Radiographic Outcomes of Preoperative CT Scan–Derived Patient-Specific Total Ankle Arthroplasty

Hsu, Andrew R.; Davis, W. Hodges; Cohen, Bruce E.; Jones, Carroll P.; Ellington, J. Kent; Anderson, Robert B.

doi:10.1177/1071100715585561

Cited by 70 publications

(58 citation statements)

References 21 publications

(27 reference statements)

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“…Apart from orthopedics (guides for knee arthroplasties), 3D-printed surgical guides were also used in neurosurgery, dental surgery, spinal surgery, and maxillofacial surgery. 28 of the 53 studies that mentioned reduced operation room time also supported this claim with numbers or statistics [ 39 , 74 , 81 , 84 , 118 , 131 , 132 , 135 , 136 , 140 , 141 , 145 , 151 , 152 , 162 , 175 , 177 , 181 , 190 , 194 , 196 , 200 , 207 , 210 – 212 , 219 ]. Increased procedural time was seen in seven papers, of which five supported this with numbers or statistics [ 62 , 73 , 125 , 143 , 153 , 161 , 225 ].…”

Section: Resultsmentioning

confidence: 87%

3D-printing techniques in a medical setting: a systematic literature review

et al. 2016

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BackgroundThree-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes.MethodsThree major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans.Results227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure.Conclusion3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost–effectiveness analysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12938-016-0236-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 87%

3D-printing techniques in a medical setting: a systematic literature review

et al. 2016

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“…These results also support the emphasis on the manufacture of talar components of patient-specific size for use in total ankle arthroplasty implants [29]. Even if the measurement of the ankle-related bones had been done for the sizing of implant in the total ankle arthroplasty, Hsu et al found that talar implant sizing was not as accurate due to individual surgeon preference regarding the extent of gutter debridement [30]. Based on the results of the present study, measurement of the contralateral talus may not be the only useful method for determining the size of the talus of interest.…”

Section: Plos Onementioning

confidence: 61%

Morphometric geometric differences between right and left human tali: A cadaveric study of fluctuating asymmetry via systematic measurement and three-dimensional scanning

et al. 2020

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Background Little is known about differences in the size and morphology of the right and left human tali. The present study demonstrates differences between right and left talar morphometric geometric profiles as fluctuating asymmetry in matched pairs of cadaveric specimens. Methods In total, 24 tali were collected in this study. All eligible tali were systematically measured with a Vernier caliper and three-dimensional laser scanner, which provided data for further analysis regarding the talar morphometric geometric profiles. Data were calculated to demonstrate differences between the right and left talar profiles using a matched-pair method, including the general size of the talus. Results The average talar length was 53.5 mm, the average talar dome height was 31.2 mm, and the average talar body width was 41.3 mm. The average anterior trochlear width, middle trochlear width, posterior trochlear width, and trochlear length were 31.8, 31.2, 28.3, and 30.7 mm, respectively. Eleven matched pairs of intact tali were eligible for the matched-pair study. Paired t-tests showed significant differences in the talar dome height (P = 0.019), middle trochlear width (P = 0.027), and posterior trochlear width (P = 0.016) between the right

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“…The use of computer-aided surgery and custom-made cutting guides have been proposed in recent years to improve surgical technique, implant positioning, and theoretically clinical outcomes [10,11]. However, there is still no clear evidence about which type of instrument or device is capable of providing better clinical results [12].…”

Section: Discussionmentioning

confidence: 99%

“…Even a small malpositioning of the implant components has a relevant impact on motion and contact pressure, which may lead ultimately to failure [9]. Great efforts have been devoted to improving surgical techniques and implant positioning, including the use of computer-aided surgery and custom cutting guides, supported also by imaging from computed tomography (CT) scans and by preoperative planning software [10]. In particular, personalized cutting guides, also known in general as patient-specific instrumentation (PSI), are customized with respect to each patient anatomy and are expected to provide more accurate component positioning [11].…”

Section: Introductionmentioning

confidence: 99%

A new ligament-compatible patient-specific 3D-printed implant and instrumentation for total ankle arthroplasty: from biomechanical studies to clinical cases

et al. 2020

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Background: Computer navigation and patient-specific instrumentation for total ankle arthroplasty have still to demonstrate their theoretical ability to improve implant positioning and functional outcomes. The purpose of this paper is to present a new and complete total ankle arthroplasty customization process for severe posttraumatic ankle joint arthritis, consisting of patient-specific 3D-printed implant and instrumentation, starting from a ligament-compatible design. Case presentation: The new customization process was proposed in a 57-year-old male patient and involved image analysis, joint modeling, prosthesis design, patient-specific implant and instrumentation development, relevant prototyping, manufacturing, and implantation. Images obtained from a CT scan were processed for a 3D model of the ankle, and the BOX ankle prosthesis (MatOrtho, UK) geometries were customized to best fit the model. Virtual in silico, i.e., at the computer, implantation was performed to optimize positioning of these components. Corresponding patient-specific cutting guides for bone preparation were designed. The obtained models were printed in ABS by additive manufacturing for a final check. Once the planning procedure was approved, the models were sent to final state-of-the-art additive manufacturing (the metal components using cobalt-chromium-molybdenum powders, and the guides using polyamide). The custom-made prosthesis was then implanted using the cutting guides. The design, manufacturing, and implantation procedures were completed successfully and consistently, and final dimensions and location for the implant corresponded with the preoperative plan. Immediate post-op X-rays showed good implant positioning and alignment. After 4 months, clinical scores and functional abilities were excellent. Gait analysis showed satisfactory joint moment at the ankle complex and muscle activation timing within normality. Conclusions: The complete customization process for total ankle arthroplasty provided accurate and reliable implant positioning, with satisfactory short-term clinical outcomes. However, further studies are needed to confirm the potential benefits of this complete customization process. Level of evidence: 5. Case report.

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Radiographic Outcomes of Preoperative CT Scan–Derived Patient-Specific Total Ankle Arthroplasty

Abstract: Level IV, retrospective case series.

Cited by 70 publications

References 21 publications

3D-printing techniques in a medical setting: a systematic literature review

3D-printing techniques in a medical setting: a systematic literature review

Morphometric geometric differences between right and left human tali: A cadaveric study of fluctuating asymmetry via systematic measurement and three-dimensional scanning

A new ligament-compatible patient-specific 3D-printed implant and instrumentation for total ankle arthroplasty: from biomechanical studies to clinical cases

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