Metabolomics patterns of breast cancer tumors using mass spectrometry imaging.

PURPOSE: Intraoperative assessment of surgical margins is important for reducing the rate of revisions in breast conserving surgery for palpable malignant tumors. The hypothesis was that metabolomics methods, based on mass spectrometry, could find patterns of relative abundances of molecules that distinguish clusters of benign tissue and cancer in surgical resections. METHODS: Excisions from 8 patients were used to acquire 112,317 mass spectrometry signals by desorption electrospray ionization. A process of nonnegative matrix factorization and graph decomposition produced clusters that were approximated as affine spaces. Each signal's distance to the affine space of a cluster was used to visualize the clustering. RESULTS: The distance maps were superior to binary clustering in identifying cancer regions. They were particularly effective at finding cancer regions that were discontinuously distributed within benign tissue. CONCLUSIONS: Desorption electrospray ionization mass spectrometry, which has been shown to be useful intraoperatively, can acquire signals that distinguish malignant from benign breast tissue in surgically excised tumors. The method may be suitable for real-time surgical decisions based on cancer margins.

Chromatin accessibility mapping of the striatum identifies tyrosine kinase FYN as a therapeutic target for heroin use disorder.

The current opioid epidemic necessitates a better understanding of human addiction neurobiology to develop efficacious treatment approaches. Here, we perform genome-wide assessment of chromatin accessibility of the human striatum in heroin users and matched controls. Our study reveals distinct neuronal and non-neuronal epigenetic signatures, and identifies a locus in the proximity of the gene encoding tyrosine kinase FYN as the most affected region in neurons. FYN expression, kinase activity and the phosphorylation of its target Tau are increased by heroin use in the post-mortem human striatum, as well as in rats trained to self-administer heroin and primary striatal neurons treated with chronic morphine in vitro. Pharmacological or genetic manipulation of FYN activity significantly attenuates heroin self-administration and responding for drug-paired cues in rodents. Our findings suggest that striatal FYN is an important driver of heroin-related neurodegenerative-like pathology and drug-taking behavior, making FYN a promising therapeutic target for heroin use disorder.

Technical report: Rapid intraoperative reconstruction of cranial implants using additively manufactured moulds.

During craniotomies, a portion of the calvarium or skull is removed to gain access to the intracranial space. When it is not possible to re-implant the flap, surgeons may repair the defect intraoperatively or at a later date. With larger defects being more difficult to repair intraoperatively, we investigated a method for the creation of patient-specific moulds for ad hoc bone flap reconstruction using rapid prototyping. Patient-specific moulds were created based on light scanned models of the defect, using custom software and rapid prototyping. Polymethylmethacrylate bone implants were created for three retrospective craniotomy cases and evaluated based on original flap and skull reconstruction accuracy. Bone implants created using our moulding method reconstruct the original flap and skull with an average reconstruction accuracy of 0.82 and 1.3 mm, respectively. Average skull reconstruction accuracy obtained by surgeons performing freehand implant reconstruction was 1.49 mm. Time needed to generate moulds was between 2 h and 45 min and 6 h and 20 min. Improvements to current printing technology will make this procedure technically feasible for future cranial procedures.

An automatic approach to establish clinically desired final dental occlusion for one-piece maxillary orthognathic surgery.

PURPOSE: One critical step in routine orthognathic surgery is to reestablish a desired final dental occlusion. Traditionally, the final occlusion is established by hand articulating stone dental models. To date, there are still no effective solutions to establish the final occlusion in computer-aided surgical simulation. In this study, we consider the most common one-piece maxillary orthognathic surgery and propose a three-stage approach to digitally and automatically establish the desired final dental occlusion. METHODS: The process includes three stages: (1) extraction of points of interest and teeth landmarks from a pair of upper and lower dental models; (2) establishment of Midline-Canine-Molar (M-C-M) relationship following the clinical criteria on these three regions; and (3) fine alignment of upper and lower teeth with maximum contacts without breaking the established M-C-M relationship. Our method has been quantitatively and qualitatively validated using 18 pairs of dental models. RESULTS: Qualitatively, experienced orthodontists assess the algorithm-articulated and hand-articulated occlusions while being blind to the methods used. They agreed that occlusion results of the two methods are equally good. Quantitatively, we measure and compare the distances between selected landmarks on upper and lower teeth for both algorithm-articulated and hand-articulated occlusions. The results showed that there was no statistically significant difference between the algorithm-articulated and hand-articulated occlusions. CONCLUSION: The proposed three-stage automatic dental articulation method is able to articulate the digital dental model to the clinically desired final occlusion accurately and efficiently. It allows doctors to completely eliminate the use of stone dental models in the future.

Clinical Evaluation of Digital Dental Articulation for One-Piece Maxillary Surgery.

PURPOSE: Methods for digital dental alignment are not readily available to automatically articulate the upper and lower jaw models. The purpose of the present study was to assess the accuracy of our newly developed 3-stage automatic digital articulation approach by comparing it with the reference standard of orthodontist-articulated occlusion. MATERIALS AND METHODS: Thirty pairs of stone dental models from double-jaw orthognathic surgery patients who had undergone 1-piece Le Fort I osteotomy were used. Two experienced orthodontists manually articulated the models to their perceived final occlusion for surgery. Each pair of models was then scanned twice-while in the orthodontist-determined occlusion and again with the upper and lower models separated and positioned randomly. The separately scanned models were automatically articulated to the final occlusion using our 3-stage algorithm, resulting in an algorithm-articulated occlusion (experimental group). The models scanned together represented the manually articulated occlusion (control group). A qualitative evaluation was completed using a 3-point categorical scale by the same orthodontists, who were unaware of the methods used to articulate the models. A quantitative evaluation was also completed to determine whether any differences were present in the midline, canine, and molar relationships between the algorithm-determined and manually articulated occlusions using repeated measures analysis of variance (ANOVA). Finally, the mean ± standard deviation values were computed to determine the differences between the 2 methods. RESULTS: The results of the qualitative evaluation revealed that all the algorithm-articulated occlusions were as good as the manually articulated ones. The results of the repeated measures ANOVA found no statistically significant differences between the 2 methods [F(1,28) = 0.03; P = .87]. The mean differences between the 2 methods were all within 0.2 mm. CONCLUSIONS: The results of our study have demonstrated that dental models can be accurately, reliably, and automatically articulated using our 3-stage algorithm approach, meeting the reference standard of orthodontist-articulated occlusion.

An Automatic Approach to Reestablish Final Dental Occlusion for 1-Piece Maxillary Orthognathic Surgery.

Accurately establishing a desired final dental occlusion of the upper and lower teeth is a critical step in orthognathic surgical planning. Traditionally, the final occlusion is established by hand-articulating the stone dental models. However, this process is inappropriate to digitally plan the orthognathic surgery using computer-aided surgical simulation. To date, there is no effective method of digitally establishing final occlusion. We propose a 3-stage approach to digitally and automatically establish a desired final dental occlusion for 1-piece maxillary orthognathic surgery, including: 1) to automatically extract points of interest and four key teeth landmarks from the occlusal surfaces; 2) to align the upper and lower teeth to a clinically desired Midline-Canine-Molar relationship by minimization of sum of distances between them; and 3) to finely align the upper and lower teeth to a maximum contact with the constraints of collision and clinical criteria. The proposed method was evaluated qualitatively and quantitatively and proved to be effective and accurate.

Reliability of a novel 3-dimensional computed tomography method for reverse shoulder arthroplasty postoperative evaluation.

BACKGROUND: Long-term function and survival of reverse shoulder arthroplasties (RSAs) are reliant on component positioning and fixation. Conventional postoperative analysis is performed using plain radiographs or 2-dimensional (2D) computed tomography (CT) images. Although 3-dimensional (3D) CT would be preferred, its use is limited by metal artifacts. This study proposes a new 3D CT method for postoperative RSA evaluation and compares its interobserver reliability with conventional methods. MATERIALS AND METHODS: Preoperative and postoperative CT scans, as well as postoperative radiographs, were obtained from 18 patients who underwent RSA implantation; the scapula, implant, and screws were reconstructed as 3D CT models. The postoperative 3D scapula and implant were imported into preoperative coordinates and matched to the preoperative scapula. Standardized scapula coordinates were defined, in which the glenoid baseplate version and inclination angle were measured. The percentage of screw volume in bone was measured from a Boolean intersection operation between the preoperative scapula and screw models. Four independent reviewers performed the measurements using 3D CT and conventional 2D methods. Intraclass correlation coefficients (ICCs) were used to compare the reliability of the methods. RESULTS: The 3D CT method showed excellent reliability (ICC > 0.75) in baseplate inclination (ICC = 0.92), version (ICC = 0.97), and screw volume in bone (ICC = 0.99). Conventional 2D methods demonstrated poor reliability (ICC < 0.4). For radiographs, inclination showed poor reliability (ICC = 0.09) and the screw percentage in bone showed fair reliability (ICC = 0.54). Version was not measured with plain radiographs. For 2D CT slice measurements, inclination showed poor reliability (ICC = 0.02), version showed excellent reliability (ICC = 0.81), and the screw percentage in bone showed poor reliability (ICC = 0.28). CONCLUSION: The new 3D CT-based method for evaluating RSA glenoid implant positioning and screw volume in bone showed excellent reliability and overcame the metal-artifact limitation of postoperative CT and 3D CT reconstruction.

Deformable multimodal registration for navigation in beating-heart cardiac surgery.

PURPOSE: Minimally invasive beating-heart surgery is currently performed using endoscopes and without navigation. Registration of intraoperative ultrasound to a preoperative cardiac CT scan is a valuable step toward image-guided navigation. METHODS: The registration was achieved by first extracting a representative point set from each ultrasound image in the sequence using a deformable registration. A template shape representing the cardiac chambers was deformed through a hierarchy of affine transformations to match each ultrasound image using a generalized expectation maximization algorithm. These extracted point sets were matched to the CT by exhaustively searching over a large number of precomputed slices of 3D geometry. The result is a similarity transformation mapping the intraoperative ultrasound to preoperative CT. RESULTS: Complete data sets were acquired for four patients. Transesophageal echocardiography ultrasound sequences were deformably registered to a model of oriented points with a mean error of 2.3 mm. Ultrasound and CT scans were registered to a mean of 3 mm, which is comparable to the error of 2.8 mm expected by merging ultrasound registration with uncertainty of cardiac CT. CONCLUSION: The proposed algorithm registered 3D CT with dynamic 2D intraoperative imaging. The algorithm aligned the images in both space and time, needing neither dynamic CT imaging nor intraoperative electrocardiograms. The accuracy was sufficient for navigation in thoracoscopically guided beating-heart surgery.

Preservation of neural tissue with a formaldehyde-free phenol-based embalming protocol.

The adverse effects formaldehyde fixation has on tissues both gross anatomically and histologically are well documented. Consequently, researchers are seeking alternative embalming techniques that better preserve in vivo characteristics of tissues. Phenol-based embalming is one method that has shown promise in its ability to adequately preserve the in vivo qualities of tissues through preliminary explorations at the gross anatomical level. The literature on phenol-based embalming is currently scarce, especially with regard to its effects on tissues at the microscopic level. For the current study we aimed to document the histologic effects of a formaldehyde-free phenol-based embalming solution on neural tissue, with the hope of providing novel insight into the effects of soft-embalming on tissues at the microscopic level. Cerebral and cerebellar tissue obtained from porcine brains was fixed in phenol- and formaldehyde-based fixatives; the latter served as a control. Fixed samples were processed for histological analysis. The phenol-based embalming solution provided excellent preservation of the cerebral and cerebellar tissue morphology. Of note was the decrease in separation artifact seen in both tissue types relative to the control tissue, as well as anomalous circular artifacts in the white matter. The results of this study indicate that the phenol-based embalming solution preserves neural tissue at the histological level, perhaps superiorly in many aspects when compared to the formaldehyde-fixed samples. Further investigations of both gross anatomy and histology are recommended on the basis of these promising new findings to determine its potential utilities within research and education. Clin. Anat. 32:224-230, 2019. © 2018 Wiley Periodicals, Inc.

Translatory hip kinematics measured with optoelectronic surgical navigation.

PURPOSE: An optoelectronic surgical navigation system was used to detect small but measurable translational motion of human hip cadavers in high-range passive motions. Kinematic data were also examined to demonstrate the role of soft tissues in constraining hip translation. METHODS: Twelve cadaver hips were scanned using CT, instrumented for navigation, and passively taken through motion assessment. Center of the femoral head was tracked in the acetabular coordinates. Maximum non-impinging translation of the femoral head for each specimen hip was reported. This was repeated for 5 tissue states: whole, exposed to the capsule, partially or fully incised capsule, resection of the ligamentum teres and labrectomy. Femoral motions were compared to the reported value for ideal ball and socket model. RESULTS: Whole and exposed hips underwent maximal translations of [Formula: see text] and [Formula: see text] mm, respectively. These translational motions were statistically significantly different from reported value for a purely spherical joint, [Formula: see text]. Further tissue removal almost always significantly increased maximum non-impingement translational motion with [Formula: see text]. CONCLUSION: We found subtle but definite translations in every cadaver hip. There was no consistent pattern of translation. It is possible to use the surgical navigation systems for the assessment of human hip kinematics intra-operatively and improve the treatment of total hip arthroplasty patients by the knowledge of the fact that their hips translate. Better procedure selection and implantation optimization may arise from improved understanding of the motion of this critically important human joint.

Rectus Capitis Posterior Minor: Histological and Biomechanical Links to the Spinal Dura Mater.

STUDY DESIGN: Serial histological investigation was performed on 10 cadaveric specimens and biomechanical tests were performed on five specimens, both focused on the tissue connexion between the rectus capitis posterior minor (RCPMi) and the spinal dura. OBJECTIVE: This study had two components: to clarify the microscopic structure of the tissue link between RCPMi and the dura mater, and to evaluate the mechanical role of this tissue complex. SUMMARY OF BACKGROUND DATA: Dissection-based and imaging-based reports have suggested a connective tissue link between the RCPMi and the dura mater at the posterior-atlanto-occipital (PAO) level. Existence of this link, and properties, remain unclear. METHODS: Histological investigation: RCPMi muscles, their bony attachments, PAO space, and adjacent spinal dura mater were resected from 10 cadavers. Tissues were subdivided into medial and lateral parts. Serial histological sections were prepared to cover maximum surface area; Masson trichrome stain was used to evaluate the tissue connection. Biomechanical investigation: individualized RCPMi muscles from five cadavers were detached from their origin. Each muscle was loaded incrementally up to 2 kg, with the cervical spine hyperextended. Using a structured light scanner, the dura mater was scanned for each loaded state. Comparison between unloaded and each loaded scanned surface quantified the displacement of the dura mater. RESULTS: Histological investigation confirmed the existence of a connective tissue link between the RCPMi and the dura mater. The biomechanical testing suggests that this tissue link complex can reduce the bulging of the dura mater into the spinal canal, caused during hyperextension, by 53.4% ±â€Š6.9% under RCPMi loading. CONCLUSION: This histological investigation clarified the structure of the tissue link between the RCPMi and the dura mater. The biomechanical testing indicated a potential mechanical function of the RCPMi in regards to the spinal dura mater, which may include a stabilizing role of the dura mater during neck extension. LEVEL OF EVIDENCE: N/A.

Electromagnetically tracked personalized templates for surgical navigation.

PURPOSE: An electromagnetic (EM) surgical tracking system was developed for orthopedic navigation. The reportedly poor accuracy of point-based EM navigation was improved by using anatomical impressions, which were EM-tracked personalized templates. Lines, rather than points, were consistently used for calibration and error evaluation. METHODS: Technical accuracy was tested using models derived from CT scans of ten cadaver shoulders. Tracked impressions were first designed, calibrated, and tested using lines as fiducial objects. Next, tracked impressions were tested against EM point-based navigation and optical point-based navigation, in environments that were either relatively empty or that included surgical instruments. Finally, a tracked impression was tested on a cadaver forearm in a simulated fracture-repair task. RESULTS: Calibration of anatomical impressions to EM tracking was highly accurate, with mean fiducial localization errors in positions of 0.3 mm and in angles of [Formula: see text]. Technical accuracy on physical shoulder models was also highly accurate; in an EM field with surgical instruments, the mean of target registration errors in positions was 2.2 mm and in angles was [Formula: see text]. Preclinical accuracy in a cadaver forearm in positions was 0.4 mm and in angles was [Formula: see text]. The technical accuracy was significantly better than point-based navigation, whether by EM tracking or by optical tracking. The preclinical accuracy was comparable to that achieved by point-based optical navigation. CONCLUSIONS: EM-tracked impressions-a hybrid of personalized templates and EM navigation-are a promising technology for orthopedic applications. The two technical contributions are the novel hybrid navigation and the consistent use of lines as fiducial objects, replacing traditional point-based computations. The accuracy improvement was attributed to the combination of physical surfaces and line directions in the processes of calibration and registration. The technical studies and preclinical trial suggest that EM-tracked impressions are an accurate, ergonomic innovation in image-guided orthopedic surgery.

Principal components of wrist circumduction from electromagnetic surgical tracking.

PURPOSE: An electromagnetic (EM) surgical tracking system was used for a functionally calibrated kinematic analysis of wrist motion. Circumduction motions were tested for differences in subject gender and for differences in the sense of the circumduction as clockwise or counter-clockwise motion. METHODS: Twenty subjects were instrumented for EM tracking. Flexion-extension motion was used to identify the functional axis. Subjects performed unconstrained wrist circumduction in a clockwise and counter-clockwise sense. Data were decomposed into orthogonal flexion-extension motions and radial-ulnar deviation motions. PCA was used to concisely represent motions. Nonparametric Wilcoxon tests were used to distinguish the groups. RESULTS: Flexion-extension motions were projected onto a direction axis with a root-mean-square error of [Formula: see text]. Using the first three principal components, there was no statistically significant difference in gender (all [Formula: see text]). For motion sense, radial-ulnar deviation distinguished the sense of circumduction in the first principal component ([Formula: see text]) and in the third principal component ([Formula: see text]); flexion-extension distinguished the sense in the second principal component ([Formula: see text]). CONCLUSION: The clockwise sense of circumduction could be distinguished by a multifactorial combination of components; there were no gender differences in this small population. These data constitute a baseline for normal wrist circumduction. The multifactorial PCA findings suggest that a higher-dimensional method, such as manifold analysis, may be a more concise way of representing circumduction in human joints.

Component Position and Metal Ion Levels in Computer-Navigated Hip Resurfacing Arthroplasty.

BACKGROUND: Metal ion levels are used as a surrogate marker for wear in hip resurfacing arthroplasties. Improper component position, particularly on the acetabular side, plays an important role in problems with the bearing surfaces, such as edge loading, impingement on the acetabular component rim, lack of fluid-film lubrication, and acetabular component deformation. There are little data regarding femoral component position and its possible implications on wear and failure rates. The purpose of this investigation was to determine both femoral and acetabular component positions in our cohort of mechanically stable hip resurfacing arthroplasties and to determine if these were related to metal ion levels. METHODS: One hundred fourteen patients who had undergone a computer-assisted metal-on-metal hip resurfacing were prospectively followed. Cobalt and chromium levels, Harris Hip, and UCLA activity scores in addition to measures of the acetabular and femoral component position and angles of the femur and acetabulum were recorded. RESULTS: Significant changes included increases in the position of the acetabular component compared to the native acetabulum; increase in femoral vertical offset; and decreases in global offset, gluteus medius activation angle, and abductor arm angle (P < .05). Multiple regression analysis found no significant predictors of cobalt and chromium metal ion levels. CONCLUSION: Femoral and acetabular components placed in acceptable position failed to predict increased metal ion levels, and increased levels did not adversely impact patient function or satisfaction. Further research is necessary to clarify factors contributing to prosthesis wear.

Personalized Guides for Registration in Surgical Navigation.

Personalized guides are increasingly used in orthopedic procedures but do not provide for intraoperative re-planning. This work presents a tracked guide that used physical registration to provide an anatomy-to-tracking coordinate frame transformation for surgical navigation. In a study using seven femoral models derived from clinical CT scans used for hip resurfacing, a guide characterization FRE of 0.4°±0.2°, drill-path drill-path angular TRE of 0.9°±0.4° and a positional TRE of 1.2mm±0.4mm were found; these values are comparable to conventional optical tracking accuracy. This novel use of a tracked guide may be particularly applicable to procedures that require a small surgical exposure, or when operating on anatomical regions with small bones that are difficult to track or reliably register.

A Toroidal Probe for Measuring Surgically Exposed Joint Centers.

Maintaining the hip center can improve the success of a total hip arthroplasty. A novel probe design, based on mating a toroid with a sphere, was used for kinematic measurements of the femoral head center and implant center in a pre-clinical study of hip joints. In an electromagnetically tracked implementation tested in a laboratory environment, the device measured a spherical center to within 1.2±0.2 mm in a technical validation. Applied to a plastic model of a cadaveric femur, the center of the femoral head was measured to 1.8±0.4 mm and the implant was measured to within 1.5±0.5 mm. Because leg length changes and offset changes in conventional hip arthroplasty can be as much as 16 mm, this device has relatively high accuracy that may improve implant localization for the hip.

Intraoperative application of hand-held structured light scanning: a feasibility study.

PURPOSE: Structured light scanning is an emerging technology that shows potential in the field of medical imaging and image-guided surgery. The purpose of this study was to investigate the feasibility of applying a hand-held structured light scanner in the operating theatre as an intraoperative image modality and registration tool. METHODS: We performed an in vitro study with three fresh frozen knee specimens and a clinical pilot study with three patients (one total knee arthroplasty and two hip replacements). Before the procedure, a CT scan of the affected joint was obtained and isosurface models of the anatomies were created. A conventional surgical exposure was performed, and a hand-held structured light scanner (Artec Group, Palo Alto, USA) was used to scan the exposed anatomy. Using the texture information of the scanned model, bony anatomy was selected and registered to the CT models. Registration RMS errors were documented, and distance maps between the scanned model and the CT model were created. RESULTS: For the in vitro trial, the average RMS error was 1.00 mm for the femur and 1.17 mm for the tibia registration. We found comparable results during clinical trials, with an average RMS error of 1.3 mm. CONCLUSIONS: The results of this preliminary study indicate that structured light scanning could be applied accurately and safely in a surgical environment. This could result in a variety of applications for these scanners in image-guided interventions as intraoperative imaging and registration tools.

Calibration of mobile-gantry computed tomography for surgical navigation.

PURPOSE: Image-guided interventions that use preoperative 3D computed tomography (CT) models are limited by the preoperative segmentation time 3D image and collection of intraoperative registration data. Intraoperative CT imaging can be ergonomically efficient in a direct navigation system if the imaging device is accurately calibrated. A mobile-gantry CT scanner offers improved patient safety but presents technical challenges beyond those of a conventional scanner. The goal was to calibrate an optoelectronic navigation system to mobile-gantry CT with millimeter-level accuracy. METHODS: A custom calibration device was designed and manufactured. The calibrator contained optoelectronic markers for navigation reference and radio-opaque markers for CT reference. Calibrations were performed with a ceiling-mounted optoelectronic camera and with a portable camera, and then verified for accuracy. RESULTS: The component fiducial registration errors were extremely small, being 0.36 mm, with standard deviation of 0.16 mm, for the ceiling-mounted camera, and 0.05 mm, with standard deviation of 0.01 mm, for the portable camera. The net target registration error, measured as RMS deviation, was 1.58 mm for the ceiling-mounted camera and 0.73 mm for the portable camera. CONCLUSIONS: High-accuracy calibration of the mobile-gantry CT scanner was possible from a single preoperative CT image. A ceiling-mounted optoelectronic camera, which is ergonomically preferable, marginally met the accuracy criteria. The portable camera, which is in widespread use for conventional navigated surgery, had deep sub-millimeter error. This study demonstrates that high accuracy is achievable and offers a system developer options to trade off accuracy and user convenience in direct surgical navigation.

Computer-assisted hip resurfacing planning using Lie group shape models.

INTRODUCTION: Hip resurfacing is a surgical option for osteoarthritis young and active patients. Early failures has been reported due to improper implant placement. Computer-assisted surgery is a promising avenue for more successful procedures. PURPOSE: This paper presents a novel automatic surgical planning for computer-assisted hip resurfacing procedures. The plan defined the femoral head axis that was used to place the implant. The automatic planning was based on a Lie group statistical shape model. METHODS: A statistical shape model was constructed using 50 femurs from osteoarthritis patients who underwent computer-assisted hip resurfacing. The model was constructed using product Lie groups representation of shapes and nonlinear analysis on the manifold of shapes. A surgical plan was drawn for the derived base shape. The base shape was transformed to 14 femurs with known manual plans. The transformed base plan was used as the computed plan for each femur. Both actual and computed plans were compared. RESULTS: The method showed a success by computing plans that differ from the actual plans within the surgical admissible ranges. The minimum crossing distance between the two plans had a mean of 0.75 mm with a standard deviation of 0.54 mm. The angular difference between the two plans had the mean of 5.94° with a standard deviation of 2.145.94°. CONCLUSION: Product Lie groups shape models were proved to be successful in automatic planning for hip resurfacing computer-assisted surgeries. The method can be extended to other orthopedic and general surgeries.

Comparing conventional and computer-assisted surgery baseplate and screw placement in reverse shoulder arthroplasty.

BACKGROUND: Preoperative planning and intraoperative navigation technologies have each been shown separately to be beneficial for optimizing screw and baseplate positioning in reverse shoulder arthroplasty (RSA) but to date have not been combined. This study describes development of a system for performing computer-assisted RSA glenoid baseplate and screw placement, including preoperative planning, intraoperative navigation, and postoperative evaluation, and compares this system with a conventional approach. MATERIALS AND METHODS: We used a custom-designed system allowing computed tomography (CT)-based preoperative planning, intraoperative navigation, and postoperative evaluation. Five orthopedic surgeons defined common preoperative plans on 3-dimensional CT reconstructed cadaveric shoulders. Each surgeon performed 3 computer-assisted and 3 conventional simulated procedures. The 3-dimensional CT reconstructed postoperative units were digitally matched to the preoperative model for evaluation of entry points, end points, and angulations of screws and baseplate. Values were used to find accuracy and precision of the 2 groups with respect to the defined placement. Statistical analysis was performed by t tests (α = .05). RESULTS: Comparison of the groups revealed no difference in accuracy or precision of screws or baseplate entry points (P > .05). Accuracy and precision were improved with use of navigation for end points and angulations of 3 screws (P < .05). Accuracy of the inferior screw showed a trend of improvement with navigation (P > .05). Navigated baseplate end point precision was improved (P < .05), with a trend toward improved accuracy (P > .05). CONCLUSION: We conclude that CT-based preoperative planning and intraoperative navigation allow improved accuracy and precision for screw placement and precision for baseplate positioning with respect to a predefined placement compared with conventional techniques in RSA.