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Computer-assisted mosaic arthroplasty using patient-specific instrument guides

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Success of mosaic arthroplasty requires that the transplanted plugs be positioned to reconstruct the curvature and height of the original articular surface. This case report demonstrates how to achieve correct plug positioning using patient-specific instrument guides manufactured on a 3D printer.

Methods

Using a 3D computer model of bone and cartilage, the harvesting of plugs and their placement at the defect site was planned on the computer. Instrument guides were manufactured in thermoplastic on a 3D printer; the bottom surface of the guides fit to the contour of the knee and the top surface contained holes to precisely position the surgical instruments. The instrument guides were used on a young female patient to repair a large articular cartilage defect in the left knee.

Results

The patient showed an increased range of motion in the knee and also a decrease in pain and discomfort at her 2-year follow-up. A CT arthrogram at 2 years postoperative showed a smooth and appropriate contour of the reconstructed cartilage over the defect.

Conclusions

Image-based preoperative planning and the use of patient-specific instrument guides can yield a good patient outcome without requiring optically tracked intraoperative guidance.

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References

  1. Birnbaum K, Schkommodau E, Decker N, Prescher A, Klapper U, Radermacher K (2001) Computer-assisted orthopedic surgery with individual templates and comparison to conventional operation method. Spine 26(4):365–370

    Article  PubMed  CAS  Google Scholar 

  2. Brown GA, Firoozbakhsh K, DeCoster TA, Reyna JR Jr, Moneim M (2003) Rapid prototyping: the future of trauma surgery? J Bone Jt Surg 85-A(Suppl 4):49–55

    Google Scholar 

  3. Delp SL, Stulberg SD, Davies B, Picard F, Leitner F (1998) Computer assisted knee replacement. Clin Orthop Relat Res 354:49–56

    Article  PubMed  Google Scholar 

  4. Dessenne V, Lavallee S, Julliard R, Orti R, Martelli S, Cinquin P (1995) Computer-assisted knee anterior cruciate ligament reconstruction: first clinical tests. J Imag Guided Surg 1(1):59–64

    Article  CAS  Google Scholar 

  5. Hangody L, Rathonyi GK, Duska Z, Vasarhelyi G, Fules P, Modis L (2004) Autologous osteochondral mosaicplasty. Surgical technique. J Bone Jt Surg 86-A(Suppl 1):65–72

    Google Scholar 

  6. Hangody L, Vásárhelyi G, Hangody LR, Sükösd Z, Tibay G, Bartha L, Bodó G (2008) Autologous osteochondral grafting-technique and long-term results. Injury 39(Suppl 1):S32–S39

    Article  PubMed  Google Scholar 

  7. Imhoff AB, Ottl GM, Burkart A, Traub S (1999) Autologous osteochondral transplantation on various joints. Orthopade 28(1):33–44

    PubMed  CAS  Google Scholar 

  8. Inoue J, Kunz M, Hurtig M, Waldman S, Stewart J (2011) Automated planning of computer assisted mosaic arthroplasty, proceedings of medical image computing and computer assisted intervention (MICCAI). pp 267–274

  9. Jakob RP, Franz T, Gautier E, Mainil-Varlet P (2002) Autologous osteochondral grafting in the knee: indication, results, and reflections. Clin Orthop Relat Res 401:170–184

    Article  PubMed  Google Scholar 

  10. Klos TV, Habets RJ, Banks AZ, Banks SA, Devilee RJ, Cook FF (1998) Computer assistance in arthroscopic anterior cruciate ligament reconstruction. Clin Orthop Relat Res 354:65–69

    Article  PubMed  Google Scholar 

  11. Koh JL, Wirsing K, Lautenschlager E, Zhang LO (2004) The effect of graft height mismatch on contact pressure following osteochondral grafting: a biomechanical study. Am J Sports Med 32(2):317–320

    Article  PubMed  Google Scholar 

  12. Koulalis D, Di Benedetto P, Citak M, O’Loughlin P, Pearle AD, Kendoff DO (2009) Comparative study of navigated versus freehand osteochondral graft transplantation of the knee. Am J Sports Med 37(4):803–807

    Article  PubMed  Google Scholar 

  13. Kunz M, Rudan JF, Xenoyannis GL, Ellis RE (2010) Computer-assisted hip resurfacing using individualized drill templates. J Arthroplas 25(4):600–606

    Article  Google Scholar 

  14. Ma B, Ellis RE (2003) Robust registration for computer-integrated orthopedic surgery: laboratory validation and clinical experience. Med Image Anal 7(3):237–250

    Article  PubMed  CAS  Google Scholar 

  15. Owen BD, Christensen GE, Reinhardt JM, Ryken TC (2007) Rapid prototype patient-specific drill template for cervical pedicle screw placement. Comp Surg 12(5):303–308

    Google Scholar 

  16. Radermacher K, Portheine F, Anton M, Zimolong A, Kaspers G, Rau G, Staudte HW (1998) Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res 354:28–38

    Article  PubMed  Google Scholar 

  17. Sati M, Staeubli H-U, Bourquin Y, Kunz M, Kaesermann S, Nolte L-P (2000) Clinical integration of new computer assisted technology in orthopaedics. Operative Tech Orthop 10:9

    Article  Google Scholar 

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Acknowledgments

This work was supported by grant STPGP 336779 from the Natural Sciences and Engineering Research Council of Canada. The authors are grateful to Nanette Isaac for her help with data collection and to the surgical and perioperative teams of the Kingston General Hospital, Canada.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Kingston General Hospital, Queen’s University, Kingston, ON, K7L 3N6, Canada

    Manuela Kunz, John F. Rudan & Davide D. Bardana

  2. School of Computing, Queen’s University, Kingston, ON, K7L 3N6, Canada

    Manuela Kunz & A. James Stewart

  3. Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, K7L 3N6, Canada

    Stephen D. Waldman

Authors
  1. Manuela Kunz
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  2. Stephen D. Waldman
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  3. John F. Rudan
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  4. Davide D. Bardana
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  5. A. James Stewart
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Corresponding author

Correspondence to A. James Stewart.

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Kunz, M., Waldman, S.D., Rudan, J.F. et al. Computer-assisted mosaic arthroplasty using patient-specific instrument guides. Knee Surg Sports Traumatol Arthrosc 20, 857–861 (2012). https://doi.org/10.1007/s00167-011-1638-2

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  • DOI: https://doi.org/10.1007/s00167-011-1638-2

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