Preoperative, Computer Simulation-Based, Three-Dimensional Corrective Osteotomy for Cubitus Varus Deformity with Use of a Custom-Designed Surgical Device

Takeyasu, Yukari; Oka, Kunihiro; Miyake, Junichi; Kataoka, Takao; Moritomo, Hisao; Murase, Tsuyoshi

doi:10.2106/jbjs.l.01622

Cited by 81 publications

(84 citation statements)

References 40 publications

(68 reference statements)

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“…Part of the clinical results of these patients has already been provided in a previous study (cases 1-10). 34 The mean age of the patients at corrective osteotomy was 17.6 years (range, 8-45 years), and the mean duration from initial injury to surgery was 135 months (range, 12-480 months). Of the 17 patients, 13 had been treated with cast immobilization for the initial fracture, 3 had undergone percutaneous pinning, and 1 had undergone open reduction and internal fixation with Kirschner wire.…”

Section: Subjectsmentioning

confidence: 99%

“…9,10,15,30,38 Since 2003, we have been developing an original computer program that employs 3D imaging to simulate anatomic correction of the upper limb deformity based on computed tomography (CT) data. 18,19,22,34 In this system, we used a custom-made osteotomy and reduction guide to reproduce preoperative simulation in the actual surgical treatment of cubitus varus deformities, malunited distal radial fractures, and forearm fractures. 18,19,22 Internal fixation of the osteotomy site was performed with Kirschner wires or bone plates while the correction was being temporarily maintained.…”

mentioning

confidence: 99%

“…34 However, detailed 3D accuracy of the osteotomy, measured with CT data, remains to be determined. The purpose of this study was to determine the accuracy of this system in clinical cases with use of preoperative and postoperative 3D CT bone models.…”

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confidence: 99%

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Postoperative accuracy analysis of three-dimensional corrective osteotomy for cubitus varus deformity with a custom-made surgical guide based on computer simulation

Omori

Murase

Oka

et al. 2015

Journal of Shoulder and Elbow Surgery

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Section: Subjectsmentioning

confidence: 99%

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confidence: 99%

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Postoperative accuracy analysis of three-dimensional corrective osteotomy for cubitus varus deformity with a custom-made surgical guide based on computer simulation

Omori

Murase

Oka

et al. 2015

Journal of Shoulder and Elbow Surgery

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“…PSI is applied to joint arthroplasty, [8,9] spinal pedicle screws insertion [10,11] and deformity correction. [12,13] PSI has recently been investigated in bone tumor surgery. Pelvic tumor resection under the PSI guidance was simulated in a sawbone study.…”

Section: Introductionmentioning

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

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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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“…Note that the intra-articular fragments of the preoperative plan (brown) were virtually fused to make the registration more robust (Color figure online) accuracy of 1°/1 mm was reported for distal radius osteotomies performed with a similar technique. Several other studies have evaluated the feasibility and accuracy in a clinical setting for the forearm bones [29][30][31], the humerus [52], and the lower extremities [34]. In these studies, an average deviation from the 3D preoperative plan between 1°and 5°was measured after surgery, but the evaluation was only performed on postoperative radiographs.…”

Section: Resultsmentioning

confidence: 99%

Surgical Treatment of Long-Bone Deformities: 3D Preoperative Planning and Patient-Specific Instrumentation

Fürnstahl

Schweizer

Graf

et al. 2015

Computational Radiology for Orthopaedic Interventions

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Congenital or posttraumatic bone deformity may lead to reduced range of motion, joint instability, pain, and osteoarthritis. The conventional joint-preserving therapy for such deformities is corrective osteotomy-the anatomical reduction or realignment of bones with fixation. In this procedure, the bone is cut and its fragments are correctly realigned and stabilized with an implant to secure their position during bone healing. Corrective osteotomy is an elective procedure scheduled in advance, providing sufficient time for careful diagnosis and operation planning. Accordingly, computer-based methods have become very popular for its preoperative planning. These methods can improve precision not only by enabling the surgeon to quantify deformities and to simulate the intervention preoperatively in three dimensions, but also by generating a surgical plan of the required correction. However, generation of complex surgical plans is still a major challenge, requiring sophisticated techniques and profound clinical expertise. In addition to preoperative planning, computer-based approaches can also be used to support surgeons during the course of interventions. In particular, since recent advances in additive manufacturing technology have enabled cost-effective production of patient-and intervention-specific osteotomy instruments, customized interventions can thus be planned for and performed using such instruments. In this chapter, state of the art and future perspectives of computer-assisted deformity-correction surgery of the upper and lower extremities are presented. We elaborate on the benefits and pitfalls of different approaches based on our own experience in treating over 150 patients with three-dimensional preoperative planning and patient-specific instrumentation.

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Preoperative, Computer Simulation-Based, Three-Dimensional Corrective Osteotomy for Cubitus Varus Deformity with Use of a Custom-Designed Surgical Device

Abstract: Three-dimensional corrective osteotomy with the use of a custom-made surgical template that is designed and produced on the basis of computer simulation is a feasible and useful treatment option for cubitus varus deformity.

Cited by 81 publications

References 40 publications

Postoperative accuracy analysis of three-dimensional corrective osteotomy for cubitus varus deformity with a custom-made surgical guide based on computer simulation

Postoperative accuracy analysis of three-dimensional corrective osteotomy for cubitus varus deformity with a custom-made surgical guide based on computer simulation

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

Surgical Treatment of Long-Bone Deformities: 3D Preoperative Planning and Patient-Specific Instrumentation

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