Postoperative results on computer assisted planning and navigation of femoral head reduction osteotomies in severe perthes deformities
ESSKA Academy. Casari F. 11/08/19; 284450; epESMA-50 Topic: E13 - Open proximal femoral osteotomy
Fabio A. Casari
Fabio A. Casari
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Postoperative results on computer assisted planning and navigation of femoral head reduction osteotomies in severe perthes deformities

ePoster - epESMA-50

Topic: Sports Trauma

Casari F.A.1,2, Fuernstahl P.2, Leunig M.3, Ganz R.4
1Orthopedic University Hospital Balgrist, Zürich, Switzerland, 2Computer Assisted Research & Development Group, Balgrist University Hospital, University of Zurich, Zürich, Switzerland, 3Clinic Wilhelm Schulthess, Zurich, Switzerland, 4Medical University of Berne, Berne, Switzerland

Legg-Calvé-Perthes disease can cause severe deformity of femoral head and acetabulum. Mobility is very restricted. Sustainable improvement is difficult to achieve with common osteotomy techniques, while reduction of the femur head significantly improved motion and pain relief in short and long-term studies. The high complexity of the deformity makes preoperative planning and execution of FHRO a difficult thing to deal with, reason why surgeons may hesitate to venture the task. To allow FHRO as a feasible treatment option we developed the computer-assisted technique, employing computer simulation for pre-operative planning of the surgery. For execution, patient-specific instruments (PSI) are employed as navigation aids to realize the complex reshaping. We present our previous experience and radiologic outcomes of 7 cases treated with the new technique.
Methods: 7 patients underwent preoperative CT imaging for generation of 3D anatomical bone models using threshold segmentation. The models were imported into the planning software CASPA (Balgrist CARD AG, Zurich, Switzerland). Biomedical engineers planned the cutting planes (trochanter, medial head, and lateral head osteotomy) with the surgeons support. Osteotomy direction and reduction were iteratively simulated and refined yielding the most spherical shape. PSI, having an unique fit on the bone surface, were designed and 3D printed.
Results: In all 7 patients, surgical precision, challenges and surgery time were assessed. radiographies were obtained for the assessment of the sphericity index, Shenton's line, extrusion index, LCE-, CCD-, alpha-, Tönnisangle, acetabular index and femoral off-set. Planning and simulation of the first case, was 10h. Time for the following case could be reduced to 3h. In all patients the PSI could be placed without difficulties and the osteotomies could be performed as designed. Postoperative radiographs showed excellent agreement with the 3D planning. The early postoperative course was uneventful.
Conclusion: First results of the computer assisted FHRO's with 3D planning are very encouraging. The performing surgeons favored the application of the PSI as helpful tool to achieve the planned reduction. Time and costs are main limitations of this method, but remain superior to costs but may be further reduced an automated planning algorithm. We believe computer-assisted-FHRO is a feasible surgical therapy to treat the severely deformed LCDP hip.
Postoperative results on computer assisted planning and navigation of femoral head reduction osteotomies in severe perthes deformities

ePoster - epESMA-50

Topic: Sports Trauma

Casari F.A.1,2, Fuernstahl P.2, Leunig M.3, Ganz R.4
1Orthopedic University Hospital Balgrist, Zürich, Switzerland, 2Computer Assisted Research & Development Group, Balgrist University Hospital, University of Zurich, Zürich, Switzerland, 3Clinic Wilhelm Schulthess, Zurich, Switzerland, 4Medical University of Berne, Berne, Switzerland

Legg-Calvé-Perthes disease can cause severe deformity of femoral head and acetabulum. Mobility is very restricted. Sustainable improvement is difficult to achieve with common osteotomy techniques, while reduction of the femur head significantly improved motion and pain relief in short and long-term studies. The high complexity of the deformity makes preoperative planning and execution of FHRO a difficult thing to deal with, reason why surgeons may hesitate to venture the task. To allow FHRO as a feasible treatment option we developed the computer-assisted technique, employing computer simulation for pre-operative planning of the surgery. For execution, patient-specific instruments (PSI) are employed as navigation aids to realize the complex reshaping. We present our previous experience and radiologic outcomes of 7 cases treated with the new technique.
Methods: 7 patients underwent preoperative CT imaging for generation of 3D anatomical bone models using threshold segmentation. The models were imported into the planning software CASPA (Balgrist CARD AG, Zurich, Switzerland). Biomedical engineers planned the cutting planes (trochanter, medial head, and lateral head osteotomy) with the surgeons support. Osteotomy direction and reduction were iteratively simulated and refined yielding the most spherical shape. PSI, having an unique fit on the bone surface, were designed and 3D printed.
Results: In all 7 patients, surgical precision, challenges and surgery time were assessed. radiographies were obtained for the assessment of the sphericity index, Shenton's line, extrusion index, LCE-, CCD-, alpha-, Tönnisangle, acetabular index and femoral off-set. Planning and simulation of the first case, was 10h. Time for the following case could be reduced to 3h. In all patients the PSI could be placed without difficulties and the osteotomies could be performed as designed. Postoperative radiographs showed excellent agreement with the 3D planning. The early postoperative course was uneventful.
Conclusion: First results of the computer assisted FHRO's with 3D planning are very encouraging. The performing surgeons favored the application of the PSI as helpful tool to achieve the planned reduction. Time and costs are main limitations of this method, but remain superior to costs but may be further reduced an automated planning algorithm. We believe computer-assisted-FHRO is a feasible surgical therapy to treat the severely deformed LCDP hip.
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