Patient-specific Reconstruction of Large Bone Defects: Clinical Success Due to an Integrated Bioengineering Workflow

被引:2
作者
Bartels, W. [1 ]
Gelaude, F. [2 ]
Delport, H.
Jonkers, I. [3 ]
Vander Sloten, J. [1 ]
机构
[1] Katholieke Univ Leuven, Biomech Sect, Leuven, Belgium
[2] Materialise NV, Leuven, Belgium
[3] Katholieke Univ Leuven, Dept Kinesiol, Leuven, Belgium
来源
XIV MEDITERRANEAN CONFERENCE ON MEDICAL AND BIOLOGICAL ENGINEERING AND COMPUTING 2016 | 2016年 / 57卷
关键词
Biomechanics; joint replacement; acetabular reconstruction; patient specific procedure; MECHANICAL-PROPERTIES; ARTHROPLASTY; ACCURACY; IMPLANT;
D O I
10.1007/978-3-319-32703-7_126
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
Surgical reconstruction of major acetabular defects (Paprosky type IIIb) in view of total hip replacement is a challenge. Existing systems have a documented failure rate between 20% and 50% at five years post-operatively. Our first hypothesis is that this limited success is due to the fact that standard components have to be adapted and assembled intraoperatively to provide a patient solution. Hence our second hypothesis is that a fully personalized solution for acetabular reconstruction will provide an added value for the patient's outcome. An integrated workflow has been developed that starts from the patient's CT images of the pelvic region and then generates a Computer Aided Design based proposal for an acetabular reconstruction of the defect. This design is iterated between biomedical engineers and the surgeon. It is then evaluated by means of a patient-specific finite element analysis including patient-specific estimation of the musculoskeletal loading at the hip joint. Also the fixation of the acetabular implant by means of screws is optimized taking into account local bone quantity and quality. Production is achieved through additive manufacturing in metal. In addition to the implant, a patient-specific drill guide is designed and produced to assist the surgeon during drilling the preholes for the screw fixation. A bone model and a trial implant are provided as well for use during the surgical procedure. So far (November 2015) over 260 procedures have been performed since 2009, of which 183 are fully documented. Patient success is very high, only three revisions have been reported (of which two due to infections). We believe this is a successful example of technology transfer from biomedical engineering research to patient treatment. However, as this is a niche application, cost-effective implementation of an integrated design and production workflow is essential to achieve commercial success.
引用
收藏
页码:653 / 656
页数:4
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