Custom-designed orthopedic implants evaluated using finite element analysis of patient-specific computed tomography data: femoral-component case study

Harrysson, Ola L. A.; Hosni, Yasser; Nayfeh, Jamal

doi:10.1186/1471-2474-8-91

Cited by 186 publications

(138 citation statements)

References 10 publications

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“…It can then generate the complex free-form structure such as scaffold lattice in a metal monoblock that would be impossible using conventional subtractive manufacturing techniques by computer numerical control machines. The ALM technique has been successfully used in the craniofacial reconstruction, dental applications and customized hip implants, [22][23][24][25] but is not reported in orthopedic bone tumor surgery. The early results of using 3D printed titanium trabecular lattice structure to fill up and reconstruct extensive acetabular bone defect were promising in the revision hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection

Kumta

et al. 2015

Computer Aided Surgery

198

146

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Resection of a pelvic tumor is challenging because of its complex three-dimensional (3D) anatomy and deep-seated location with nearby vital structures. The resection is technically demanding if a custom implant is used for reconstruction of the bone defect as the surgeon needs to ensure the resection margin is sufficiently wide and the orientation of intended resection planes must match that of the custom implant. We describe a novel workflow of performing a partial acetabular resection in a patient with pelvic chondrosarcoma and reconstruction with a custom pelvic implant in a one-step operation. A multi-planar bone resection was virtually planned. A computer-aided design implant that both matched the bone defect and biomechanically evaluated was prefabricated with 3D printing technology. The 3D-printed patient-specific instruments (PSIs) were used to reproduce the same planned resection. The histology of the tumor specimen showed a clear resection margin. The errors of the achieved resection and implant position were deviating (1-4 mm) from the planned. The patient could walk unaided with a good hip function. No tumor recurrence and implant loosening were noted at 11 months after surgery. The use of this novel CTbased method for surgical planning, the engineering software for implant design and validation, together with 3D printing technology for implant and PSI fabrication makes it possible to generate a personalized, biomechanically evaluated implant for accurate reconstruction after a pelvic tumor resection in a one-step operation. Further study in a larger population is needed to assess the clinical efficacy of the workflow in complex bone tumor surgery. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection

Kumta

et al. 2015

Computer Aided Surgery

198

146

View full text Add to dashboard Cite

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“…Nowadays, knee and hip implant surgeries are performed around the world and considered one of the most common operations in clinical practice. A total of 300,000 knee arthroplasties are performed each year in the United States alone with the number increasing every year [1].…”

Section: Introductionmentioning

confidence: 99%

Experimental investigations of forces and torque in conventional and ultrasonically-assisted drilling of cortical bone

Alam

Mitrofanov

Silberschmidt

2011

Medical Engineering & Physics

185

135

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Citation: ALAM, K., MITROFANOV, A.V. and SILBERSCHMIDT, V.V., 2010.Experimental investigations of forces and torque in conventional and AbstractBone drilling is widely used in orthopaedics and surgery; it is a technically demanding surgical procedure. Recent technological improvements in this area are focused on efforts to reduce forces in bone drilling. This study focuses on forces and a torque required for conventional and ultrasonically-assisted tool penetration into fresh bovine cortical bone.Drilling tests were performed with two drilling techniques, and the influence of drilling speed, feed rate and parameters of ultrasonic vibration on the forces and torque was studied.Ultrasonically-assisted drilling (UAD) was found to reduce a drilling thrust force and torque compared to conventional drilling (CD). The mechanism behind lower levels of forces and torque was explored using high-speed filming of a drill-bone interaction zone and was linked to the chip shape and character of its formation. It is expected that UAD will produce holes with minimal effort and avoid unnecessary damage and accompanying pain during the incision.

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“…This technology gained widespread acceptance in dental surgery [18,19] and was gradually introduced in TKA [16,17,20,27,37,43]. Using a preoperative CT or MRI scan, disposable cutting blocks are produced.…”

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confidence: 99%

Patient-specific Guides Do Not Improve Accuracy in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Victor

Dujardin

Vandenneucker

et al. 2014

Clinical Orthopaedics &Amp; Related Research

158

197

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Background Recently, patient-specific guides (PSGs) have been introduced, claiming a significant improvement in accuracy and reproducibility of component positioning in TKA. Despite intensive marketing by the manufacturers, this claim has not yet been confirmed in a controlled prospective trial. Questions/purposes We (1) compared three-planar component alignment and overall coronal mechanical alignment between PSG and conventional instrumentation and (2) logged the need for applying changes in the suggested position of the PSG. Methods In this randomized controlled trial, we enrolled 128 patients. In the PSG cohort, surgical navigation was used as an intraoperative control. When the suggested cut deviated more than 3°from target, the use of PSG was abandoned and marked as an outlier. When cranial-caudal position or size was adapted, the PSG was marked as modified. All patients underwent long-leg standing radiography and CT scan. Deviation of more than 3°from the target in any plane was defined as an outlier. Results The PSG and conventional cohorts showed similar numbers of outliers in overall coronal alignment (25% versus 28%; p = 0.69), femoral coronal alignment (7% versus 14%) (p = 0.24), and femoral axial alignment (23% versus 17%; p = 0.50). There were more outliers in tibial coronal (15% versus 3%; p = 0.03) and sagittal 21% versus 3%; p = 0.002) alignment in the PSG group than in the conventional group. PSGs were abandoned in 14 patients (22%) and modified in 18 (28%). Conclusions PSGs do not improve accuracy in TKA and, in our experience, were somewhat impractical in that the procedure needed to be either modified or abandoned with some frequency. Level of Evidence Level I, therapeutic study. See instructions for authors for a complete description of levels of evidence.

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Custom-designed orthopedic implants evaluated using finite element analysis of patient-specific computed tomography data: femoral-component case study

Cited by 186 publications

References 10 publications

One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection

One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection

Experimental investigations of forces and torque in conventional and ultrasonically-assisted drilling of cortical bone

Patient-specific Guides Do Not Improve Accuracy in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

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