Docking Robustness of Patient Specific Surgical Guides for Joint Replacement Surgery

2015 ◽  
Vol 137 (6) ◽  
Author(s):  
Joost Mattheijer ◽  
Just L. Herder ◽  
Gabriëlle J. M. Tuijthof ◽  
Edward R. Valstar
Keyword(s):  
Joint Replacement ◽  
Patient Specific ◽  
Angular Deviation ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Surgical Guides ◽  
Surgery Patient ◽  
Graphical Tool ◽  
Robustness Framework ◽  
Contact Efficiency

In joint replacement surgery, patient specific surgical guides (PSSGs) are used for accurate alignment of implant components. PSSGs are designed preoperatively to have a geometric fit with the patient's bone such that the incorporated guidance for drilling and cutting is instantly aligned. The surgeon keeps the PSSG in position with a pushing force, and it is essential that this position is maintained while drilling or cutting. Hence, the influence of the location and direction of the pushing force should be minimal. The extent that the pushing force may vary is what we refer to as docking robustness. In this article, we present a docking robustness framework comprising the following quantitative measures and graphical tool. Contact efficiency ηc is used for the quantification of the selected bone–guide contact. Guide efficiency ηg is used for the quantification of the whole guide including an application surface whereon the surgeon can push. Robustness maps are used to find a robust location for the application surface based on gradient colors. Robustness R is a measure indicating what angular deviation is minimally allowed at the worst point on the application surface. The robustness framework is utilized in an optimization of PSSG dimensions for the distal femur. This optimization shows that 12 contacts already result in a relatively high contact efficiency of 0.74 ± 0.02 (where the maximum of 1.00 is obtained when the guide is designed for full bone–guide contact). Six contacts seem to be insufficient as the obtained contact efficiency is only 0.18 ± 0.02.

Shaping Patient Specific Surgical Guides for Arthroplasty to Obtain High Docking Robustness

2013 ◽  
Vol 135 (7) ◽  
Author(s):  
Joost Mattheijer ◽  
Just L. Herder ◽  
Gabriëlle J. M. Tuijthof ◽  
Rob G. H. H. Nelissen ◽  
Jenny Dankelman ◽  
...  
Keyword(s):  
Analytical Method ◽  
Joint Surface ◽  
Patient Specific ◽  
Theoretic Approach ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Surgical Guides ◽  
Physical Experiments ◽  
Minimal Contact ◽  
Angular Limits

Patient specific surgical guides (PSSGs) are used in joint replacement surgery to simplify the surgical process and to increase the accuracy in alignment of implant components with respect to the bone. Each PSSG is fabricated patient specifically and fits only in the planned position on the joint surface by the matching shape. During surgery, the surgeon holds the PSSG in the planned position and the incorporated guidance is used in making the essential cuts to fit the implant components. The shape of the PSSG determines its docking robustness (i.e., the range of forces that the surgeon may apply without losing the planned position). Minimal contact between the PSSG and the joint surface is desired, as this decreases the likelihood of interposition with undetected tissues. No analytical method is known from literature where the PSSG shape can be optimized to have high docking robustness and minimal bone-guide contact. Our objective is to develop and validate such an analytical method. The methods of motion restraint, moment labeling and wrench space—applied in robotic grasping and workpart fixturing—are employed in the creation of this new method. The theoretic approach is utilized in an example by optimizing the PSSG shape for one joint surface step-by-step. The PSSGs that arise from these optimization steps are validated with physical experiments. The following design tools for the analytical method are introduced. The optimal location for bone-guide contact and the application surface where the surgeon may push can be found graphically, respectively, by the use of the wrench space map and the application angle map. A quantitative analysis can be conducted using the complementary wrench space metrics and the robustness metric R. Utilization of the analytical method with an example joint surface shows that the PSSG's shape can be optimized. Experimental validation shows that the standard deviation of the error between the measured and calculated angular limits in the docking force is only 0.7 deg. The analytical method provides valid results and thus can be used for the design of PSSGs.

scholarly journals Anti-Phospholipid Antibodies in Patients Undergoing Total Joint Replacement Surgery

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Melissa Simpson ◽  
Michael J. Sanfelippo ◽  
Adedayo A. Onitilo ◽  
James K. Burmester ◽  
William Hocking ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Patient Specific ◽  
Preoperative Period ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Increased Risk ◽  
Patients At Risk ◽  
Total Knee ◽  
Arthroplasty Procedure

Background. Patients undergoing joint replacement remain at increased risk for venous thromboembolism (VTE) compared to other types of surgery, regardless of thromboprophylactic regimen. The pathophysiologic processes rendering this group of patients at risk for VTE are multifactorial. Procedure-specific and patient-specific exposures play a role in the postoperative development of VTE, including the development of anti-phospholipid antibodies (aPL). Methods. We measured three aPL (anti-cardiolipin, anti-β2 glycoprotein, and lupus anticoagulant) in 123 subjects undergoing total knee or hip arthroplasty to describe the presence of these antibodies preoperatively and to describe the rate of postoperative seroconversion among those people who were negative preoperatively. Postoperative antibodies were measured at day 7, 14, and 21. Results. The prevalence of aPL antibodies in the preoperative period was 44%, positive subjects were more likely to be smokers (P=0.05) and were less likely to have undergone a previous arthroplasty procedure (P=0.002). Subjects seroconverted in a 21 day postoperative period at a rate of 79%. Conclusions. These pilot data suggest that the prevalence of aPL in this population both preoperatively and postoperatively is higher than previously expected. Further studies are needed to describe aPL in a larger population and to establish their clinical significance in populations undergoing joint replacement surgeries.

scholarly journals COVID-19 (SARS-CoV-2) lymphocyte responses are associated with inflammatory biomarkers in total joint replacement surgery candidates pre-operatively

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Marco S. Caicedo ◽  
Vianey Flores ◽  
Alicia Padilla ◽  
Samelko Lauryn ◽  
Joshua J. Jacobs ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Cross Reactivity ◽  
Inflammatory Biomarkers ◽  
Nucleocapsid Proteins ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Operative Planning ◽  
Lymphocyte Responses ◽  
Reactive Lymphocytes

Abstract Background Recent studies indicate that, in addition to antibody production, lymphocyte responses to SARS-CoV-2 may play an important role in protective immunity to COVID-19 and a percentage of the general population may exhibit lymphocyte memory due to unknown/asymptomatic exposure to SARS-CoV-2 or cross-reactivity to other more common coronaviruses pre-vaccination. Total joint replacement (TJR) candidates returning to elective surgeries (median age 68 years) may exhibit similar lymphocyte and/or antibody protection to COVID-19 prior to vaccination Methods In this retrospective study, we analyzed antibody titters, lymphocyte memory, and inflammatory biomarkers specific for the Spike and Nucleocapsid proteins of the SARS-CoV-2 virus in a cohort of n=73 returning TJR candidates (knees and/or hips) pre-operatively. Results Peripheral blood serum of TJR candidate patients exhibited a positivity rate of 18.4% and 4% for IgG antibodies specific for SARS-CoV-2 nucleocapsid and spike proteins, respectively. 13.5% of TJR candidates exhibited positive lymphocyte reactivity (SI > 2) to the SARS-CoV-2 nucleocapsid protein and 38% to the spike protein. SARS-CoV-2 reactive lymphocytes exhibited a higher production of inflammatory biomarkers (i.e., IL-1β, IL-6, TNFα, and IL-1RA) compared to non-reactive lymphocytes. Conclusions A percentage of TJR candidates returning for elective surgeries exhibit pre-vaccination positive SARS-CoV-2 antibodies and T cell memory responses with associated pro-inflammatory biomarkers. This is an important parameter for understanding immunity, risk profiles, and may aid pre-operative planning. Trial registration Retrospectively registered.

scholarly journals Meaningful changes for the Oxford hip and knee scores after joint replacement surgery

2015 ◽  
Vol 68 (1) ◽  
pp. 73-79 ◽  
Author(s):  
David J. Beard ◽  
Kristina Harris ◽  
Jill Dawson ◽  
Helen Doll ◽  
David W. Murray ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Joint Replacement Surgery ◽  
Replacement Surgery

Quantifying function before and after total joint replacement surgery in patients with hip osteoarthritis

2015 ◽  
Vol 42 ◽  
pp. S32
Author(s):  
J.E. Naili ◽  
A.C. Esbjörnsson ◽  
M.D. Iversen ◽  
M.H. Schwartz ◽  
C. Häger ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Hip Osteoarthritis ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Before And After
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