Computer-assisted optimization of correction osteotomies on lower extremities

Abstract

Automated methods are presented for the planning of correction osteotomies and osteosynthesis on lower extremities. Intraoperative calibrated X-ray images and kinematic measurements using optical tracking systems are the basis for the identification of the individual anatomy of the patient. The correction input of the surgeon, together with optimization algorithms, allows the calculation of the position and orientation of the osteotomies and the repositioning of the bone fragments. A navigation module supports the surgeon during the execution of osteotomies and repositioning, as well as osteosynthesis. So far, the approach has been evaluated in laboratory trials and ex vivo tests.

An automatic genetic algorithm framework for the optimization of three-dimensional surgical plans of forearm corrective osteotomies

“…Menetrey and Paul (2004) did a similar parametrization of the osteotomy plane and wedge size for osteotomies around the knee, optimizing only the reduction alignment. Schkommodau et al (2005) developed a multi-objective optimization strategy for corrective osteotomies of lower extremities that considered the following optimization objectives: leg length, translation, antetorsion, and angulation. Their method solved a simplified osteotomy sub-problem with only 12 DoF, which did not include the position of the fixation plate or the fixation screws into the optimization process.…”

“…In the field of corrective osteotomies of long bones, only a few works have tried to tackle the automatic optimization problem (Belei et al, 2007;Carrillo et al, 2017;Schkommodau et al, 2005). Although these approaches have been promising and are pioneers in the filed of automatic optimization for surgical planning of orthopedic surgeries, they still lack of solutions that can be readily applied in clinical practice without further modifications.…”

Die kniegelenksnahe Korrekturosteotomie und Navigation - eine Standortbestimmung im Rahmen des „OrthoMIT“-Projektes zur Entwicklung einer integrierten Plattform für schonende operative orthopädisch-traumatologische Therapie

“…B. maximale Osteotomieneigung, Osteotomiebereich, minimale Knochenkontaktfläche etc.) berücksichtigt werden, wurde von Schkommodau et al vorgestellt [35]. Dieser Ansatz berechnet…”

“…Zusammenfassend lässt sich sagen, dass alle hier vorgestellten Ansätze zur Deformitäten-Quantifizierung, Planung und intraoperativen Umsetzung meist nur die knöchernen Strukturen berücksichtigen. Funktionelle Informationen wie beispielsweise die Messung der Kniekinematik auf Basis von dynamischen Positionsmessungen [35], oder die Messung der Bandstabilität wie sie in einigen Navigationssystemen zur Knieendoprothetik verwendet werden [39], stellen bei den hier vorgestellten Ansätzen die Ausnahme dar. Vor allem die Messung der Bandstabilität dient dem Arzt mit den momentan vorgestellten Systemen lediglich als eine eher qualitative Informationsquelle und ist bis dato nur auf die Messung der Kollateralbänder beschränkt [39].…”

Comparison of an oblique single cut rotation osteotomy with a novel 3D computer-assisted oblique double cut alignment approach

“…By choosing an optimal set of correction parameters (osteotomy plane locations, osteotomy plane orientations, bone-segment rotations, in-plane bone-to-bone translations) one can minimize residual translations, yielding optimal alignment of the bone segments with a target bone. Preoperatively planning the right set of osteotomy parameters, however, is not a trivial task because several degrees of freedom have to be optimized for spatial adjustment of bone fragments, osteotomy locations and orientations, while taking into account biomechanical and medical constraints 8 .…”