10.1007/s12070-021-02994-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023] Open
Abstract
We report an interesting case of a post-traumatic actinomycotic oro-antral fistula of the left posterior maxilla, that was not salvageable via local flaps due to the size of the defect and was managed with the patient-specific titanium implant, fabricated by three-dimensional stereolithographic model planning followed by primary closure.
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Affiliation(s)
- T. Anish Poorna
- Government Medical College, Kottayam, Kerala India
- Government Dental College, Kottayam, Kerala India
| | - P. G. Antony
- Government Medical College, Kottayam, Kerala India
| | - J. R. Lokesh
- Government Medical College, Kottayam, Kerala India
| | - E. K. Joshna
- Government Medical College, Kottayam, Kerala India
| | - Bobby John
- Government Medical College, Kottayam, Kerala India
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Thimukonda Jegadeesan J, Baldia M, Basu B. Next-generation personalized cranioplasty treatment. Acta Biomater 2022; 154:63-82. [PMID: 36272686 DOI: 10.1016/j.actbio.2022.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
Decompressive craniectomy (DC) is a surgical procedure, that is followed by cranioplasty surgery. DC is usually performed to treat patients with traumatic brain injury, intracranial hemorrhage, cerebral infarction, brain edema, skull fractures, etc. In many published clinical case studies and systematic reviews, cranioplasty surgery is reported to restore cranial symmetry with good cosmetic outcomes and neurophysiologically relevant functional outcomes in hundreds of patients. In this review article, we present a number of key issues related to the manufacturing of patient-specific implants, clinical complications, cosmetic outcomes, and newer alternative therapies. While discussing alternative therapeutic treatments for cranioplasty, biomolecules and cellular-based approaches have been emphasized. The current clinical practices in the restoration of cranial defects involve 3D printing to produce patient-specific prefabricated cranial implants, that provide better cosmetic outcomes. Regardless of the advancements in image processing and 3D printing, the complete clinical procedure is time-consuming and requires significant costs. To reduce manual intervention and to address unmet clinical demands, it has been highlighted that automated implant fabrication by data-driven methods can accelerate the design and manufacturing of patient-specific cranial implants. The data-driven approaches, encompassing artificial intelligence (machine learning/deep learning) and E-platforms, such as publicly accessible clinical databases will lead to the development of the next generation of patient-specific cranial implants, which can provide predictable clinical outcomes. STATEMENT OF SIGNIFICANCE: Cranioplasty is performed to reconstruct cranial defects of patients who have undergone decompressive craniectomy. Cranioplasty surgery improves the aesthetic and functional outcomes of those patients. To meet the clinical demands of cranioplasty surgery, accelerated designing and manufacturing of 3D cranial implants are required. This review provides an overview of biomaterial implants and bone flap manufacturing methods for cranioplasty surgery. In addition, tissue engineering and regenerative medicine-based approaches to reduce clinical complications are also highlighted. The potential use of data-driven computer applications and data-driven artificial intelligence-based approaches are emphasized to accelerate the clinical protocols of cranioplasty treatment with less manual intervention and shorter intraoperative time.
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Affiliation(s)
| | - Manish Baldia
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharashtra 400026, India
| | - Bikramjit Basu
- Materials Research Centre, Indian Institute of Science, CV Raman Road, Bangalore, Karnataka 560012, India; Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, Karnataka 560012, India.
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Via GG, Brueggeman DA, Lyons JG, Ely IC, Froehle AW, Krishnamurthy AB. Funding has no effect on clinical outcomes of total joint arthroplasty emerging technologies: a systematic review of bibliometrics and conflicts of interest. Arthroplasty 2022; 4:45. [PMID: 36316729 PMCID: PMC9623935 DOI: 10.1186/s42836-022-00146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/14/2022] [Indexed: 11/06/2022]
Abstract
Background The use of new total joint arthroplasty technologies, including patient-specific implants/instrumentation (PSI), computer-assisted (CA), and robotic-assisted (RA) techniques, is increasing. There is an ongoing debate regarding the value provided and potential concerns about conflicts of interest (COI). Methods PRISMA guidelines were followed. PubMed, MEDLINE, and Web of Science databases were searched for total hip and knee arthroplasties, unicompartmental knee arthroplasties (UKA), PSI, CA, and RA. Bibliometric data, financial COI, clinical/functional scores, and patient-reported outcomes were assessed. Results Eighty-seven studies were evaluated, with 35 (40.2%) including at least one author reporting COI, and 13 (14.9%) disclosing industry funding. COI and industry funding had no significant effects on outcomes (P = 0.682, P = 0.447), and there were no significant effects of conflicts or funding on level of evidence (P = 0.508, P = 0.826). Studies in which author(s) disclosed COI had significantly higher relative citation ratio (RCR) and impact factor (IF) than those without (P < 0.001, P = 0.032). Subanalysis demonstrated RA and PSI studies were more likely to report COI or industry funding (P = 0.045). RA (OR = 6.31, 95% CI: 1.61–24.68) and UKA (OR = 9.14, 95% CI: 1.43–58.53) had higher odds of reporting favorable outcomes than PSI. Conclusions Author COIs (about 40%) may be lower than previously reported in orthopedic technologies/techniques reviews. Studies utilizing RA and PSI were more likely to report COI, while RA and UKA studies were more likely to report favorable outcomes than PSI. No statistically significant association between the presence of COIs and/or industry funding and the frequency of favorable outcomes or study level of evidence was found. Level of evidence Level V Systematic Review Supplementary Information The online version contains supplementary material available at 10.1186/s42836-022-00146-3.
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Affiliation(s)
- Garrhett G. Via
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - David A. Brueggeman
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Joseph G. Lyons
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Isabelle C. Ely
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Andrew W. Froehle
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Anil B. Krishnamurthy
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
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Zhong S, Shi Q, Van Dessel J, Gu Y, Sun Y, Yang S. Biomechanical validation of structural optimized patient-specific mandibular reconstruction plate orienting additive manufacturing. Comput Methods Programs Biomed 2022; 224:107023. [PMID: 35872386 DOI: 10.1016/j.cmpb.2022.107023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Owing to the unexpected in vivo fracture failure of the original design, structural optimized patient-specific mandibular reconstruction plates (PSMRPs) were created to boost the biomechanical performance of bridging segmental bony defect in the mandibular reconstruction after tumor resection. This work aimed to validate the biomechanical benefit of the structural optimized PSMRPs relative to the original design and compare the biomechanical performance between PSMRP1 with generic contour customization and PSMRP2 with a tangent arc upper margin in mandibular angle region. METHODS Finite Element Analysis (FEA) was used to evaluate the biomechanical behavior of mandibular reconstruction assemblies (MRAs) concerning these two structural optimized PSMRPs by simulating momentary left group clenching and incisal clenching tasks. Bonded contact was set between mandibular bone and fixation screws and between PSMRP and fixation screws in the MRA, while the frictionless connection was allocated between mandibular bone and PSMRP. The loads were applied on four principal muscles, including masseter, temporalis, lateral and medial pterygoid, whose magnitudes along the three orthogonal directions. The mandibular condyles were retrained in all three directions, and either the left molars or incisors area were restrained from moving vertically. RESULTS The peak von Mises stresses of structural optimized PSMRPs (264 MPa, 296 MPa) were way lower than that of the initial PSMRP design (393 MPa), with 33 and 25% reduction during left group clenching. The peak magnitude of von Mises stress, minimum principal stress, and maximum principal strain of PSMRP1 (264 MPa, 254 MPa; -297 MPa, -285 MPa; 0.0020, 0.0020) was lower than that of PSMRP2 (296 MPa, 286 MPa; -319 MPa, -306 MPa; 0.0022, 0.0020), while the peak maximum principal stress of PSMRP1 (275 MPa, 257 MPa) was higher than that of PSMRP2 (254 MPa, 235 MPa) during both left group clenching and incisal clenching tasks. CONCLUSIONS The structural optimized PSMRPs reveal their biomechanical advantage compared with the original design. The PSMRP1 presents better biomechanical performance to the patient-specific mandibular reconstruction than PSMRP2 as a result of its superior safety, preferable flexibility, and comparable stability. The PSMRP2 provides biomechanical benefit in reducing the maximum tension than PSMRP1, indicated by lower peak maximum principal stress, through tangent arc upper margin in mandibular angle region.
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Affiliation(s)
- Shengping Zhong
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium
| | - Qimin Shi
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium
| | - Jeroen Van Dessel
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium
| | - Yifei Gu
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium
| | - Yi Sun
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium.
| | - Shoufeng Yang
- Faculty of Engineering and Physical Sciences, Highfield, University of Southampton, Southampton SO17 1BJ, United Kingdom.
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van Kootwijk A, Moosabeiki V, Saldivar MC, Pahlavani H, Leeflang MA, Kazemivand Niar S, Pellikaan P, Jonker BP, Ahmadi SM, Wolvius EB, Tümer N, Mirzaali MJ, Zhou J, Zadpoor AA. Semi-automated digital workflow to design and evaluate patient-specific mandibular reconstruction implants. J Mech Behav Biomed Mater 2022; 132:105291. [PMID: 35660552 DOI: 10.1016/j.jmbbm.2022.105291] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 12/31/2022]
Abstract
The reconstruction of large mandibular defects with optimal aesthetic and functional outcomes remains a major challenge for maxillofacial surgeons. The aim of this study was to design patient-specific mandibular reconstruction implants through a semi-automated digital workflow and to assess the effects of topology optimization on the biomechanical performance of the designed implants. By using the proposed workflow, a fully porous implant (LA-implant) and a topology-optimized implant (TO-implant) both made of Ti-6Al-4V ELI were designed and additively manufactured using selective laser melting. The mechanical performance of the implants was predicted by performing finite element analysis (FEA) and was experimentally assessed by conducting quasi-static and cyclic biomechanical tests. Digital image correlation (DIC) was used to validate the FE model by comparing the principal strains predicted by the FEM model with the measured distribution of the same type of strain. The numerical predictions were in good agreement with the DIC measurements and the predicted locations of specimen failure matched the actual ones. No statistically significant differences (p < 0.05) in the mean stiffness, mean ultimate load, or mean ultimate displacement were detected between the LA- and TO-implant groups. No implant failures were observed during quasi-static or cyclic testing under masticatory loads that were substantially higher (>1000 N) than the average maximum biting force of healthy individuals. Given its relatively lower weight (16.5%), higher porosity (17.4%), and much shorter design time (633.3%), the LA-implant is preferred for clinical application. This study clearly demonstrates the capability of the proposed workflow to develop patient-specific implants with high precision and superior mechanical performance, which will greatly facilitate cost- and time-effective pre-surgical planning and is expected to improve the surgical outcome.
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Affiliation(s)
- A van Kootwijk
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - V Moosabeiki
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands.
| | - M Cruz Saldivar
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - H Pahlavani
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - M A Leeflang
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - S Kazemivand Niar
- Department of Mechanical Engineering, Tarbiat Modares University, Tehran, Iran
| | - P Pellikaan
- Amber Implants BV, Prinses Margrietplantsoen 33, 2595 AM, The Hague, the Netherlands
| | - B P Jonker
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - S M Ahmadi
- Amber Implants BV, Prinses Margrietplantsoen 33, 2595 AM, The Hague, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - N Tümer
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - M J Mirzaali
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - J Zhou
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - A A Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
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Salli MI, Nikunen M, Snäll J. Primary reconstruction of extensive orbital fractures using two-piece patient-specific implants: the Helsinki protocol. Oral Maxillofac Surg 2022:10.1007/s10006-022-01065-y. [PMID: 35585440 DOI: 10.1007/s10006-022-01065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE We present our experience of titanium-milled two-piece patient-specific implants (PSIs) for primary reconstructions of extensive orbital floor and medial wall fractures (EOFMFs) and evaluate their postoperative functional and aesthetic outcomes in relation to commercially available implants. METHODS We included all patients with primary reconstructions (< 22 days from injury) of EOFMFs treated in our department between January 2011 and October 2020. Extensive orbital floor and medial wall fracture was defined as involvement of orbital floor, medial wall and maxilloethmoidal junction; a fracture defect 5 mm or more; defect size more than a third of both inferior and medial walls; and Jaquiéry classification III or more. Patient characteristics, details of fracture defects and surgeries, postoperative outcomes and implant positions were retrospectively evaluated and compared between study groups. RESULTS Nineteen patients were included: 5 with two-piece PSIs and 14 with commercial implants. Implant position was good in 4/5 patients with two-piece PSIs and 2/14 with commercial implants. Revision surgery, globe malposition (GMP) > 2 mm, significant diplopia and poor implant position were more frequent in patients with commercial implants than two-piece PSIs. None of the patients with a good overall implant position had any significant postoperative symptoms. CONCLUSION Extensive orbital fracture reconstructions are somewhat rare, and surgical treatment is associated with a high rate of complications and postoperative symptoms. Titanium-milled two-piece PSIs are well suited for primary reconstructions of EOFMFs, as they lead to more precise reconstructions and fewer postoperative symptoms than commercially available implants.
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Affiliation(s)
- Malla I Salli
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland.
| | - Matti Nikunen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland
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Le JM, Gigliotti J, Ying Y, Kase MT, Morlandt AB. Computer-Assisted Microvascular Free Flap Reconstruction and Implant Rehabilitation of the Maxilla-Treatment of a Rare Post-orthognathic Complication. J Maxillofac Oral Surg 2022; 21:82-87. [PMID: 35400916 PMCID: PMC8934816 DOI: 10.1007/s12663-020-01492-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022] Open
Abstract
Orthognathic surgery is generally a safe and predictable procedure. Major postoperative complications are rare and often non-life threatening. An example of a rare complication associated with the LeFort I osteotomy is avascular necrosis of the maxilla (ANM). While cases of ANM have been described in the literature, the majority involves only a portion or segment of the maxillary complex and is commonly treated with conservative measures such as strict oral hygiene, hyperbaric oxygen therapy and local debridement. Occasionally, larger segments of osteonecrosis may require extensive reconstruction such as bone grafting with local soft tissue flaps. Here, we present a patient that underwent a single-stage microvascular free tissue reconstruction with concomitant placement of dental implants and a patient-specific implant (PSI) for post-orthognathic ANM.
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Affiliation(s)
- John M. Le
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Jordan Gigliotti
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Yedeh Ying
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Michael T. Kase
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Anthony B. Morlandt
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
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Lin CL, Wang YT, Chang CM, Wu CH, Tsai WH. Design Criteria for Patient-specific Mandibular Continuity Defect Reconstructed Implant with Lightweight Structure using Weighted Topology Optimization and Validated with Biomechanical Fatigue Testing. Int J Bioprint 2022; 8:437. [PMID: 35187275 PMCID: PMC8852200 DOI: 10.18063/ijb.v8i1.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
This study developed design criterion for patient-specific reconstructed implants with appearance consideration and structural optimization of various mandibular continuity defects. The different mandible continuity defects include C (from left to right canines), B (from 1st premolar to 3rd molar), and A (from 3rd molar to ramus) segments defined based on the mandible image. The finite element (FE) analysis and weighted topology optimization methods were combined to design internal support beam structures within different reconstructed implants with corresponding occlusal conditions. Five continuity mandibular defects (single B/C/A+B and combination of B+C and B+C+B segments) were restored using additive manufacturing (AM) reconstructed implant and bone plate to confirm reasonable design criterion through biomechanical fatigue testing. The worst mandible strength was filtered based on the material mechanics and results from segmental bone length, thickness, and height statistics from the established database containing mandible images of 105 patients. The weighted optimization analysis results indicated that the sizes and positions of internal supporting beams within the reconstructed C, B, and A+B implants can be defined parametrically through corresponding segmental bone length, width, and height. The FE analysis found that the weight variation percentage between the parametric designed implants and original core solid implants in the C, B, and A+B was reduced by 54.3%, 63.7%, and 69.7%, respectively. The maximum stress values of the reconstructed implant and the remaining bone were not obviously reduced but the stress values were far lower than the material ultimate strength. The biomechanical fatigue testing indicated that all cases using the AM reconstructed implant could pass the 250,000 dynamic load. However, condyle head, bone plate fracture, and bone screw loosening could be found in cases using bone plates. This study developed a design criterion for patient-specific reconstructed implants for various mandibular continuity defects applicable for AM to further clinical use.
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Affiliation(s)
- Chun-Li Lin
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Tzu Wang
- Department of Mechanical and Electro-Mechanical Engineering, TamKang University, New Taipei City, Taiwan
| | - Chun-Ming Chang
- National Applied Research Laboratories, Instrument Technology Research Center, Hsinchu, Taiwan
| | - Cheng-Hsien Wu
- Department of Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, School of Dentistry, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Wei-Heng Tsai
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Cherny AA, Kovalenko AN, Kulyaba TA, Kornilov NN. A prospective study on outcome of patient-specific cones in revision knee arthroplasty. Arch Orthop Trauma Surg 2021; 141:2277-86. [PMID: 34264382 DOI: 10.1007/s00402-021-04047-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/01/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cones are known to be good substitutes for metaphyseal and diaphyseal bone loss during revision total knee arthroplasty (RTKA). Often the off-the-shelf cones do not fit to the individual patient's anatomy. New 3D-printing additive technologies allow to develop patient-specific cones. The aim of this prospective study was to describe their outcome. METHODS From 2017 until 2020, 35 patient-specific titanium cones (15 femoral and 20 tibial) were implanted during 31 RTKAs (45% varus-valgus constrained implants and 55% rotating hinges). Clinical outcome was evaluated using KSS, WOMAC and FJS-12 scoring systems at 12 and 24 months. No patients were lost for follow-up. RESULTS In all cases, there were no technical difficulties in adapting the cones to both the host bone and the revision implant. By the time of performing data analysis (January 2021), none of the 31 patients needed revision surgery for any reason. At 12 months of follow-up, the mean values of scores for knee function improved significantly from baseline (p < 0.01): KSS-103.00 (min 100-max 111, SD 5.35), WOMAC-16.5 (min 9-max 24, SD 6.45), FJS-12-61.60 (min 52-max 76, SD 9.20). At 24 months, the trend towards improvement of functional results continued but did not reached statistical significance comparing to 12 months: KSS was 105.92 (min 95-max 155, SD 16.18), WOMAC-14.07 (min 0-max 42, SD 12.42), FJS-12-83.78 (min 65-max 97, SD 09.64). Radiographic signs of osteointegration were detected within the first 6 month after surgery in all cases. Loosening of femoral or tibial components as well as peri-prosthetic infection was not observed in any of the patients during the follow-up. CONCLUSION The original additive technology for designing and producing patient-specific metaphyseal and diaphyseal cones with different porosity zones for extensive femoral and tibial bone defects in RTKA is precise and clinically effective solution, at least in the short term. It could be a valid alternative to "off-the-shelf" cones or sleeves as well as structural allografts and even mega-prosthesis, but a longer follow-up period is required to assess its medium- and long-term reliability.
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Pachisia SK, Ganguli A, Sahu S, Maity C, Ghosh A, Sen S. Patient-Specific Implants (PSI) in Maxillary Hypoplasia Secondary to Cleft Lip and Palate Deformity. J Maxillofac Oral Surg 2021; 20:581-585. [PMID: 34776688 DOI: 10.1007/s12663-020-01443-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022] Open
Abstract
Maxillary hypoplasia is often evident in cleft patients due to impaired growth and dense scarring from previous cleft surgeries. For these patients, treatment scenario has taken many turns over ages, evolved from orthognathic correction to distraction osteogenesis, with mixed prognosis and outcome depending on severity of the case and other several factors. We are reporting a case of 24-year-old female with maxillary hypoplasia secondary to bilateral cleft lip and palate with hypoplastic prolabium, who has been treated with two patient-specific implants in bilateral maxillary region for facial profile enhancement.
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Affiliation(s)
- Sandeep Kr Pachisia
- Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, Haldia, WB India
| | | | - Sudipta Sahu
- Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, Haldia, WB India
| | - Chirantan Maity
- Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, Haldia, WB India
| | - Adhiraj Ghosh
- Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, Haldia, WB India
| | - Saikat Sen
- Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, Haldia, WB India
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Zhong S, Shi Q, Sun Y, Yang S, Van Dessel J, Gu Y, Chen X, Lübbers HT, Politis C. Biomechanical comparison of locking and non-locking patient-specific mandibular reconstruction plate using finite element analysis. J Mech Behav Biomed Mater 2021; 124:104849. [PMID: 34563812 DOI: 10.1016/j.jmbbm.2021.104849] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 01/01/2023]
Abstract
Patient-specific mandibular reconstruction plate (PSMRP), as one of the patient-specific implants (PSIs), offers a host of benefits to mandibular reconstruction. Due to the limitation of fabricating screw hole threads in the PSMRP, 3D printed PSMRP is applied to the non-locking system directly in the mandibular reconstruction with bone graft regardless of the locking system. Since the conventional manual-bending reconstruction plate (CMBRP) provides better fixation in the locking system, it needs to be validated whether the locking PSMRP performs better than the non-locking PSMRP in the patient-specific mandibular reconstruction. Thereupon, the purpose of this study was to compare the biomechanical behavior between the locking and non-locking PSMRP. Finite element analysis (FEA) was used to conduct the biomechanical comparison between the locking PSMRP and non-locking PSMRP by simulating the momentary incisal clenching through static structural analysis. Mandible was reconstructed through the virtual surgical planning, and subsequently a 3D model of mandibular reconstruction assembly, including reconstructed mandible, PSMRP, and fixation screws, was generated and meshed for the following FEA simulations. In the form of equivalent von Mises stress, equivalent elastic strain, and total deformation, the locking PSMRP demonstrated its higher strengths of preferable safety, desirable flexibility, and anticipated stability compared with the non-locking PSMRP, indicated by much lower maximum stress, lower maximum strain and equivalent displacement. Locking PSMRP/screw system provides a better fixation effect to the patient-specific mandibular reconstruction than the non-locking one as a result of its productive fixation nature. FEA plays a paramount role in pre-validating the design of PSMRP through the biomechanical behavior evaluation in static structural analysis.
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Affiliation(s)
- Shengping Zhong
- Department of Biomedical Sciences, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Qimin Shi
- Department of Biomedical Sciences, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Yi Sun
- Department of Biomedical Sciences, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Shoufeng Yang
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom.
| | - Jeroen Van Dessel
- Department of Biomedical Sciences, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Yifei Gu
- Department of Biomedical Sciences, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Heinz-Theo Lübbers
- Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Frauenklinikstrasse 24, Zurich CH, 8091, Switzerland; Surgical Planning Laboratory, Harvard Medical School, Brigham and Women's Hospital, Francis Street 75, Boston, MA, 02115, USA
| | - Constantinus Politis
- Department of Biomedical Sciences, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
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Gonzalez LV, Arango A, López JP, Gnecco JP. Technological Integration of Virtual Surgical Planning, Surgical Navigation, Endoscopic Support and Patient-Specific Implant in Orbital Trauma. J Maxillofac Oral Surg 2021; 20:459-63. [PMID: 34408374 DOI: 10.1007/s12663-020-01423-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022] Open
Abstract
Currently, we have different technologies and techniques that improve the results in orbital trauma. However, there are few studies that study the technological integration in orbital trauma and the synergism of all the techniques. For this reason, the objective of this case is to illustrate the management of orbital trauma by integrating endoscopic support, virtual surgical navigation, patient-specific implant, virtual surgical planning in the management of a sequel due to insufficient reconstruction of orbital volume.
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Amin T, Lin H, Parr WCH, Lim P, Mobbs RJ. Revision of a Failed C5-7 Corpectomy Complicated by Esophageal Fistula Using a 3-Dimensional-Printed Zero-Profile Patient-Specific Implant: A Technical Case Report. World Neurosurg 2021; 151:29-38. [PMID: 33862295 DOI: 10.1016/j.wneu.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Esophageal fistulae are rare, though serious, complications of anterior cervical surgery. Hardware-related issues are important etiologic factors. Patient-specific implants (PSIs) have increasingly been adapted to spinal surgery and offer a range of benefits. Zero-profile implants are a recent development primarily aimed at combating postoperative dysphagia. We report the first use of a 3-dimensional (3D)-printed zero-profile PSI in managing implant failure with migration and a secondary esophageal fistula. METHODS A 68-year-old female had a prior C5-7 corpectomy with cage and plate fixation, as well as posterior C3-T1 lateral mass fixation, complicated by anterior plate displacement, resulting in pseudoarthrosis and an esophageal fistula. A 3D-printed zero-profile PSI was designed and implanted as part of a revision procedure to assist in recovery, prevent recurrence, and facilitate bony fusion. RESULTS Optimal implant placement was achieved on the basis of preoperative virtual surgical planning. By 1 month postoperatively the patient had significantly improved, with evidence of esophageal fistula resolution and radiographic evidence of optimal implant placement. CONCLUSIONS Zero-profile 3D-printed PSIs may combat common and serious complications of anterior cervical surgery including postoperative dysphagia and esophageal fistulae. Further research is required to validate their widespread use for either cervical corpectomy or diskectomy and interbody fusion.
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Affiliation(s)
- Tajrian Amin
- NeuroSpine Surgery Research Group, Sydney, Australia; Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Henry Lin
- NeuroSpine Surgery Research Group, Sydney, Australia; Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - William C H Parr
- NeuroSpine Surgery Research Group, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia; 3DMorphic Pty. Ltd., Matraville, NSW, Australia
| | - Patrick Lim
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group, Sydney, Australia; Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia.
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Huys SEF, Van Gysel A, Mommaerts MY, Sloten JV. Evaluation of Patient-Specific Cranial Implant Design Using Finite Element Analysis. World Neurosurg 2021; 148:198-204. [PMID: 33529765 DOI: 10.1016/j.wneu.2021.01.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Various studies have investigated the load-bearing capacity of patient-specific cranial implants. However, little attention has been given to the evaluation of the design of ceramic-titanium (CeTi) implants. METHODS A biomechanical evaluation of 3 patient-specific cranial implants was performed using finite element analysis. RESULTS The results of the analyses allowed the identification of the implant regions as well as the magnitudes of the maximum stresses on, and displacements along, these regions after traumatic impact. The analyses also showed that polyether ether ketone cranial implants offer inferior brain and neurocranial protection due to their high flexibility and local peak stresses at the bone-screw interface. In contrast, CeTi implants were able to evenly distribute the stresses along the interface and thus reduced the risk of neurocranial fracture. The scaffold structure at the border of these implants reduced stress shielding and enhanced bone ingrowth. Moreover, brain injuries were less likely to occur, as the CeTi implant exhibits limited deflection. CONCLUSIONS From the finite element analyses, CeTi cranial implants appear less likely to induce calvarial fractures with a better potential to protect the brain under impact loads.
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Affiliation(s)
- Stijn E F Huys
- Engineering Science, Department of Mechanical Engineering, Section of Biomechanics, Catholic University of Leuven, Leuven, Belgium
| | - Anke Van Gysel
- Engineering Science, Department of Mechanical Engineering, Section of Biomechanics, Catholic University of Leuven, Leuven, Belgium
| | - Maurice Y Mommaerts
- 3D Innovations Laboratory, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Jos Vander Sloten
- Engineering Science, Department of Mechanical Engineering, Section of Biomechanics, Catholic University of Leuven, Leuven, Belgium
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Holmes S. Primary Orbital Fracture Repair. Atlas Oral Maxillofac Surg Clin North Am 2021; 29:51-77. [PMID: 33516540 DOI: 10.1016/j.cxom.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Simon Holmes
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London, UK.
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Essig H, Wagner MEH, Blumer M. Secondary Corrections of the Orbit: Solitary Fractures. Atlas Oral Maxillofac Surg Clin North Am 2020; 29:129-137. [PMID: 33516534 DOI: 10.1016/j.cxom.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Harald Essig
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, UniversitätsSpital Zürich, Frauenklinikstrasse 24, Zürich 8091, Switzerland.
| | | | - Michael Blumer
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, UniversitätsSpital Zürich, Frauenklinikstrasse 24, Zürich 8091, Switzerland
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Koper DC, Leung CAW, Smeets LCP, Laeven PFJ, Tuijthof GJM, Kessler PAWH. Topology optimization of a mandibular reconstruction plate and biomechanical validation. J Mech Behav Biomed Mater 2020; 113:104157. [PMID: 33187871 DOI: 10.1016/j.jmbbm.2020.104157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/18/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Reconstruction plates, used to bridge segmental defects of the mandible after tumor resection or traumatic bone tissue loss, are subjected to repeated stresses of mastication. High stress concentrations in these plates can result in hardware failure. Topology optimization (TO) could reduce the peak stress by computing the most optimal material distribution in a patient-specific implant (PSI) used for mandibular reconstruction. The objective of this study was biomechanical validation of a TO-PSI. METHODS A computer-aided design (CAD) model with a segmental defect was created based on the geometry of a polyurethane mandible model. A standard-PSI was designed to bridge the defect. A TO-PSI was then designed with a maximum stress equal to the ultimate tensile stress of Ti6Al4V (930 MPa) during a loading condition of 378 N. Finite element analysis (FEA) was used to analyze stresses in both PSI designs during loading. The standard-PSI and TO-PSI designs were produced in triplicate by selective laser melting of Ti6Al4V, fixated to polyurethane mandible models with segmental defects identical to the CAD model, and subsequently subjected to continuous compression with a speed of 1 mm/min on a universal testing machine, while recording the load. Peak loads before failure in the TO-PSI group within a 30% range of the predicted peak load (378 N) were considered a successful biomechanical validation. RESULTS Fracture of the TO-PSI occurred at a median peak load of 334 N (range 304-336 N). These values are within the 30% range of the predicted peak load. Fracture of the mandible model in the standard-PSI group occurred at a median peak load of 1100 N (range 1010-1460 N). Failure locations during biomechanical testing of TO-PSI and standard-PSI samples corresponded to regions in the FEA where stresses exceeded the ultimate tensile strength of titanium and polyurethane, respectively. CONCLUSION This study demonstrates a successful preliminary biomechanical validation of TO in the design process for mandibular reconstruction plates. Further work is needed to refine the finite element model, which is necessary to ultimately design TO-PSIs for clinical use.
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Affiliation(s)
- David C Koper
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands; Department of Instructive Biomaterials Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Carine A W Leung
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - Lars C P Smeets
- Department of Instrument Design, Engineering and Evaluation, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Paul F J Laeven
- Department of Instrument Design, Engineering and Evaluation, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Gabriëlle J M Tuijthof
- Department of Instrument Design, Engineering and Evaluation, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Peter A W H Kessler
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
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Affiliation(s)
- Brian B Farrell
- Carolinas Center for Oral and Facial Surgery, 411 Billingsley Road, Suite 105, Charlotte, NC 28211, USA; Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
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De Cuyper B, Pottel L, Würsching T, Abeloos J, De Ceulaer J, Neyt N, Lamoral P, Swennen G. Presentation and short-term evaluation of an all-in-one patient-specific implant for cranial reconstruction: A randomized controlled trial. Int J Oral Maxillofac Surg 2020; 49:1551-1558. [PMID: 32507404 DOI: 10.1016/j.ijom.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/10/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
Cranial reconstruction after bone graft harvesting remains a challenge. A patient-specific implant (PSI) to guide harvesting and reconstruction was evaluated and compared with the use of a free-hand procedure with calcium phosphate cement (C). Patients were randomized to either the PSI or C group. The outcome was measured clinically and radiographically as the primary endpoint. Secondary endpoints were ease of application, patient and surgeon satisfaction, and the complication rate. Twenty patients were randomized to the PSI (n=10) and C (n=10) groups. Two PSI patients were switched to the cement group due to a poor fit of the PSI. There was a non-significant trend towards more successful outcomes in the PSI group. Two PSI patients presented palpable screws, and one cement patient had a palpable dimple. Cone beam computed tomography showed a significantly lower median volume discrepancy in the PSI group (P<0.0001). The total surgical manipulation time was significantly higher in the PSI group. At 10 days postoperative, three PSI and two C patients presented with minor postoperative complications. There was no significant difference in patient or surgeon satisfaction. PSIs are a reliable alternative to cement. This PSI is novel as it also serves as a guide for harvesting the bone blocks required for reconstructive purposes.
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Affiliation(s)
- B De Cuyper
- Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium.
| | - L Pottel
- Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - T Würsching
- Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - J Abeloos
- Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - J De Ceulaer
- Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - N Neyt
- Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - P Lamoral
- Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - G Swennen
- Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
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Rückschloß T, Ristow O, Kühle R, Weichel F, Roser C, Aurin K, Engel M, Hoffmann J, Freudlsperger C. Accuracy of laser-melted patient-specific implants in genioplasty - A three-dimensional retrospective study. J Craniomaxillofac Surg 2020; 48:653-660. [PMID: 32505528 DOI: 10.1016/j.jcms.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/10/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess the accuracy of laser-melted patient-specific implants (PSI) with regard to a preoperative virtual treatment plan for genioplasty based on a new analysis method without the use of landmarks. MATERIALS AND METHODS A retrospective evaluation of a cohort of Class II and Class III patients who had undergone virtually planned orthognathic surgery (including genioplasty) was carried out. The preoperative virtual treatment plan and the postoperative outcome were fused to calculate the translational and rotational discrepancies between the 3D planning and the actual surgical outcome. RESULTS The accuracy of left/right positioning was 0.25 ± 0.28 mm (p < 0.001), that of anterior/posterior positioning was 0.70 ± 0.64 mm (p < 0.001), and that of up/down-positioning was 0.45 ± 0.38 mm (p < 0.001). The rotational discrepancies were less than 2 deg. The virtually planned and postoperative positions of the chin differed significantly from each other (p < 0.001 for all rotational and translational discrepanices). CONCLUSION The findings demonstrate that PSIs can transfer the planned virtual genioplasty into the operation theatre with small but significant deviations. However, since no conclusions can be drawn from the results regarding surgical success in terms of shaping the soft tissue profile as well as the esthetic result, no superiority of PSI over traditional plate osteosynthesis can be demonstrated.
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Affiliation(s)
- Thomas Rückschloß
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
| | - Oliver Ristow
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Reinald Kühle
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Frederic Weichel
- University of Heidelberg, Institute of Medical Biometry and Informatics, Marsilius-Arkaden, Turm West, Im Neuenheimer Feld 130.3, D-69120, Heidelberg, Germany
| | - Christoph Roser
- University of Heidelberg, Department of Orthodontics, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Kerstin Aurin
- University of Heidelberg, Department of Conservative Dentistry, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Michael Engel
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Jürgen Hoffmann
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Christian Freudlsperger
- University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
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Mayer C, Bittersohl B, Haversath M, Franz A, Krauspe R, Jäger M, Zilkens C. The learning curve of patient-specific unikondylar arthroplasty may be advantageous to off-the-shelf implants: A preliminary study. J Orthop 2020; 22:256-260. [PMID: 32435106 DOI: 10.1016/j.jor.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Introducing a new arthroplasty system into clinical routine is challenging and could have an effect on early results. Since UKA are known to have failure mechanisms related to technical factors, reliable results and easy adoption are ideal. The question remains whether there are differences in objective procedure parameters in the early learning curve of different UKA systems. Methods two different UKA implants (Biomet Oxford[BO] followed by Conformis iuni[CI]) were introduced consecutively into clinical routine. We retrospectively analyzed the first 20 cases of each implant for one arthroplasty surgeon regarding operating time, correction of the mechanical axis, learning curve parameters, and revision rate of implants for 1.5 years postoperatively. Results Operating time (BO:98.3 ± 26.3min, CI:83.85 ± 21.8min (p < 0.078)), and tourniquet time differed in favor of the CI implant (BO:97.5 ± 29.5min; CI:73.5 ± 33.2 min; p < 0.017)). Mechanical alignment was restored in boths (preop:BO:mean 2.9°varus, CI:2.7°varus, postop:BOmean1.3°varus, CI:1°varus), while one BO patient and two CI patients were overcorrected. Operating time decreased from the first five implants to implants 16-20 for CI (95.2 ± 18.5min to 69 ± 21.5min, p < 0.076) and BO (130.6 ± 27.6min to 78 ± 17.3min, p < 0.009). Within 18 months of follow-up, 2 BO and 1 CI implants were revised. Conclusion The introduction of an UKA implant was associated with longer surgery in both implants. Procedure time seems to differ between implants, while a learning curve was observed regarding instrumentation. CI implants seem to be reliable and adaptable in a medium-volume practice. The early results of this retrospective single-surgeon study were in favor of the individualized implant. Certainly, further studies encompassing larger cohorts with various implants are needed.
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Affiliation(s)
- C Mayer
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, St. Marien Hospital Mülheim, Mülheim, Germany
| | - B Bittersohl
- Department of Orthopaedics and Trauma Surgery, University of Duesseldorf, University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Haversath
- Department of Orthopaedics, St. Vinzenz Hospital, Duesseldorf, Germany
| | - A Franz
- Department of Orthopaedics, Orthoparc Clinic, Cologne, Germany
| | - R Krauspe
- Department of Orthopaedics and Trauma Surgery, University of Duesseldorf, University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Jäger
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, St. Marien Hospital Mülheim, Mülheim, Germany
| | - C Zilkens
- Department of Orthopaedics, Orthoparc Clinic, Cologne, Germany
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Li Y, Zheng G, Liu T, Liang Y, Huang J, Liu X, Huang J, Cheng Z, Lu S, Huang L. Surgical Resection of Solitary Bone Plasmacytoma of Atlas and Reconstruction with 3-Dimensional-Printed Titanium Patient-Specific Implant. World Neurosurg 2020; 139:322-329. [PMID: 32311548 DOI: 10.1016/j.wneu.2020.04.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Solitary plasmacytoma of bone (SPB) is a rare malignancy of localized osseous lesion consisting of neoplastic monoclonal plasma cells. Recommended treatment of SPB includes a combination of surgery and radiation therapy. We present a rare case of SPB lesion in the atlas requiring surgical resection, followed by restoration of atlas stability with a custom 3-dimensional-printed (3DP) patient-specific implant (PSI). CASE DESCRIPTION A 57-year-old man presented with severe neck pain. Assessment by radiographs, computed tomography, and magnetic resonance imaging was found to harbor a single osteolytic lesion at the C1 (atlas) vertebra. Diagnostic tumor screening returned negative results. Transoral biopsy suggested solitary plasmacytoma. Spinal instability was apparent-hence the decision for surgical intervention via the retropharyngeal external approach to resect the lesion. Atlas reconstruction and stabilization were achieved using a custom 3DP titanium PSI. Subsequent pathologic findings confirmed plasma cell infiltration of the atlas. Histologic evaluations and cytogenetic risk analysis indicated a non-high-risk SPB. The patient was given localized radiation therapy at 57 Gy in 27 fractions. Her neurologic complaints were subsequently relieved, and mobility was restored 7 days postoperatively. CONCLUSIONS No consensus on the appropriate surgical approaches and perioperative strategies for spinal SPB exists. Surgical intervention is recommended when vertebral instability is evident, followed by radiation therapy to minimize local recurrence and/or progression to multiple myeloma. The use of 3D modeling for preoperative planning improves intraoperative accuracy and avoids iatrogenic injuries to vital anatomic structures. Customized 3DP-PSI to restore atlas stability is an effective option for the treatment of spinal SPBs.
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Affiliation(s)
- Yuxi Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guan Zheng
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Ting Liu
- Department of Anesthesia, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuwei Liang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiajun Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangge Liu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junshen Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziying Cheng
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shixin Lu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Wei F, Li Z, Liu Z, Liu X, Jiang L, Yu M, Xu N, Wu F, Dang L, Zhou H, Li Z, Cai H. Upper cervical spine reconstruction using customized 3D-printed vertebral body in 9 patients with primary tumors involving C2. Ann Transl Med 2020; 8:332. [PMID: 32355776 PMCID: PMC7186708 DOI: 10.21037/atm.2020.03.32] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Reconstruction following resection of the primary tumors of the upper cervical spine is challenging, and conventional internal implants develop complications in this region. 3D printing, also known as additive manufacturing, can produce patient-specific porous implants in a particular shape for bone defect reconstruction. This study aimed to describe the clinical outcomes of upper cervical spine reconstruction using customized 3D-printed vertebral body in 9 patients with primary tumors involving C2. Methods Patients with primary tumors involving C2 who were treated in our institution between July 2014 and November 2018 were enrolled. A two-stage intralesional spondylectomy was performed using the posterior-anterior approach. Anterior reconstruction was accomplished using a customized 3D-printed vertebral body, which was fabricated by successive layering of melted titanium alloy powder using electron beam melting. No bone graft was used. Results Nine patients (2 males and 7 females) were included in the study with a mean age of 31.4 years (12 to 59 years). Seven patients demonstrated tumors located in C2 and 2 showed involvement of C2 and C3. During a mean follow-up of 28.6 months (range, 12–42 months), 1 patient died of systemic metastasis and 1 had local tumor recurrence, the other 7 patients were alive and functional in their daily living until the last follow-up without evidence of disease. The 3D-printed vertebral bodies were all stable with no sign of displacement or subsidence, evidence of implant osseointegration was observed on the imaging studies. For the posterior instrumentation systems, no screw loosening or rod breakage was found. Conclusions Spinal reconstruction in the upper cervical region using customized 3D-printed vertebral body is reliable. The tailored shape matching with the contact surfaces and the porous structure conductive to osseointegration provide both short- and long-term stability to the implant.
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Affiliation(s)
- Feng Wei
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zhehuang Li
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Nanfang Xu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Fengliang Wu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Lei Dang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Hua Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zihe Li
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Hong Cai
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
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Degen N, Sass J, Jalali J, Kovacs L, Euler E, Prall WC, Böcker W, Thaller PH, Fürmetz J. Three-dimensional assessment of lower limb alignment: Reference values and sex-related differences. Knee 2020; 27:428-35. [PMID: 31806504 DOI: 10.1016/j.knee.2019.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/17/2019] [Accepted: 11/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Three-dimensional (3D) preoperative planning and assisted surgery is increasingly popular in deformity surgery and arthroplasty. Reference ranges for 3D lower limb alignment are needed as a prerequisite for standardized analysis of alignment and preoperative planning in 3D, but are not yet established. METHODS On 60 3D bone models of the lower limbs based on computed tomography data, fifteen parameters per leg were assessed by standardized validated 3D analysis. Distribution parameters and differences between sexes were evaluated. Reference values were generated by adding/subtracting one standard deviation from the mean. RESULTS Women had a significantly lower mean mechanical lateral distal femoral angle compared with men (86.4 ± 2.1° vs. 87.8 ± 2.0°; P < .05) and significantly lower mean joint line convergence angle (-2.5 ± 1.4° vs. -1.3 ± 1.2; P < .01), but higher mean hip knee ankle angle (178.9 ± 1.9° vs. 177.8 ± 2.3°; P < .05) and mean femoral torsion (18.2 ± 9.5° vs. 13.2 ± 6.4°; P < .05), resulting in a tendency towards valgus alignment and vice versa for men. Differences in mean medial proximal tibial angle were not significant. The mean mechanical axis deviation from the tibial knee joint center was 6.9 ± 7.3 mm medial and 1.4 ± 16.1 mm ventral without significant differences between sexes. CONCLUSIONS We describe total and sex-related reference ranges for all alignment relevant axes and joint angles of the lower limb. There are sex-related differences in certain alignment parameters, which should be considered in analysis and surgical planning.
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Koh YG, Park KM, Lee HY, Park JH, Kang KT. Prediction of wear performance in femoral and tibial conformity in patient-specific cruciate-retaining total knee arthroplasty. J Orthop Surg Res 2020; 15:24. [PMID: 31969195 PMCID: PMC6977248 DOI: 10.1186/s13018-020-1548-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/06/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Articular surface curvature design is important in tibiofemoral kinematics and the contact mechanics of total knee arthroplasty (TKA). Thus far, the effects of articular surface curvature have not been adequately discussed with respect to conforming, nonconforming, and medial pivot designs in patient-specific TKA. Therefore, this study evaluates the underlying relationship between the articular surface curvature geometry and the wear performance in patient-specific TKA. METHODS We compare the wear performances between conventional and patient-specific TKA under gait loading conditions using a computational simulation. Patient-specific TKAs investigated in the study are categorized into patient-specific TKA with conforming articular surfaces, medial pivot patient-specific TKA, and bio-mimetic patient-specific TKA with a patient's own tibial and femoral anatomy. The geometries of the femoral components in patient-specific TKAs are identical. RESULTS The anterior-posterior and internal-external kinematics change with respect to different TKA designs. Moreover, the contact pressure and area did not directly affect the wear performance. In particular, conforming patient-specific TKAs exhibit the highest volumetric wear and wear rate. The volumetric wear in a conforming patient-specific TKA is 29% greater than that in a medial pivot patient-specific TKA. CONCLUSION The findings in this study highlight that conformity changes in the femoral and tibial inserts influence the wear performance in patient-specific TKA. Kinematics and contact parameters should be considered to improve wear performance in patient-specific TKA. The conformity modification in the tibiofemoral joint changes the kinematics and contact parameters, and this affects wear performance.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Kyoung-Mi Park
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Joon-Hee Park
- Department of Anesthesiology & Pain Medicine, Hallym University College of Medicine and Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul, 05355, Republic of Korea.
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Parr WCH, Burnard JL, Singh T, McEvoy A, Walsh WR, Mobbs RJ. C3-C5 Chordoma Resection and Reconstruction with a Three-Dimensional Printed Titanium Patient-Specific Implant. World Neurosurg 2019; 136:226-233. [PMID: 31811966 DOI: 10.1016/j.wneu.2019.11.167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND With this case report, we aim to add to the clinical literature on the use of three-dimensional printed patient-specific implants in spinal surgery, show the current state of the art in patient-specific implant device design, present thorough clinical and radiographic outcomes, and discuss the suitability of titanium alloy as an implant material for patients with cancer. CASE DESCRIPTION A 45-year-old man presented with neck and left arm pain combined with shoulder weakness. Imaging revealed significant destruction of the C3-C5 vertebrae, and chordoma diagnosis was confirmed by biopsy. Gross total tumor resection including multilevel corpectomy was performed in combination with reconstruction using a three-dimensional printed titanium custom implant. Custom-designed features aimed to reduce reconstruction time and result in good clinical and radiographic outcomes. Clinical scores improved postoperatively and remained improved at 17-month postoperative follow-up: visual analog scale score 10/10 preoperatively improved to 2-6/10 at 17 months; Neck Disability Index 46% preoperatively improved to 32% at 17 months. Neither dysphagia nor dysphonia remained after surgical soft tissue swelling subsided. The patient was successfully treated with proton beam therapy after surgery, with no tumor recurrence at 17-month follow-up. Radiographic assessment showed incomplete fusion at 3 months, with clinically insignificant implant subsidence (2.7 mm) and no implant migration or failure at 14 months. CONCLUSIONS Computer-aided preoperative planning with three-dimensional printed biomodels and custom implant resulted in relatively quick and simple reconstruction after tumor resection, with good clinical and radiographic outcomes at 17 and 14 months, respectively. For patients with primary tumors who may require follow-up radiotherapy or postoperative magnetic resonance imaging, metals used in the devices cause significant imaging artifact.
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Affiliation(s)
- William C H Parr
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia; 3DMorphic Pty Ltd., Sydney, Australia.
| | - Joshua L Burnard
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia
| | - Telvinderjit Singh
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia
| | - Aidan McEvoy
- Matrix Medical Innovations Pty Ltd., Sydney, Australia
| | - William R Walsh
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Ralph J Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group, Sydney, Australia; Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
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Suojanen J, Järvinen S, Hodzic Z, Reunanen J, Leikola J, Stoor P. No differences in infections between patient-specific implants and conventional mini-plates in mandibular bilateral sagittal split osteotomy - Up to 3-year follow-up. J Craniomaxillofac Surg 2019; 47:1181-1184. [PMID: 31178267 DOI: 10.1016/j.jcms.2018.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/19/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022] Open
Abstract
The use of individually designed osteotomies, combined with individually manufactured osteosynthesis material, is rapidly becoming a standard for more challenging maxillofacial surgery. The benefits of patient-specific implants (PSI) in orthognathic surgery are clear in complex cases. PSIs can enhance precision and ease up the surgical protocol. We previously reported on the benefits of PSIs as reposition and fixation systems during Le Fort I osteotomy. The aim of this study was to evaluate a cohort of 28 patients, treated with bilateral sagittal split osteotomy (BSSO) and PSIs for fixation, with regard to healing for up to 3 years. A retrospective cohort of 48 patients with conventional mini-plate repositioned mandibles was also collected for statistical analysis. No statistically significant differences were found with regard to infection, soft tissue problems, or reoperations between these two groups.
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Affiliation(s)
- Juho Suojanen
- Department of Plastic Surgery, Cleft Palate and Craniofacial Centre, (Head: Hannu Kuokkanen), Helsinki University Central Hospital, Helsinki, Finland; Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillo-Facial Surgery, (Head: Eeva Kormi), Lahti, Finland.
| | - Sanna Järvinen
- Department of Oral and Maxillo-Facial Diseases, Clinicum, Faculty of Medicine, (Head: Risto Kontio), University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Zlatan Hodzic
- Department of Oral and Maxillo-Facial Diseases, Clinicum, Faculty of Medicine, (Head: Risto Kontio), University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Justus Reunanen
- Cancer and Translational Medicine Research Unit, Biocenter Oulu, (Head: Johanna Myllyharju), University of Oulu, Oulu, Finland
| | - Junnu Leikola
- Department of Plastic Surgery, Cleft Palate and Craniofacial Centre, (Head: Hannu Kuokkanen), Helsinki University Central Hospital, Helsinki, Finland
| | - Patricia Stoor
- Department of Oral and Maxillo-Facial Diseases, Clinicum, Faculty of Medicine, (Head: Risto Kontio), University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Koh YG, Park KM, Kang KT. The biomechanical effect of tibiofemoral conformity design for patient-specific cruciate retainging total knee arthroplasty using computational simulation. J Exp Orthop 2019; 6:23. [PMID: 31161463 PMCID: PMC6546798 DOI: 10.1186/s40634-019-0192-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022] Open
Abstract
Background Alterations to normal knee kinematics performed during conventional total knee arthroplasty (TKA) focus on the nonanatomic articular surface. Patient-specific TKA was introduced to provide better normal knee kinematics than conventional TKA. However, no study on tibiofemoral conformity has been performed after patient-specific TKA. The purpose of this study was to compare the biomechanical effect of cruciate-retaining (CR) implants after patient-specific TKA and conventional TKA under gait and deep-knee-bend conditions. Methods The examples of patient-specific TKA were categorized into conforming patient-specific TKA, medial pivot patient-specific TKA and anatomy mimetic articular surface patient-specific TKA. We investigated kinematics and quadriceps force of three patient-specific TKA and conventional TKA using validated computational model. The femoral component designs in patient specific TKA were all identical. Results The anatomy mimetic articular surface patient-specific TKA provided knee kinematics that was closer to normal than the others under the gait and deep-knee-bend conditions. However, the other two patient-specific TKA designs could not preserve the normal knee kinematics. In addition, the closest normal quadriceps force was found for the anatomic articular surface patient-specific TKA. Conclusions Our results showed that the anatomy mimetic articular surface patient-specific TKA provided close-to-normal knee mechanics. Other clinical and biomechanical studies are required to determine whether anatomy mimetic articular surface patient-specific TKA restores more normal knee mechanics and provides improved patient satisfaction.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Kyoung-Mi Park
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Reimann P, Brucker M, Arbab D, Lüring C. Patient satisfaction - A comparison between patient-specific implants and conventional total knee arthroplasty. J Orthop 2019; 16:273-277. [PMID: 31015755 DOI: 10.1016/j.jor.2019.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/31/2019] [Indexed: 12/14/2022] Open
Abstract
Background Despite recent innovations in total knee arthroplasty, 20% of the patients are not completely satisfied with the clinical results. Regarding patient-specific implants (PSI), the study aims to compare individual and off-the-shelf implant (OSI) total knee arthroplasty (TKA) concerning the postoperative outcome like function and global patient satisfaction. Methods In 2013/14 228 patients received a TKA due to primary osteoarthritis with an indication for a bicondylar, cruciate retaining prosthesis. 125 patients received a PSI and 103 an OSI TKA. The outcome after surgery was evaluated retrospectively by two questionnaires and a clinical follow-up examination. The Knee Society Score (KSS) was used to evaluate function. To compare the satisfaction the Knee Injury and Osteoarthrosis Outcome Score (KOOS) and a modified EuroQol (EQ) including five additional questions were used. Finally, 84 patients with PSI and 57 with OSI completed follow-up. Results Concerning demographic data, the PSI group showed a significantly younger age, five years on average. The ROM was comparable in both groups. The KSS and the separate function score achieved significantly better results in the PSI group. For subjects with PSI TKA, the global satisfaction showed significant better values. Conclusions The significantly higher values in KSS and its function score lead to a better basic daily function in PSI group. In addition, the PSI TKA achieved a higher global patient satisfaction. Nevertheless, both should mainly be assessed in the context of average younger age and the influence of expectations.
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Affiliation(s)
- Pia Reimann
- Department of Orthopedic Surgery, Klinikum Dortmund gGmbH, Beurhausstraße 40, 44137 Dortmund, Germany
| | - Martin Brucker
- Department of Orthopedic Surgery, Klinikum Dortmund gGmbH, Beurhausstraße 40, 44137 Dortmund, Germany
| | - Dariusch Arbab
- Department of Orthopedic Surgery, Klinikum Dortmund gGmbH, Beurhausstraße 40, 44137 Dortmund, Germany
| | - Christian Lüring
- Department of Orthopedic Surgery, Klinikum Dortmund gGmbH, Beurhausstraße 40, 44137 Dortmund, Germany
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Abstract
Objectives Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty for patients who require treatment of single-compartment osteoarthritis, especially for young patients. To satisfy this requirement, new patient-specific prosthetic designs have been introduced. The patient-specific UKA is designed on the basis of data from preoperative medical images. In general, knee implant design with increased conformity has been developed to provide lower contact stress and reduced wear on the tibial insert compared with flat knee designs. The different tibiofemoral conformity may provide designers the opportunity to address both wear and kinematic design goals simultaneously. The aim of this study was to evaluate wear prediction with respect to tibiofemoral conformity design in patient-specific UKA under gait loading conditions by using a previously validated computational wear method. Methods Three designs with different conformities were developed with the same femoral component: a flat design normally used in fixed-bearing UKA, a tibia plateau anatomy mimetic (AM) design, and an increased conforming design. We investigated the kinematics, contact stress, contact area, wear rate, and volumetric wear of the three different tibial insert designs. Results Conforming increased design showed a lower contact stress and increased contact area. In addition, increased conformity resulted in a reduction of the wear rate and volumetric wear. However, the increased conformity design showed limited kinematics. Conclusion Our results indicated that increased conformity provided improvements in wear but resulted in limited kinematics. Therefore, increased conformity should be avoided in fixed-bearing patient-specific UKA design. We recommend a flat or plateau AM tibial insert design in patient-specific UKA. Cite this article: Y-G. Koh, K-M. Park, H-Y. Lee, K-T. Kang. Influence of tibiofemoral congruency design on the wear of patient-specific unicompartmental knee arthroplasty using finite element analysis. Bone Joint Res 2019;8:156–164. DOI: 10.1302/2046-3758.83.BJR-2018-0193.R1.
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Affiliation(s)
- Y-G Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea
| | - K-M Park
- Department of Mechanical Engineering, Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
| | - H-Y Lee
- Department of Mechanical Engineering, Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
| | - K-T Kang
- Department of Mechanical Engineering, Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
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Koh YG, Son J, Kwon OR, Kwon SK, Kang KT. Tibiofemoral conformity variation offers changed kinematics and wear performance of customized posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1213-1223. [PMID: 29974167 DOI: 10.1007/s00167-018-5045-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/27/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE Posterior-stabilized (PS)-total knee arthroplasty (TKA) can be applied in any of several variations in terms of the tibiofemoral conformity and post-cam mechanism. However, previous studies have not evaluated the effect of the condylar surface radii (tibiofemoral conformity) on wear in a customized PS-TKA. The present study involved evaluating the wear performance with respect to three different conformities of the tibiofemoral articular surface in a customized PS-TKA by means of a computational simulation. METHODS An adaptive computational simulation method was developed that conduct wear simulation for tibial insert to predict kinematics, weight loss due to wear, and wear contours to results. Wear predictions using computational simulation were performed for 5 million gait cycles with force-controlled inputs. Customized PS-TKA designs were developed and categorized as conventional conformity (CPS-TKA), medial pivot conformity (MPS-TKA), and anatomical conformity (APS-TKA). The post-cam design in the customized PS-TKA is identical. We compared the kinematics, contact mechanics, and wear performance. RESULTS The findings revealed that APS-TKA exhibited the highest internal tibial rotation relative to other TKA designs. Additionally, the higher contact area led to there being less contact stress although it did not directly affect the wear performance. Specifically, MPS-TKA exhibited the lowest volumetric wear. CONCLUSIONS The results of the present study showed that tibiofemoral articular surface conformity should be considered carefully in customized PS-TKA design. Different wear performances were observed with respect to different tibiofemoral conformities. Even though APS-TKA exhibited an inferior wear performance compared to MPS-TKA, it proved to be better in terms of kinematics so its functionality may be improved through the optimization of the tibiofemoral articular surface conformity. Additionally, it should be carefully designed since any changes may affect the post-cam mechanism.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Juhyun Son
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Oh-Ryong Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Sae Kwang Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Fürmetz J, Sass J, Ferreira T, Jalali J, Kovacs L, Mück F, Degen N, Thaller PH. Three-dimensional assessment of lower limb alignment: Accuracy and reliability. Knee 2019; 26:185-193. [PMID: 30473372 DOI: 10.1016/j.knee.2018.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/29/2018] [Accepted: 10/24/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Three-dimensional (3D) surgical planning and patient-specific implants are becoming increasingly popular in orthopedics and trauma surgery. In contrast to the established and standardized alignment assessment on two-dimensional (2D) long standing radiographs (LSRs) there is neither a standardized nor a validated protocol for the analysis of 3D bone models of the lower limb. This study aimed to create a prerequisite for pre-operative planning. METHODS According to 2D analysis and after meticulous research, 24 landmarks were defined on 3D bone models obtained from computed axial tomography (CT) scans for a 3D alignment assessment. Three observers with different experience levels performed the test three different times on three specimens. Intraobserver and interobserver variability of the landmarks and the intraclass correlation coefficient (ICC) of the resulting axes and joint angles were evaluated. RESULTS Overall, the intraobserver and interobserver variability was low, with a mean deviation <5 mm for all landmarks. The ICC of all joint angles and axis deviations was >0.8, except for tibial torsion (ICC = 0.69). All knee joint angles showed excellent ICC (>0.95). CONCLUSIONS Using the defined landmarks, a standardized 3D alignment assessment with low intraobserver and interobserver variability and high ICC values for the knee joint angles can be performed regardless of examiner's experience. The described method serves as a reliable standardized protocol for a 3D malalignment test of the lower limb. Three-dimensional pre-operative analysis might enhance understanding of deformities and lead to a new focus in surgical planning.
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Affiliation(s)
- J Fürmetz
- 3D-Surgery, Department of General, Trauma- and Reconstructive Surgery, University Hospital Munich LMU, Germany.
| | - J Sass
- 3D-Surgery, Department of General, Trauma- and Reconstructive Surgery, University Hospital Munich LMU, Germany
| | - T Ferreira
- Research Group CAPS-Computer Aided Plastic Surgery, Department of Plastic Surgery and Hand Surgery, University Hospital Klinikum rechts der Isar, Technische Universität München, Germany; Faculty of Sciences, University of Lisbon, Portugal
| | - J Jalali
- Research Group CAPS-Computer Aided Plastic Surgery, Department of Plastic Surgery and Hand Surgery, University Hospital Klinikum rechts der Isar, Technische Universität München, Germany
| | - L Kovacs
- Research Group CAPS-Computer Aided Plastic Surgery, Department of Plastic Surgery and Hand Surgery, University Hospital Klinikum rechts der Isar, Technische Universität München, Germany
| | - F Mück
- Department of Radiology, University Hospital Munich LMU, Germany
| | - N Degen
- 3D-Surgery, Department of General, Trauma- and Reconstructive Surgery, University Hospital Munich LMU, Germany
| | - P H Thaller
- 3D-Surgery, Department of General, Trauma- and Reconstructive Surgery, University Hospital Munich LMU, Germany
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Caiti G, Dobbe JGG, Bervoets E, Beerens M, Strackee SD, Strijkers GJ, Streekstra GJ. Biomechanical considerations in the design of patient-specific fixation plates for the distal radius. Med Biol Eng Comput 2018; 57:1099-1107. [PMID: 30588576 PMCID: PMC6477011 DOI: 10.1007/s11517-018-1945-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/10/2018] [Indexed: 01/08/2023]
Abstract
Use of patient-specific fixation plates is promising in corrective osteotomy of the distal radius. So far, custom plates were mostly shaped to closely fit onto the bone surface and ensure accurate positioning of bone segments, however, without considering the biomechanical needs for bone healing. In this study, we investigated how custom plates can be optimized to stimulate callus formation under daily loading conditions. We calculated implant stress distributions, axial screw forces, and interfragmentary strains via finite element analysis (FEA) and compared these parameters for a corrective distal radius osteotomy model fixated by standard and custom plates. We then evaluated these parameters in a modified custom plate design with alternative screw configuration, plate size, and thickness on 5 radii models. Compared to initial design, in the modified custom plate, the maximum stress was reduced, especially under torsional load (- 31%). Under bending load, implants with 1.9-mm thickness induced an average strain (median = 2.14%, IQR = 0.2) in the recommended range (2-10%) to promote callus formation. Optimizing the plate shape, width, and thickness in order to keep the fixation stable while guaranteeing sufficient strain to enhance callus formation can be considered as a design criteria for future, less invasive, custom distal radius plates. Graphical abstract ᅟ.
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Affiliation(s)
- G Caiti
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands.
| | - J G G Dobbe
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - E Bervoets
- Metrotech Engineering & Physics, Begtrupvej 75, Sporup, Denmark
| | - M Beerens
- Xilloc Medical B. V., Urmonderbaan 22, Geleen, Netherlands
| | - S D Strackee
- Amsterdam UMC, University of Amsterdam, Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - G J Strijkers
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - G J Streekstra
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
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Koh YG, Nam JH, Kang KT. Effect of geometric variations on tibiofemoral surface and post-cam design of normal knee kinematics restoration. J Exp Orthop 2018; 5:53. [PMID: 30578465 PMCID: PMC6303222 DOI: 10.1186/s40634-018-0167-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background Restoration of natural knee kinematics for a designed mechanism in knee implants is required to achieve full knee function in total knee arthroplasty (TKA). In different posterior-stabilized TKAs, there are wide variations in tibiofemoral surfaces and post-cam design. However, it is not known whether these design variations preserve natural knee kinematics. The purpose of this study was to determine the most appropriate tibiofemoral surface and post-cam designs to restore natural knee kinematics of the TKA. Methods A subject-specific finite element knee modal was used to evaluate tibiofemoral surface and post-cam design. Three different posts in convex, straight, and concave geometries were considered with a fixed circular cam design in this study. In addition, this post-cam design was applied to three different surface conformities for conforming, medial pivot, and subject anatomy mimetic tibiofemoral surfaces. We evaluated the femoral rollback, internal-external rotation, and quadriceps muscle force under a deep-knee-bend condition. Results The three different tibiofemoral conformities showed that the convex post provided the most natural-knee-like femoral rollback. This was also observed in internal rotation. In surface conformity, subject anatomy mimetic tibiofemoral surfaces showed the most natural -knee-like kinematics and quadriceps force. Conclusions This study confirmed that convex post design and subject anatomy mimetic tibiofemoral surfaces provided the most natural-knee-like kinematics. This study suggested that post-cam design and tibiofemoral surface conformity should be considered in conventional and customized TKA.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Wagner MEH, Essig H, Rücker M, Gander T. [Reconstructive orbital surgery]. HNO 2018; 66:827-33. [PMID: 30327822 DOI: 10.1007/s00106-018-0568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND In complex orbital reconstructions ideal positioning of the bony buttress and surrounding soft tissue is a prerequisite for an aesthetic and functional result. The use of computer-assisted surgery can support the surgeon before and during the reconstruction procedure and facilitate quality control processes. This is illustrated using three clinical examples. MATERIAL AND METHODS The areas of interest (bony defect areas, surrounding tissues) are segmented in a 3D image series. In most cases, the contralateral non-affected side can serve as the reference in virtual reconstruction. The virtual model obtained can now be used for the manufacturing of patient specific models and implants, as well as for intraoperative navigation or direct quality control with the use of intraoperative cone beam computed tomography (CBCT). RESULTS For the reconstruction of primary and secondary traumatic defects as well as for congenital malformations or neoplastic diseases, the presented workflow can be used. Preoperative virtual visualization, patient specific reconstruction and direct quality control using intraoperative CBCT ensure that the preoperatively planned result can be achieved. Together with the interplay of hard and soft tissue the best possible results can be achieved. CONCLUSION Computer-assisted surgery has been continuously further developed over the last two decades and is currently used in the clinical routine. Patient specific implants in combination with the use of direct intraoperative quality control facilitate the reconstruction of complex orbital injuries and defects and enable the ideal reconstruction from both aesthetic and functional aspects.
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