Sima Zakani1, Christopher Chapman2, Adam Saule3, Anthony Cooper4,5, Kishore Mulpuri6,7, David R Wilson5. 1. Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. 2. Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA. 3. Department of Mechanical Engineering, Dalhousie University, Halifax, NS, Canada. 4. Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada. 5. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada. 6. Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada. kmulpuri@cw.bc.ca. 7. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada. kmulpuri@cw.bc.ca.
Abstract
BACKGROUND: Subcapital osteotomy by means of surgical hip dislocation is a treatment approach offered for moderate-to-severe cases of Slipped Capital Femoral Epiphysis (SCFE). This procedure is demanding, highly dependent on the surgeon's experience, and requires considerable radiation exposure for monitoring and securing the spatial alignment of the femoral head. We propose the use of individualized drill guides as an accurate method for placing K-wires during subcapital correction osteotomies in SCFE patients. METHODS: Five CT scans of the hip joint from otherwise healthy patients with moderate-to-severe SCFE were selected (ages 11-14). Three dimensional models of each patient's femur were reconstructed by manual segmentation and physically replicated using additive manufacturing techniques. Five orthopaedic surgeons virtually identified the optimal entry point and direction of the two threaded wires for each case. 3D printed drill guides were designed specific to each surgical plan, with one side shaped to fit the patient's bone and the other side containing holes to guide the surgical drill. Each surgeon performed three guided (using the drill guides) and three conventional (freehand) simulated procedures on each case. Each femur model was laser scanned and digitally matched to the preoperative model for evaluation of entry points and wire angulations. We compared wire entry point, wire angulation, procedure time and number of x-rays between guided and freehand simulated surgeries. RESULTS: The guided group (1.4 ± 0.9 mm; 2.5° ± 1.4°) was significantly more accurate than the freehand group (5.8 ± 3.2 mm; 5.3° ± 4.4°) for wire entry location and angulation (p < 0.001). Guided surgeries required significantly less drilling time and intraoperative x-rays (90.5 ± 42.2 s, 3 ± 1 scans) compared to the conventional surgeries (246.8 ± 122.1 s, 14 ± 5 scans) (p < 0.001). CONCLUSIONS: We conclude that CT-based preoperative planning and intraoperative navigation using individualized drill guides allow for improved accuracy of wires, reduced operative time and less radiation exposure in simulated hips. CLINICAL RELEVANCE: This preliminary study shows promising results, suggesting potential direct benefits to SCFE patients by necessitating less time under anesthesia and less intra-operative radiation exposure to patients, and increasing surgical accuracy.
BACKGROUND: Subcapital osteotomy by means of surgical hip dislocation is a treatment approach offered for moderate-to-severe cases of Slipped Capital Femoral Epiphysis (SCFE). This procedure is demanding, highly dependent on the surgeon's experience, and requires considerable radiation exposure for monitoring and securing the spatial alignment of the femoral head. We propose the use of individualized drill guides as an accurate method for placing K-wires during subcapital correction osteotomies in SCFE patients. METHODS: Five CT scans of the hip joint from otherwise healthy patients with moderate-to-severe SCFE were selected (ages 11-14). Three dimensional models of each patient's femur were reconstructed by manual segmentation and physically replicated using additive manufacturing techniques. Five orthopaedic surgeons virtually identified the optimal entry point and direction of the two threaded wires for each case. 3D printed drill guides were designed specific to each surgical plan, with one side shaped to fit the patient's bone and the other side containing holes to guide the surgical drill. Each surgeon performed three guided (using the drill guides) and three conventional (freehand) simulated procedures on each case. Each femur model was laser scanned and digitally matched to the preoperative model for evaluation of entry points and wire angulations. We compared wire entry point, wire angulation, procedure time and number of x-rays between guided and freehand simulated surgeries. RESULTS: The guided group (1.4 ± 0.9 mm; 2.5° ± 1.4°) was significantly more accurate than the freehand group (5.8 ± 3.2 mm; 5.3° ± 4.4°) for wire entry location and angulation (p < 0.001). Guided surgeries required significantly less drilling time and intraoperative x-rays (90.5 ± 42.2 s, 3 ± 1 scans) compared to the conventional surgeries (246.8 ± 122.1 s, 14 ± 5 scans) (p < 0.001). CONCLUSIONS: We conclude that CT-based preoperative planning and intraoperative navigation using individualized drill guides allow for improved accuracy of wires, reduced operative time and less radiation exposure in simulated hips. CLINICAL RELEVANCE: This preliminary study shows promising results, suggesting potential direct benefits to SCFE patients by necessitating less time under anesthesia and less intra-operative radiation exposure to patients, and increasing surgical accuracy.
Authors: Alessandro Massè; Alessandro Aprato; Guido Grappiolo; Luigino Turchetto; Antonio Campacci; Reinhold Ganz Journal: Hip Int Date: 2012 Mar-Apr Impact factor: 2.135
Authors: Kenneth T Bono; Michael D Rubin; Kerwyn C Jones; Patrick M Riley; Todd F Ritzman; William C Schrader; Paul Fleissner; Richard P Steiner; Melanie A Morscher; Mark J Adamczyk Journal: J Pediatr Orthop Date: 2013-03 Impact factor: 2.324
Authors: Gregory R Roytman; Alim F Ramji; Brian Beitler; Brad Yoo; Michael P Leslie; Michael Baumgaertner; Steven Tommasini; Daniel H Wiznia Journal: 3D Print Med Date: 2022-07-04