Among autologous somatic stem cells, bone marrow-derived mesenchymal stem cells (BMSCs) are the most widely used worldwide to repair not only mesenchymal tissues (bone, cartilage) but also many other kinds of tissues, including heart, skin, and liver. Autologous BMSCs are thought to be safe because of the absence of immunological reaction and disease transmission. However, it is possible that they will form tumours during long-term follow-up. In 1988, we transplanted autologous BMSCs to repair articular cartilage, which was the first such trial ever reported. Subsequently we performed this procedure in about 40 patients. Demonstration that neither partial infections nor tumours appeared in these patients provided strong evidence for the safety of autologous BMSC transplantation. Thus, in this study we checked these patients for tumour development and infections. Between January 1998 and November 2008, 41 patients received 45 transplantations. We checked their records until their last visit. We telephoned or mailed the patients who had not visited the clinics recently to establish whether there were any abnormalities in the operated joints. Neither tumours nor infections were observed between 5 and 137 (mean 75) months of follow-up. Autologous BMSC transplantation is a safe procedure and will be widely used around the world.
Malalignment of the cup in total hip arthroplasty (THA) increases the risks of postoperative complications such as neck cup impingement, dislocation, and wear. We asked whether a tailor-made surgical guide based on CT images would reduce the incidence of outliers beyond 10°from preoperatively planned alignment of the cup compared with those without the surgical guide. We prospectively followed 38 patients (38 hips, Group 1) having primary THA with the conventional technique and 31 patients (31 hips, Group 2) using the surgical guide. We designed the guide for Group 2 based on CT images and fixed it to the acetabular edge with a Kirschner wire to indicate the planned cup direction. Postoperative CT images showed the guide reduced the number of outliers compared with the conventional method (Group 1, 23.
This paper describes procedures for repositioning calculations of fractured bone fragments using 3-D-computed tomography (CT), aimed at preoperative planning for computer-guided fracture reduction of the proximal femur. Fracture boundaries of the bone fragments, as "fracture lines (FLs)," and the mirror-transformed contralateral femur shape extracted from 3-D-CT were used for repositioning of the fragments. We first describe a method for extracting FLs based on 3-D curvature analysis and then formulate repositioning methods based on registration of bone fragments using the following three constraints: 1) contralateral (CL) femur shape; 2) FLs; and 3) both CL femur shape and fracture lines, as "both constraints". We performed experiments using CT datasets from five simulated and four real patients with proximal femoral fracture. We evaluated the rotation error in reposition calculations and the contact ratio between repositioned fragment boundaries, which are crucial for the recovery of proper functional axes and bone adhesion of fragments, respectively. Experimental results showed that good accuracy and stability were attainable when registration using both constraints was performed after registration using the fracture-line constraint. On average, 6.0 degrees +/-0.8 degrees in rotation error and 89%+/-3 % in contact ratio were obtained without providing precise initial values.
Purpose: To estimate the accuracy and consistency of a method using a voxel-based MR image registration algorithm for precise monitoring of knee joint diseases.
Materials and Methods:Rigid body transformation was calculated using a normalized cross-correlation (NCC) algorithm involving simple manual segmentation of the bone region based on its anatomical features. The accuracy of registration was evaluated using four phantoms, followed by a consistency test using MR data from the 11 patients with knee joint disease.
Results:The registration accuracy in the phantom experiment was 0.49 Ϯ 0.19 mm (SD) for the femur and 0.56 Ϯ 0.21 mm (SD) for the tibia. The consistency value in the experiment using clinical data was 0.69 Ϯ 0.25 mm (SD) for the femur and 0.77 Ϯ 0.37 mm (SD) for the tibia. These values were all smaller than a voxel (1.25 ϫ 1.25 ϫ 1.5 mm).
Conclusion:The present method based on an NCC algorithm can be used to register serial MR images of the knee joint with error on the order of a subvoxel. This method would be useful for precisely assessing therapeutic response and monitoring knee joint diseases; normalized cross-correlation; accuracy
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