Introduction. Peroneal tendon subluxation & dislocation is a rare phenomenon. It is a commonly misdiagnosed cause of lateral ankle pain and instability. Aim(s). Our aim was to establish the morphometric (quantification of components) features of retromalleolar fibular groove in cadavers using 3D technique. Study points. To map the version and inclination based on the 3D techniques. To determine the depth of peroneal groove sufficient to prevent subluxation of tendons. Method/materials. We used 12 of embalmed lower extremities. 6 males and 6 females. All were Caucasians (Age: 61–94). The orientation is calculated using the cartilage boundary of the peroneal groove and using the centroid of the curved surface of the groove. We used rhinoceros software for data collection and mapping of peroneal grooves using
We have been using 3-dimensional CAD software for preoperative planning as a desktop tool daily. In ordinary cases, proper size stems and cups can be decided without much labor but in our population, many arthritic hip cases have dysplastic condition and they often come to see us for hip replacement after severe defects were created over the acetabulum. It is often the case that has Crowe's type III, IV hips with leg length difference. For those cases preoperative planning using 3D CAD is a very powerful tool. Although we only have 2-dimensional display with our computer during preoperative planning, 3 dimensional geometries are not so difficult to be understood, because we can turn the objects with the mouse and can observer from different directions. We can also display their sections and can peep inside of the geometries. It is quite natural desire that a surgeon wishes to see the planed geometries as a 3-dimensional materials. For some complicated cases, we had prepared plastic model and observed at the theater for better understanding. When we ask for a model service, each model costs $2,500. We also have small scale desk top rapid processing tool too, however it takes 2 days to make one side of pelvis. Observation of the geometries using 3-dimensional display can be its substitute without much cost and without taking much time. The problem of using 3D display had been the special goggle to mask either eye alternatively. In the present paper, we have used a 3D display which has micro arrays of powerful prism to deriver different image for each eye without using any goggle. After preoperative planning, 2 images were prepared for right eye and left eye giving 2-3 degree's parallax. These images were encoded into a special AVI file for 3-dimensional display. To keep fingers away from the device, several scenes were selected and 3-dimensional slide show was endlessly shown during the surgery. Cup geometries with screws had been prepared and cup position with screws direction were very useful. The edge of acetabulum and cup edge are well compared then could obtain a better cup alignment. Screws are said to be safe if they were inserted in upper posterior quadrant. However so long as the cluster cup was used, when the cup was given 30 degrees anterior rotation, 25 mm screw was still acceptable using CAT angiography.Method
Result
In foot and ankle surgery incorrect placement of implants, or inaccuracy in fracture reduction may remain undiscovered with the use of conventional C-arm fluoroscopy. These imperfections are often only recognized on postoperative computer tomography scans. The apparition of three dimensional (3D) mobile Imaging system has allowed to provide an intraoperative control of fracture reduction and implant placement. Three dimensional computer assisted surgery (CAS) has proven to improve accuracy in spine and pelvic surgery. We hypothesized that 3D-based CAS could improve accuracy in foot and ankle surgery. The purpose of our study was to evaluate the feasibility and utility of a multi-dimensional surgical imaging platform with intra-operative three dimensional imaging and/or CAS in a broad array of foot and ankle traumatic and orthopaedic surgery. Cohort study of patients where the
Background. Paediatric pelvic corrective surgery for developmentally dysplastic hips requires that the acetabular roof is angulated to improve stability and reduce morbidity. Accurate bony positioning is vital in a weight-bearing joint as is appropriate placement of metalwork without intrusion into the joint. This can often be difficult to visualise using conventional image intensifier equipment in a 2D plane. Methods. The ARCADIS Orbic
Introduction. Total knee arthroplasty (hereinafter TKA), it is thought that the setting position of each component and the angle have a big influence on surgical results. Preoperative planning with accurate and detailed 3D templates are has been done in many facilities in TKA. However, in the setting position, the 2D evaluation with X-rays is still common after operation, and there are few facilities going in
CT-based three-dimensional (3D) pre-operative imaging along with 2D orthogonal sections defined by the plane of the scapula (axial, sagittal and coronal planes) has been demonstrated by many research groups to be a very accurate way to define the bone pathology and alignment/subluxation of the humeral head in relationship to the center line of the scapula or the center of the glenoid fossa. When
Quantitative assessment of metastatic involvement of the bony spine is important for assessing disease progression and treatment response. Quantification of metastatic involvement is challenging as tumours may appear as osteolytic (bone resorbing), osteoblastic (bone forming) or mixed. This investigation aimed to develop an automated method to accurately segment osteoblastic lesions in a animal model of metastatically involved vertebrae, imaged with micro computed tomography (μCT). Radiomics seeks to apply standardized features extracted from medical images for the purpose of decision-support as well as diagnosis and treatment planning. Here we investigate the application of radiomic-based features for the delineation of osteoblastic vertebral metastases. Osteoblastic lesions affect bone deposition and bone quality, resulting in a change in the texture of bony material physically seen through μCT imaging. We hypothesize that radiomics based features will be sensitive to changes in osteoblastic lesion bone texture and that these changes will be useful for automating segmentation. Osteoblastic metastases were generated via intracardiac injection of human ZR-75-1 breast cancer cells into a preclinical athymic rat model (n=3). Four months post inoculation, ex-vivo μCT images (µCT100, Scanco) were acquired of each rodent spine focused on the metastatically involved third lumbar vertebra (L3) at 7µm/voxel and resampled to 34µm/voxel. The trabecular bone within each vertebra was isolated using an atlas and level-set based segmentation approach previously developed by our group. Pyradiomics, an open source Radiomics library written in python, was used to calculate
Introduction. Three-dimensional (3D) printing is a precise method of reproducing complex structures. Orthopaedic surgeons may utilize
Juvenile Osteochondritis dissecans (JOCD) in humans and subchondral cystic lesions (SCL) in horses (also termed radiolucencies) share similarities: they develop in skeletally immature individuals at the same location in the medial femoral condyle (MFC) and their etiology is only partially understood but trauma is suspected to be involved. JOCD is relatively uncommon in people whereas SCLs arise in 6% of young horses leading to lameness. Ischemic chondronecrosis is speculated to have a role in both osteochondrosis and SCL pathogenesis. We hypothesize that MFC radiolucencies develop very early in life following a focal internal trauma to the osteochondral junction. Our aims were to characterize early MFC radioluciencies in foals from 0 to 2 years old. Distal femurs (n=182) from Thoroughbred horses (n=91, 0–2 years old), presented for post-mortem examination for reasons unrelated to this study, were collected. Radiographs and clinical tomodensitometry were performed to identify lesions defined as a focal delay of ossification. Micro-tomodensitometry (m-CT) and histology was then performed on the MFCs (CT lesions and age-matched subset of controls). Images were constructed in 3D. The thawed condyles, following fixation, were sectioned within the region of interest, determined by CT lesion sites. Hematoxylin eosin phloxin and safran (HEPS) and Martius-Scarlet-Blue (MSB) stains were performed. Histological parameters assessed included presence of chondronecrosis, fibrin, fibroplasia and osteochondral fracture. An additional subset of CT control (lesion-free) MFCs (less 6 months old) were studied to identify early chondronecrosis lesions distant from the osteochondral junction. One MFC in clinical CT triages controls had a small lesion on m-CT and was placed in the lesion group. All m-CT and histologic lesions (n=23) had a focal delay of ossification located in the same site, a weight bearing area on craniomedial condyle. The youngest specimen with lesions was less than 2 months old. On m-CT
Biomechanical considerations are relevant to cup positioning in total hip replacement (THR) to optimise the patient-specific post-operative outcome. One goal is to place the hip centre of rotation (COR) such that parameters characterising the biomechanics of the hip joint lie within physiological ranges. Different biomechanical models have been developed and are based on exact knowledge about muscle insertion points whose positions can be estimated on the basis of bony landmarks. Therefore, accurate landmark localisation is necessary to obtain reliable and comparable parameter values. As most biomechanical considerations are limited to the frontal plane, landmark localisation relying on standardised pre-operative radiographs has been established in clinical practice. One potential drawback of this approach is that user-interactive landmark localisation in radiographs might be more error-prone and subjective than localisation in
Introduction. Although weight-bearing CT of the foot definitely reflects the morphology and deformity of joint, it is hard to obtain the standing CT due to difficulty of availability. Although
Cup position planning for total hip replacement (THR) is a complex task which is influenced by several factors. Whereas aspects like appropriate implant fixation and bone stock preservation are rather evaluated according to intra-operative findings, functional analyses using biomechanical hip models can rely on pre-operative imaging. Due to the wide availability and cost-efficiency of X-ray imaging technology along with the common restriction of biomechanical evaluations to the frontal plane, pre-operative imaging for such purposes is usually limited to AP radiographs. One example is biomechanical optimisation based on the so-called BLB score, which has already been introduced into clinical practice. In this approach, the assumed suitability of potential hip centres of rotation (CORs) is presented to the surgeon by applying colour-coding within the pre-operative AP radiograph. However, to realise the plan, the surgeon has to transfer the 2D positions presented in the radiograph into the 3D surgical site. We developed a CT-based simulation tool allowing for the generation of 3D bone surface models as well as standardised digitally reconstructed radiographs (DRRs). Within a 3D view, the cup, which is represented as a hemisphere, can freely be shifted in the coronal plane. The 2D point corresponding to the COR defined by the hemisphere is then automatically computed. In our study, four CT datasets of hips with large bony defects were used. After segmentation 3D bone surface models were generated. These bone surface models were aligned on the basis of the pelvic coordinate system [3], and standardised AP DRRs were computed. BLB score evaluation in intact hips assumes that the central beam passes through the centroid of both hip CORs. As only the contra-lateral hip COR was available due to the defects, a virtual ipsi-lateral COR was obtained by mirroring the contra-lateral hip across the mid-sagittal plane. Twelve surgeons (divided into two groups of six each according to their experience) had the task to shift the cup such that its 3D position would best match a predefined 2D target position, which was close to the virtual ipsi-lateral COR and displayed as a cross within the standardised DRR. However, the current 2D position corresponding to the current 3D position was not revealed during positioning. Once the user was satisfied with the 3D position, the corresponding 2D position was recorded. The following results were obtained (mean ± SD across six surgeons of the respective group) for the four patients:. x-error, more experienced: 2.0 ± 6.1; −3.0 ± 5.9; 4.1 ± 4.8; 2.1 ± 5.2; x-error, less experienced: 4.3 ± 4.2; −3.1 ± 1.8; 1.9 ± 4.0; 5.2 ± 4.1; |x-error|, more experienced: 5.2 ± 3.0; 5.4 ± 3.2; 5.5 ± 2.7; 4.3 ± 3.0;|x-error|, less experienced: 4.3 ± 4.2; 3.1 ± 1.8; 3.3 ± 2.7; 5.7 ± 3.3; y-error, more experienced: 12.0 ± 9.1; 0.3 ± 4.3; 6.2 ± 6.6; 1.9 ± 3.2;. y-error, less experienced: 6.1 ± 3.1; 0.8 ± 4.0; 2.4 ± 5.5; 1.4 ± 4.1;|y-error|, more experienced: 12.0 ± 9.1; 3.2 ± 2.6; 6.2 ± 6.6; 3.0 ± 1.9;|y-error|, less experienced: 6.1 ± 3.1; 3.4 ± 1.6; 4.6 ± 3.3; 3.2 ± 2.6;total error, more experienced: 13.5 ± 8.9; 6.6 ± 3.5; 9.8 ± 4.1; 5.4 ± 3.4;total error, less experienced: 8.5 ± 2.7; 4.9 ± 1.5; 6.5 ± 2.5; 6.7 ± 3.8. Our experimental results show that mental 2D/3D matching for cup positioning in pelvises with bony defects is a difficult task, and that mental 2D/3D matching cannot be expected to yield the correct 3D cup positions corresponding to positions predefined in radiographs. The largest errors were found in the patient with the lowest image quality suggesting that image quality plays an important role. On contrary, experience was not found to be an important factor. We believe that in clinical practice mental 2D/3D matching between pre-operative radiographs and the surgical site without the help of
INTRODUCTION. Rotational malalignment of the components in total knee arthroplasty has been linked to patellar maltracking, improper soft tissue balance, abnormal kinematics, premature wear of the polyethylene inlay, and subsequent clinical complications such as anterior knee pain (Barrack et al., 2001; Zihlmann et al., 2005; Lakstein at al., 2010). This study investigates an innovative image-based device that is designed to be used along with an intraoperative Isocentric (ISO-C)
Background. Degeneration of the shoulder joint is a frequent problem. There are two main types of shoulder degeneration: Osteoarthritis and cuff tear arthropathy (CTA) which is characterized by a large rotator cuff tear and progressive articular damage. It is largely unknown why only some patients with large rotator cuff tears develop CTA. In this project, we investigated CT data from ‘healthy’ persons and patients with CTA with the help of
Introduction. At present, orthopaedic surgeons utilize either CT, MRI or X-ray for imaging a joint. Unfortunately, CT and MRI are quite expensive, non weight-bearing and the orthopaedic surgeon does not receive revenue for these procedures. Although x-rays are cheaper, similar to CT scans, patients incur radiation. Also, all three of these imaging modalities are static. More recently, a new ultrasound technology has been developed that will allow a surgeon to image their patients in 3D. The objective of this study is to highlight the new opportunity for orthopaedic surgeons to use 3D ultrasound as alternative to CT, MRI and X-rays. Methods. The 3D reconstruction process utilizes statistical shape atlases in conjunction with the ultrasound RF data to build the patient anatomy in real-time. The ultrasound RF signals are acquired using a linear transducer. Raw RF data is then extracted across each scan line. The transducer is tracked using a 3D tracking system. The location and orientation for each scan line is calculated using the tracking data and known position of the tracker relative to the signal. For each scan line, a detection algorithm extracts the location on the signal of the bone boundary, if any exists. Throughout the scan process, a 3D point cloud is created for each detected bone signal. Using a statistical bone atlas for each anatomy, the patient specific surface is reconstruction by optimizing the geometry to match the point cloud. Missing regions are interpolated from the bone atlas. To validate reconstructed models output models are then compared to models generated from
INTRODUCTION. The cup component of modern resurfacing systems are often coated creating a cementless press-fit fixation in the acetabulum based on surgical under-reaming, also enabling osseoconduction/integration. Due to the higher density of cortical bone along the antero-superior and postero-inferior regions of the acetabulum, the greatest forces occur between the anterior and posterior columns of the pelvis. This produces pinching of the implant that can result in deformation of the cup. Metal shell/modularpress-fit acetabular cups are susceptible to substantial deformation immediately after implantation. This deformation may affect the lubrication, producing point loading and high friction torques between the head and the cup that increase wear and may lead to head clamping and subsequent cup loosening. We sought to test a novel ceramic on ceramic (CoC) hip resurfacing system that should allay any concerns with the Adverse Reaction to Metal Debris associated with metal on metal (MoM) resurfacing devices. AIM. We sought to quantify the deformation of a novel CoC hip-resurfacing cup after implantation, using a standard surgical technique in a cadaveric model, and compare to the MoM standard. We also assessed if the design clearances proposed for this CoC hip resurfacing implant are compatible with the measured deformations, allowing for an adequate motion of the joint. METHODS. The pelvis from four fresh frozen cadavers were placed into the lateral position. One surgeon with extensive experience in hip resurfacing surgery (JH) prepared all the pelvises for implantation using a posterior approach to the joint and sequential reaming of the acetabulum to 1mm below the implant outer diameter. The acetabulum components were then impacted into the prepared pelvis. We used four ceramic and four metal implants of equal and varying size. (2 × (40/46mm, 44/50mm, 50/56mm, 52/58mm)). The acetabulum cup bearing surface diameter and deformation was measured using a GOM-ATOS optical high precision 3D scanner. 3-Dimensional measurements were taken pre-implantation, immediately after and at 30 minutes following implantation. Two techniques were used to analyse the
Introduction. The degree of glenoid bone loss associated with primary glenohumeral osteoarthritis can influence the type of glenoid implant selected and its placement in total shoulder arthroplasty (TSA). The literature has demonstrated inaccurate glenoid component placement when using standard instruments and two-dimensional (2D) imaging without templating, particularly as the degree of glenoid deformity or bone loss worsens. Published results have demonstrated improved accuracy of implant placement when using three-dimensional (3D) computed tomography (CT) imaging with implant templating and patient specific instrumentation (PSI). Accurate placement of the glenoid component in TSA is expected to decrease component malposition and better correct pathologic deformity in order to decrease the risk of component loosening and failure over time. Different types of PSI have been described. Some PSI use 3D printed single use disposable instrumentation, while others use adjustable and reusable-patient specific instrumentation (R-PSI). However, no studies have directly compared the accuracy of different types of PSI in shoulder arthroplasty. We combined our clinical experience and compare the accuracy of glenoid implant placement with five different types of instrumentation when using
[Background]. Factors determining improvement of the long-term outcome of total knee arthroplasty include accurate reproduction of lower limb alignment. To acquire appropriate lower limb alignment, tibial component rotation is an important element for outcomes. We usually determine the tibial component rotation using the anatomical rotaional landmark of the proximal tibia and range of motion technique. In addition we followed by confirmation of overall lower limb alignment referring to the distal tibial index. When the tibia have a rotational mismatch between its proximal and distal AP axis, a larger error of the distal tibial index than those of other rotational landmark is of concern. The purpose of this study is to evaluate the reliability of the distal tibial AP axis as a reference axis of tibial compornent rotation in the intraoperative setting. [Subjects and Methods]. The 86 patients (104 knees) with osteoarthritis of the knee who underwent primary TKA were evaluated with use of computerized tomography scans. A
INTRODUCTION. In living normal knee the lateral femoral condyle rolls posteriorly more than the medial side to the extent that in deep flexion the lateral femoral condyle sublux from the tibial surface (Nakagawa et al). The purpose of this presentation is to study the tibiofemoral movement in patients who had full flexion after total knee replacements and to compare it with that of normal knee. MATERIALS AND METHODS. 23 knees were scanned using SIEMENS SIREMOBILE Iso-C with 3D Extension C-arm. The system is able reconstruct
Scaphoid non-union results the typical humpback deformity, pronation of the distal fragment, and a bone defect in the non-union site with shortening. Bone grafting, whether open or arthroscopic, relies on fluoroscopic and direct visual assessment of reduction. However, because of the bone defect and irregular geometry, it is difficult to determine the precise width of the bone gap and restore the original bone length, and to correct interfragmentary rotation. Correction of alignment can be performed by computer-assisted planning and intraoperative guidance. The use of computer navigation in guiding reduction in scaphoid non-unions and displaced fractures has not been reported. Objective. We propose a method of anatomical reconstruction in scaphoid non-union by computer-assisted preoperative planning combined with intraoperative computer navigation. This could be done in conjunction with a minimally invasive, arthroscopic bone grafting technique. Methods. A model consisting of a scaphoid bone with a simulated fracture, a forearm model, and an attached patient tracker was used. 2 titanium K-wires were inserted into the distal scaphoid fragment.