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Patients undergoing primary total hip arthroplasty (THA) who have spinal deformity and a stiff spine are the highest-risk group for instability. Despite the increasing use of dual-mobility cups and large femoral heads, dislocation remains a major complication after THA. Preoperative planning becomes a critical aspect of ensuring precise component positioning within a safe zone. The purpose of this study was to investigate dislocation rates over a 9-year period. A retrospective review of 4,731 THAs performed by 3 orthopaedic surgeons between January 2014 and March 2023 was performed. Spinopelvic measurements were conducted to determine the hip–spine classification group for each patient. Only patients classified as 2B (pelvic incidence-lumbar lordosis > 10° and Δsacral slope < 10°) were eligible. Both absolute and relative dislocation frequencies were then analyzed using time-series analysis techniques and Fisher's exact tests. A total of 281 hip–spine 2B patients undergoing primary THA were eligible for analysis (57% women; mean age, range: 66 years, 23 to 87; mean body mass index, range: 28, 16 to 45). The overall dislocation rate was 4.3%. Use of femoral head sizes ≥ 40 mm increased from 4% in 2014 to 2019 to 37% in 2020 to 2023 (P <.001), while the use of dual-mobility cups decreased from 100% in 2014 to 2019 to 37% in 2020 to 2023 (P <.001). Acetabular component planning was changed from the supine plane to the standing plane in February 2020. Those changes in surgical practice were notably correlated with a significant decrease in dislocation rates from 6.8% in 2014 to 2019 to 1.5% in 2020 to 2023 (P =.03). Our study demonstrates that the introduction of advanced preoperative THA planning to the standing plane, coupled with precise intraoperative technology for implant placement, can significantly reduce the risk of instability in high-risk THA patients. Notably, we observed a significant decrease in dislocation rates, which aligned with the shift in surgical practice. IV. [ABSTRACT FROM AUTHOR]

Preoperative planning has gained popularity in the management of reverse shoulder arthroplasty (RSA). Commercially available software provides 3-dimensional segmentation of scapula and humerus, as well as providing arc of motion for the implanted articulation and identifying potential areas of bony impingement. However, these software algorithms use a fixed scapula model, disregarding the preoperative clinical range of motion (C-ROM) of the patient, be it glenohumeral or scapulothoracic, as well as any soft tissue parameters. This study aims to compare the ROM based on preoperative planning software by using the implant position from postoperative computed tomography (CT) images (predicted ROM using preoperative planning software [P-ROM]), with the C-ROM assessed at minimum of 2 years of follow-up. Preoperative and postoperative CT scans of 46 patients who underwent primary RSA between 2017 and 2021 were analyzed. At the postoperative 2-year review, each patient was assessed for active ROM. Implant size and position based on operative notes and postoperative CT scans were used to replicate the performed surgery in the planning software. Abduction, flexion, and external rotation motion were simulated and recorded. The relationship between C-ROM and P-ROM was investigated using linear regression analysis, Pearson correlation coefficient, and paired t -test. P-ROM was significantly lower than C-ROM at 2 years postoperatively (P <.001), with an average discrepancy of 78° in abduction, 47° in flexion, and 37° in external rotation (C-ROM: abduction 155° ± 21° [80°-180°]; flexion 160° ± 17° [90°-180°]; external rotation 52° ± 14° [10°-80°] vs. P-ROM: abduction 77° ± 13° [53°-107°]; flexion 112° ± 25° [67°-180°]; external rotation 15° ± 21° [0°-79°]). The linear regression analysis indicated weak agreement between C-ROM and P-ROM (abduction R2 = 0.03; flexion R2 = 0.01; external rotation R2 = 0.04). Pearson's correlation coefficients revealed weak correlations of −0.18, 0.03, and 0.21 for abduction, flexion, and external rotation, respectively. P-ROM based on preoperative software in its current form does not allow the prediction of the C-ROM at 2 years of follow-up for patients undergoing RSA. [ABSTRACT FROM AUTHOR]

Three-dimensional, computed tomography preoperative planning has been increasingly adopted among shoulder arthroplasty surgeons. Prior studies have not examined outcomes in patients undergoing reverse total shoulder arthroplasty in which the surgeon implanted prostheses that deviated from the preoperative plan compared to patients in which the surgeon followed the preoperative plan. The hypothesis of this study was that clinical outcomes would not be different between patients in which the surgeon utilized components that deviated from those predicted in the preoperative plan and patients in which the surgeon followed the preoperative plan. A retrospective review of patients that had preoperative planning for reverse total shoulder arthroplasty from April 2017 through February 2022 was performed. Patients were stratified into two groups: patients in which the surgeon utilized components that deviated from those anticipated by the preoperative plan (changed group), and patients in which the surgeon utilized all of the components anticipated by the preoperative plan (as planned group). Patient-reported outcomes including the Western Ontario Osteoarthritis Index, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Shoulder Activity Level were recorded preoperatively, at one year, and at two years. Preoperative and one-year postoperative range of motion was recorded. One hundred and eighty-nine patients were included in this study. One hundred forty-seven patients had intraoperative changes to their preoperative plan and 42 patients underwent reverse total arthroplasty without changes to their preoperative plan. There was no difference determined between any patient-reported outcome score at the one- and two-year postoperative time points between the as planned group and the changed group. No differences were found in range of motion between groups. Patients initially planned to undergo anatomic total shoulder arthroplasty that were intraoperatively converted to a reverse total shoulder arthroplasty had equivalent outcomes compared to those that had 1) other intraoperative deviations or 2) had no changes to their original preoperative plan. Patients undergoing reverse total shoulder arthroplasty that had an intraoperative deviation to the components utilized in the preoperative plan had equivalent 1) patient-reported outcomes at one and two years after surgery and 2) range of motion one year after surgery compared to those that did not change from the preoperative plan. This study suggests it is safe to make intraoperative changes to the components utilized in the preoperative plan without concern for inferior postoperative outcomes when performing reverse total shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

Backgrounds: Advanced ovarian cancer is frequently accompanied by extensive peritoneal metastasis, complicating surgical interventions. This study aims to explore the application of 3D reconstruction and 3D printing technology in the treatment of advanced ovarian cancer. Methods: We conducted a retrospective analysis of 60 patients with stage III ovarian cancer who underwent cytoreductive surgery at Hebei University Affiliated Hospital between 2020 and 2023. Patients were randomly assigned to three groups: a 3D visualization group, a 3D visualization plus 3D printing group, and a traditional 2D CT imaging evaluation group. High-precision medical imaging techniques (e.g., CT, MRI) were employed to create digital 3D models, which were then converted into physical entities using 3D printing for surgical planning and simulation. Results: Both the 3D visualization group and the 3D visualization plus 3D printing group demonstrated superior outcomes in terms of surgery duration and blood loss compared to the traditional 2D CT group, indicating the efficacy of 3D reconstruction and 3D printing in preoperative planning. Postoperative recovery indicators, such as hospital stay and time to first flatus, were also more favorable in the groups utilizing 3D technology. Although there were no significant differences in postoperative complications and recurrence rates among the three groups, the groups using 3D technology showed advantages in reducing certain complications. Conclusions: The results indicate that medical 3D technology has significant value in the surgical planning of advanced ovarian cancer, enhancing surgical precision and reducing intraoperative risks, which may aid in improving postoperative recovery. [ABSTRACT FROM AUTHOR]

Purpose: To compare different types of short stems (SS) in terms of native hip geometry reproducibility, analyzing centrum-collum-diaphyseal angle (CCD) and femoral offset (FO). These parameters allow the SS to be adapted to patient's anatomy in order to ensure better functional outcomes in total hip arthroplasty (THA). Methods: A total of 387 cases of SS met the inclusion criteria. CCD and FO were measured using MediCAD® software Version 6 in preoperative (preop-) and postoperative (postop-) X-rays at 6–12 months after surgery. Considering preop-CCD, the sample was divided into three groups: ≤ 124.9° (A); 125°–129.9° (B); and ≥ 130°(C). Preop- and postop-CCD and FO and the respective average difference (Δ) were examined considering the SS individually and within groups, to verify reproducibility of these parameters. Results: The SS considered were eight: Fitmore Zimmer, Pulchra Adler, TRIS Adler, Trifit Corin, Trilock Depuy, Actis Depuy, Profemur Microport, and SMF Smith&Nephew. Groups A, B, and C consisted, respectively, of 113, 124, and 150 cases. Considering all cases, there was a statistically significant (p < 0.05) increase in CCD and FO with surgery. Overall, Trifit and Trilock stems were the best in reproducing preop-CCD, Trifit itself followed by Pulchra and Profemur for preop-FO. In groups A and C, the reproduction of preop-CCD was better than preop-FO, in contrast in group B. With regard to preop-CCD reproduction, in group A Trifit and Pulchra, in group B Fitmore and Trifit, and in group C Fitmore and Pulchra were the best. Fitmore in group A, SMF in group B, Pulchra and Trilock in group C were the worst in reproducing preop-FO. Conclusion: Each hip anatomy is unique, and reproduction of preop-CCD and preop-FO can be achieved with different SS characteristics. Accurate knowledge of the stems and performing correct preop- planning are crucial to allow the best restoration of the patient's native hip geometry in THA. [ABSTRACT FROM AUTHOR]

Purpose: In the last decades, there has been a refinement in total hip arthroplasty, which allowed surgeons to achieve the highest performance and better patient outcomes. Preoperative planning in primary hip arthroplasty is an essential step that guides the surgeon in restoring the anatomy and biomechanics of the joint. This study aims to evaluate the accuracy of the 2D digital planning, considering cup sizing, stem sizing, and limb length discrepancy. Additionally, we conducted a multivariable analysis of demographic data and comorbidities to find factors influencing preoperative planning. Methods: This retrospective study analyzed the planning accuracy in 800 consecutive uncemented primary total hip arthroplasty. We compared the preoperatively planned total hip arthroplasty with postoperative results regarding the planned component size, the implanted size, and the lower limb length restoration. Therefore, we investigated factors influencing planning accuracy: overweight and obesity, sex, age, past medical history, comorbidities, and implant design. All the surgeries were performed in the posterolateral approach by one expert surgeon who did the preoperative planning. The preoperative planning was determined to be (a) exact if the planned and the implanted components were the same size and (b) accurate if exact ± one size. The restoration of postoperative limb length discrepancy was classified into three groups: ± 3 mm, ± 5 mm, and ± 10 mm. This assessment was performed through a digital method 2D based on a standard hip X-ray. Results: This court of 800 implants showed that planning was exact in 60% of the cups and 44% of the stems and was accurate in 94% of the cups and 80% of the stems. The postoperative limb length discrepancy was ± 3 mm in 91% and ± 5 mm in 97%. Conclusions: This study showed preoperative 2D digital planning great precision and reliability, and we demonstrated that it was accurate in 94% of the cups and 80% of the stems. Therefore, the preoperative limb length discrepancy analysis was essential to guarantee the recovery of the operated limb's correct length. [ABSTRACT FROM AUTHOR]

We aim to predict a clinical difference in the postoperative range of motion (RoM) between 2 reverse shoulder arthroplasty (RSA) stem designs (Inlay-155° and Onlay-145°) using preoperative planning software. We hypothesized that preoperative 3D planning could anticipate the differences in postoperative clinical RoM between 2 humeral stem designs and by keeping the same glenoid implant. Thirty-seven patients (14 men and 23 women, 76 ± 7 years) underwent a BIO-RSA (bony increased offset-RSA) with the use of preoperative planning and an intraoperative 3-dimensional-printed patient-specific guide for glenoid component implantation between January 2014 and September 2019 with a minimum follow-up of 2 years. Two types of humeral implants were used: Inlay with a 155° inclination (Inlay-155°) and Onlay with a 145°inclination (Onlay-145°). Glenoid implants remained unchanged. The postoperative RSA angle (inclination of the area in which the glenoid component of the RSA is implanted) and the lateralization shoulder angle were measured to confirm the good positioning of the glenoid implant and the global lateralization on postoperative X-rays. A correlation between simulated and clinical RoM was studied. Simulated and last follow-up active forward flexion (AFE), abduction, and external rotation (ER) were compared between the 2 types of implants. No significant difference in RSA and lateralization shoulder angle was found between planned and postoperative radiological implants' position. Clinical RoM at the last follow-up was always significantly different from simulated preoperative RoM. A low-to-moderate but significant correlation existed for AFE, abduction, and ER (r = 0.45, r = 0.47, and r = 0.57, respectively; P <.01). AFE and abduction were systematically underestimated (126° ± 16° and 95° ± 13° simulated vs. 150° ± 24° and 114° ± 13° postoperatively; P <.001), whereas ER was systematically overestimated (50° ± 19° simulated vs. 36° ± 19° postoperatively; P <.001). Simulated abduction and ER highlighted a significant difference between Inlay-155° and Onlay-145° (12° ± 2°, P =.01, and 23° ± 3°, P <.001), and this was also retrieved clinically at the last follow-up (23° ± 2°, P =.02, and 22° ± 2°, P <.001). This study is the first to evaluate the clinical relevance of predicted RoM for RSA preoperative planning. Motion that involves the scapulothoracic joint (AFE and abduction) is underestimated, while ER is overestimated. However, preoperative planning provides clinically relevant RoM prediction with a significant correlation between both and brings reliable data when comparing 2 different types of humeral implants (Inlay-155° and Onlay-145°) for abduction and ER. Thus, RoM simulation is a valuable tool to optimize implant selection and choose RSA implants to reach the optimal RoM. [ABSTRACT FROM AUTHOR]

Background: The aim of this retrospective study was to evaluate the effectiveness and accuracy of the AIKNEE system in preoperative planning and intraoperative alignment for total knee arthroplasty (TKA). Methods: A total of 64 patients were planned preoperatively by the AIKNEE system, including the measurement of mechanical femorotibial angle (mFTA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) using three-dimensional reconstructed images. Intraoperatively, the actual prosthesis size and alignment were compared to the planned parameters. Postoperative outcomes, including pain levels, range of motion (ROM), and Knee Scoring System (KSS) scores, were assessed after surgery. Statistical analyses were performed to evaluate the correlation between alignment deviations and postoperative function. Results: The AIKNEE system accurately predicted the prosthesis size in thirty-one of femoral cases (48%) and forty-seven of tibial cases (73%). Deviations of mFTA, LDFA, and MPTA from the target value were within 3° in 88%, 92%, and 95% of cases, respectively. A significant improvement was observed in postoperative pain, ROM, and KSS scores (p < 0.001). Correlation analysis revealed that greater deviations in mFTA and LDFA were associated with increased pain (p = 0.004, 0.047) and lower KSS scores (p = 0.027). Conclusion: The AIKNEE system demonstrated promising results in predicting prosthesis size and achieved alignment within the desired range in a majority of cases. Postoperative outcomes, including pain levels and functional improvement, were favorable. [ABSTRACT FROM AUTHOR]

In recent years, preoperative planning has undergone significant advancements, with a dual focus: improving the accuracy of implant placement and enhancing the prediction of functional outcomes. These breakthroughs have been made possible through the development of advanced processing methods for 3D preoperative images. These methods not only offer novel visualization techniques but can also be seamlessly integrated into computer-aided design models. Additionally, the refinement of motion capture systems has played a pivotal role in this progress. These "markerless" systems are more straightforward to implement and facilitate easier data analysis. Simultaneously, the emergence of machine learning algorithms, utilizing artificial intelligence, has enabled the amalgamation of anatomical and functional data, leading to highly personalized preoperative plans for patients. The shift in preoperative planning from 2D towards 3D, from static to dynamic, is closely linked to technological advances, which will be described in this instructional review. Finally, the concept of 4D planning, encompassing periarticular soft tissues, will be introduced as a forward-looking development in the field of orthopedic surgery. [ABSTRACT FROM AUTHOR]

Introduction: In total knee arthroplasty (TKA), choosing the correct implant size is important. There is lack of data on accuracy of templating on haemophilic knees. Our aim was to test the accuracy of 2D digital templating for TKA on haemophilic arthropathy (HA) of knee. Materials and Methods: TKAs performed on HA between January 2011 and January 2022 were screened. Osteoarthritis (OA) group was created as control group by a one‐to‐one matching regarding type of implant used. Intra‐ and interobserver correlations were measured in HA, then correlation between templated and implanted sizes was investigated in four assessments (femur AP, femur lateral, tibia AP, tibia lateral), then compared with OA group. Fifty‐eight knees in each group included. Results: Regarding intraobserver correlation in HA, there was excellent correlation for femur AP [.93 (.73–.98)], femur lateral [.98 (.91–.99)], and tibia AP (1.0) templating. Regarding interobserver correlation in HA, excellent correlation was observed for femur lateral [.93 (.74–.98)] and tibia AP templating [.90 (.65–.97)]. Regarding correlation of templated and applied sizes in HA; tibia AP, tibia lateral and femur lateral templating showed good correlation [.81 (.70–.89),.86 (.77–.91),.79 (.67–.87) while femur AP templating showed moderate correlation [.67 (.50–.79)]. Comparing HA and OA, there was no difference in correlation levels regarding femur AP, femur lateral, tibia AP and tibia lateral templating (p =.056, p =.781, p =.761, p =.083, respectively). Conclusion: Although 2D digital templating shows comparable correlation in HA and OA, clinical applicability of templating on HA appears to be limited in its current state. [ABSTRACT FROM AUTHOR]

Successful total hip arthroplasty relies on accurate preoperative planning. However, the conventional preoperative planning, a two-dimensional method using X-ray template, has shown poor reliability of predicting component size. To our knowledge, artificial intelligence technology assisted three-dimensional preoperative planning is promising to improve the accuracy of preoperative planning but there is a dearth of clinical evidence. Therefore, in this study we compared the prediction accuracy of these two maneuvers. We conducted a prospective study consisting of 117 consecutive patients who underwent a primary cementless total hip arthroplasty to compare the prediction accuracy of these two methods. The two-dimensional and artificial intelligence assisted three-dimensional planning results of the same patient were compared with the definitive implant size respectively. The prediction accuracy of artificial intelligence assisted three-dimensional planning for cup and the stem sizes were 66.67% (78/117) and 65.81% (77/117), two-dimensional planning was 30.77% (36/117) and 37.61% (44/117) (p < 0.05). There were poor prediction results of two-dimensional planning in patients with hip dysplasia (p = 0.004, OR = 7.143) and excessive femoral anteversion (p = 0.012, OR = 1.052), meanwhile the failure risk of stem side two-dimensional planning increased as patients got older (p = 0.003, OR = 1.118). The accuracy of artificial intelligence assisted three-dimensional planning cannot be affected by above factors. We confirmed that artificial intelligence assisted three-dimensional preoperative planning showed higher accuracy and stability than two-dimensional preoperative planning in primary cementless total hip arthroplasty. We believe artificial intelligence assisted three-dimensional preoperative planning technology provides surgeons a new reliable choice and offers advantages whether in simple or complicated cases. [Display omitted] [ABSTRACT FROM AUTHOR]

Preoperative planning of surgical treatment is an important stage of preparation for surgical treatment in traumatology and orthopaedics, which makes it possible to emphasise the peculiarities of the clinical case, prevent possible problems during surgery and reduce the risks of postoperative complications. The leading method of diagnostics for further planning of surgical treatment nowadays is radiological studies, primarily radiography and computed tomography. The results of radiological studies allow a sufficiently qualitative assessment of the zone of interest, planning of the required degree of correction and placement of fixing metal structures and endoprostheses. At the same time, when planning, the doctor relies mostly on the knowledge of the norms of anatomical relations and structures. And in the case of a multitude of possible treatment options, the doctor relies on his or her own medical experience to make a choice. This article presents a developed generalising methodology of preoperative planning in traumatology-orthopaedics, which includes biomechanical analysis and methods of accumulation and processing of quantitative data of clinical cases along with the usual methods of preoperative planning for doctors. The methodology brings together into a single system the criteria for evaluating the success of treatment by applying three classes of criteria: geometric (anatomical), biomechanical and clinical. The methodology allows the physician to perform biomechanical modelling of the proposed treatment options and quantitatively evaluate them on the basis of comparison of stress-strain states arising in the «bone-implant» system as a result of each of the planned options. The methodology allows to determine successful treatment options and to predict changes in the patient's quality of life after treatment. The presented methodology includes a mechanism for accumulation of quantitative data on clinical cases and quality control of the used biomechanical models.

Abstract Background The aim of this retrospective study was to evaluate the effectiveness and accuracy of the AIKNEE system in preoperative planning and intraoperative alignment for total knee arthroplasty (TKA). Methods A total of 64 patients were planned preoperatively by the AIKNEE system, including the measurement of mechanical femorotibial angle (mFTA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) using three-dimensional reconstructed images. Intraoperatively, the actual prosthesis size and alignment were compared to the planned parameters. Postoperative outcomes, including pain levels, range of motion (ROM), and Knee Scoring System (KSS) scores, were assessed after surgery. Statistical analyses were performed to evaluate the correlation between alignment deviations and postoperative function. Results The AIKNEE system accurately predicted the prosthesis size in thirty-one of femoral cases (48%) and forty-seven of tibial cases (73%). Deviations of mFTA, LDFA, and MPTA from the target value were within 3° in 88%, 92%, and 95% of cases, respectively. A significant improvement was observed in postoperative pain, ROM, and KSS scores (p

Aim – to conduct a comparative assessment of the accuracy of the developed method of preoperative planning for primary hip arthroplasty. Material and methods. The "Method of preoperative planning in hip arthroplasty" and special device were developed to improve the accuracy of preoperative planning and reduce the number of complications. A clinical study was conducted in the comparison groups. In the main group (50 patients), we used the proposed method in the pre-operative planning; in the control group the patients were prepared for the operation using a standard planning method. The accuracy of evaluation of implant sizes, limb length and offset were registered in the post-operative period. The preoperative planning data were compared with the results obtained. Results. The accuracy of offset estimation in the main group was higher than in the control group (T-criterion = -2.6; p = 0.01). The average difference between the estimated offset and the one obtained in the main group was 1.4±1.5 mm, in the control group it was 2.2±1.7 mm. The error in head size estimation in the main group was less than in the control group (odds ratio = 3.02). No significant differences were registered in determining the size of components of the endoprosthesis, and there were no differences in the leg length in the study groups. Conclusion. The developed method allows for improving the accuracy of preoperative planning in hip arthroplasty. The proposed device ensures the correct placement of patients when performing pelvic radiography, and also makes it easy to change it when performing this procedure.

Introduction: Preoperative planning is a critical step in the success of any complex surgery. The pur-pose of this study is to evaluate the advantage of VR glasses in surgical planning of complex tibial plateau fractures compared to CT planning. Materials and methods: Five orthopedic surgeons performed preoperative planning for 30 fractures using either conventional CT slices or VR visualization with a VR headset. Planning was performed in a randomized order with a 3-month interval between planning sessions. A standardized questionnaire assessed planned operative time, planning time, fracture classification and understanding, and surgeons' subjective confidence in surgical planning. Results: The mean planned operative time of 156 (SD 47) minutes was significantly lower (p < 0.001) in the VR group than in the CT group (172 min; SD 44). The mean planning time in the VR group was 3.48 min (SD 2.4), 17% longer than in the CT group (2.98 min, SD 1.9; p = 0.027). Relevant parameters influencing planning time were surgeon experience (-0.61 min) and estimated complexity of fracture treatment (+ 0.65 min). Conclusion: The use of virtual reality for surgical planning of complex tibial plateau fractures resulted in significantly shorter planned operative time, while planning time was longer compared to CT planning. After VR planning, more surgeons felt (very) well prepared for surgery. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of MSCT 3D scanning and reconstruction on developmental dysplasia of the hip（DDH）in adult patients with total hip arthroplasty, The predictive value of acetabular prosthesis selection and osteotomy accuracy in THA. Methods Selection in our hospital between February 2021 and February 2023 were 60 adult DDH patients underwent total hip replacement, which USES routine preoperative planning as a control group of 30 patients, and using MSCT + reconstruction of 3 d scanning technology as observation group of 30 patients, planning after the completion of the planning of the surgical operation and implant placement, Relevant information was collected before and after the operation of the two groups. Operation time, intraoperative blood loss, intraoperative fluoroscopy time, acetabular prosthesis selection and matching rate, femur split fracture rate, pelvis and acetabular reduction quality, Majeed score and Harris hip function score were compared between the two groups. The osteotomy distance and sharp shoulder distance of the two groups were compared before planning and in actual conditions, and the correlation between MSCT 3D scanning and reconstruction technology and the accuracy of acetabular prosthesis selection was evaluated. Results Results analysis showed that MSCT 3D scanning+reconstruc⁃ tion technology used in preoperative evaluation of patients in the observation group was correlated with the accuracy of acetabular prosthesis selection（P < 0.05）， and the absolute errors of osteotomy distance and sharp shoulder distance of patients in the observation group were smaller than the actual situation before planning（P < 0.05）. In addition，compared with the control group, the operative time, intraoperative blood loss, intraoperative fluoroscopy time and incidence of femoral split fracture in the observation group were significantly lower, and the matching rate of acetabular prosthesis selection, the Majeed scores and Harris scores were significantly higher in the following 3 months were significantly higher（P < 0.05）. The reduction quality of pelvis and acetabulum was not statistically significant between the two groups（P > 0.05）. Conclusion Msct⁃based 3D scanning + reconstruction has a high predictive value for the selection of acetabular prosthesis and the accuracy of osteotomy in adult DDH total hip replacement, and the use of this technology for preoperative planning has a significant optimization effect on the actual treatment effect and patient recovery. [ABSTRACT FROM AUTHOR]

Current preoperative total knee arthroplasty (TKA) planning strategies are bone-referencing and do not consider the ligamentous profile of the knee. This study assessed the mean Hip-Knee-Ankle (HKA) angle of the planned Distracted Alignment (DA), an alignment output using a joint distraction radiology and planning protocol, which incorporates preoperative evaluation of ligament laxity. A retrospective study of 144 knees undergoing TKA was performed. Each patient received a preoperative computer tomograph scan, a weight-bearing antero-posterior knee radiograph, and distracted knee radiographs in extension and flexion. The imaging was used to develop a preoperative DA plan aiming for medio-lateral and extension-flexion space balance. The mean DA, weight-bearing, and arithmetic HKA angles were compared to each other, and to the HKA of a healthy nonarthritic population. The mean weight-bearing, arithmetic, and planned DA HKA angles were 4.8° (interquartile range [IQR] 6.5°) varus, 0.4° (IQR 4.5°) varus, and 2.2° (IQR 4.0°) varus, respectively. This compares to a healthy adult HKA angle of 1.3° varus. The difference between the planned DA and arithmetic HKA angles was greater than 3° for 36% of the patients in the study population. The planned DA HKA angle was fundamentally different from the arithmetic HKA angle, but comparable to a healthy population. Considering both hard and soft tissue information of the knee, we believe the planned DA resulting from the joint distraction radiology protocol allows for optimized preoperative surgical planning in TKA. This protocol has been shown to be clinically viable. [ABSTRACT FROM AUTHOR]

BACKGROUND: Artificial intelligence planning system can automatically establish a three-dimensional model and generate planning schemes, but its accuracy in predicting the prosthesis size has not been fully verified. OBJECTIVE: To investigate the accuracy of artificial intelligence planning system in predicting prosthesis size before total hip arthroplasty and its influence on clinical prognosis, and further analyze the risk factors affecting the accuracy of planning. METHODS: Clinical data of patients with unilateral initial total hip arthroplasty who were admitted to the Department of Orthopedics of Affiliated Hospital of Xuzhou Medical University from January 2021 to June 2022 were prospectively collected. The patients were randomly divided into the artificial intelligence planning system group (n=80) and the conventional template group (n=79). Intraoperative use of prostheses and preoperative planning of prosthesis matching were compared between the two groups. Postoperative follow-up Harris scores and the occurrence of complications such as leg length discrepancy, dislocation and prosthesis loosening were recorded in both groups. The effects of demographic indicators, preoperative diagnosis, and Dorr typing on the accuracy of femoral stem planning were explored using univariate and multivariate Logistic regression analyses. RESULTS AND CONCLUSION: (1) The prediction of the prosthesis size on the acetabular side and femoral side was 50%(40/80) and 55%(44/80) in the artificial intelligence planning system group, compared to 34%(27/79) and 37%(29/79) in the conventional template group, with statistically significant differences (P < 0.05). (2) The artificial intelligence planning system group had an accuracy rate within one size difference for the acetabular and femoral side prostheses of 91%(73/80) and 86%(69/80), compared to 82%(65/79) and 72%(58/79) in the conventional template group, with differences statistically different only on the femoral side (P < 0.05). (3) No dislocation or prosthesis loosening occurred in the two groups during postoperative follow-up. The difference in lower limb length between the artificial intelligence planning system and conventional template groups was (3.56±2.32) mm and (3.52±2.41) mm. At the last follow-up, the Harris scores of the artificial intelligence planning system and conventional template groups were (92.74±3.08) and (91.81±3.52), respectively; there was no significant difference in the above differences (P > 0.05). (4) Univariate analysis results showed that preoperative diagnosis as developmental dysplasia of the hip and osteonecrosis of the femoral head, and Dorr type B and C femurs had a significant effect on the accuracy of predicted prosthesis size using an artificial intelligence planning system (P < 0.05). (5) Multivariate logistic regression analysis showed that preoperative diagnosis of developmental dysplasia of the hip (OR=18.233, 95%CI: 2.662-124.888) was an independent risk factor for the prediction of femoral stem size by artificial intelligence planning system. (6) The artificial intelligence planning system has a higher accuracy in predicting prosthetic size than traditional two-dimensional templates, and there is not a significant difference in the risk of postoperative complications or joint function. The accuracy of the artificial intelligence planning system in patients with developmental dysplasia of the hip was low due to anatomical deformities and acetabular anatomical position reconstruction. [ABSTRACT FROM AUTHOR]

The ideal stem size and stem position is important for the success of total hip arthroplasty, since it can affect early implant loosening and periprosthetic fractures (PPF). This study aimed to investigate how small deviations from the ideal stem size and position influences the PPF risk and primary stability. Six experienced surgeons performed preoperative templating based on which the benchmark size for each femur was determined. Consecutive implantations were performed in six cadaveric femur pairs—one side was implanted with an undersized stem followed by the benchmark size and the contralateral side with a benchmark size followed by an oversized stem (Corail, Depuy Synthes). Moreover, three different alignments (six varus, six neutral, six valgus‐undersized) were compared using 18 femurs. Cortical strains during broaching and implantation were measured, and laser scans were used to determine final stem position. All specimens underwent dynamic loading. Primary stability was estimated from stem subsidence and pull‐out forces. Templated stem size varied between surgeons (±1 size; p = 0.005). Undersizing increased stem subsidence by 320% (p < 0.001). Oversized stems exhibited 52% higher pull‐out forces (p = 0.001) and 240% higher cortical strains (p = 0.056). Cortex strains increased with varus alignment (R2 = 0.356, p = 0.011) while primary stability decreased with valgus stem alignment (p = 0.043). Surgeons should be aware that small deviations from the ideal stem size and malalignments of the stem can significantly alter the mechanical situation and affect the success of their surgery. [ABSTRACT FROM AUTHOR]

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Introduction: Patient-specific 3D printed models have been widely used as a complement to 2D imaging for preoperative planning in orthopaedic surgery. This study discusses surgeons’ views on the use of custom-made 3D models for preoperative planning and intraoperative guiding through two prospective surveys. Materials and methods: 70 surgeons were required to rate on a scale of 1–5 the effectiveness of preoperative use of 3D models in 1) improving surgeons’ understanding of patients’ anatomy, 2) aiding in preoperative planning and 3) explaining the condition to others, and 4) portraying the anatomy accurately. 14 surgeons were required to evaluate on the same scale the ease of use of intraoperative jibs, effectiveness of the jigs in improving the ease, accuracy, and outcomes of surgery, and in reducing surgery time. Results and discussion: Over 90 % of surgeons rated 4 and above (agree and strongly agree) for all areas evaluated on preoperative use of 3D models. Surgeons with shorter years of practice post exit gave higher mean ratings for all areas evaluated. Over 80 % surgeons rated 4 and above for all aspects of intraoperative jigs evaluated except for “reducing surgery time”. We opine that these full-scale individualized models allow clear visualization of complex anatomy from various angles and planes, and simulation of specific surgical procedures. When used intra-operatively, these guides facilitate accurate cuts and positioning of implants, therefore improving the ease and outcome of surgery. Conclusion: In conclusion, surgeons have optimistic views on preoperative and intraoperative use of patient specific 3D models.

BackgroundHip replacement surgeries are increasing in demand, requiring rigorous improvements to a mature surgical protocol. Postoperative patient dissatisfaction mainly stems from postoperative complications resulting from the inappropriate selection of prostheses to meet the needs of each patient. This results in prosthesis loosening, hospital-related fractures, and postoperative complex pain, which can all be attributed to inappropriate sizing. In this study, we aimed to further explore the intraoperative and postoperative benefits of incorporating computer-aided design (CAD) in preoperative planning for total hip arthroplasty (THA).MethodsA total of 62 patients requiring total hip replacement surgery from January 2021 to December 2021 were collected and randomly divided into a preoperative computer-aided simulated group and a conventional x-ray interpretation group. The accuracy of implant size selection (femoral and acetabular implant) between the preoperative planning and surgical procedure of the two groups was compared. Patient parameters, perioperative Harris hip scores, operative time (skin-to-skin time), surgical blood loss, and postoperative hospital stay were recorded, and the differences between the two groups were statistically compared using a single sample t-test.ResultsAll patients in the study were successfully operated on and achieved good postoperative functional recovery. With CAD, the selection of the most suitable-sized prosthesis was significantly more accurate compared to the control group (accuracy of the acetabular component between the CAD/control: 80.6%/61.3%, and accuracy of the femoral component: 83.9%/67.7%). Intraoperative blood loss (177.4/231.0 ml, P = 0.002), operation time (84.2 ± 19.8 min/100.3 ± 25.9 min, P = 0.008), duration of hospital stay (6.5 ± 3/9.1 ± 3.9 days, P = 0.003), and postoperative Harris hip score (81.9 ± 6.5/74.7 ± 11.1, P = 0.003) were compared to the control group and showed statistical significance.ConclusionIncorporating CAD into the preoperative planning of total hip arthroplasty can effectively guide the selection of the most suitable-sized prosthesis, reduce intraoperative blood loss, and promote short-term functional recovery after THA.

Abstract Background The evolving field of rhinoplasty increasingly recognizes the importance of clinical expertise over routine preoperative nasal computed tomography (CT) for planning surgical interventions. This study evaluates the clinical utility of preoperative nasal CT in enhancing the precision of open structured rhinoplasty, focusing on both functional and aesthetic outcomes without compromising patient safety through unnecessary radiation exposure. The study aimed to assess the impact of preoperative nasal CT on surgical planning and intraoperative maneuvers. Methods A prospective cohort study involved patients undergoing open structured rhinoplasty with or without preoperative nasal CT. Participants were divided into a study group, receiving preoperative nasal CT, and a control group, undergoing rhinoplasty without such imaging. Surgical modifications were tailored based on CT findings, with outcomes evaluated through postoperative nasal airflow and aesthetic satisfaction. Results The study included 205 patients in the CT group and 514 in the control group, with comparable demographics. The CT group demonstrated significant improvements in nasal breathing and higher aesthetic satisfaction postoperatively, with a notable decrease in the NOSE score and an increase in the ROE score compared to the control group. Minor complications were observed in a small percentage of the CT group, showcasing a nuanced approach to addressing individual anatomical variations. Conclusions Preoperative nasal CT in open structured rhinoplasty significantly enhances surgical precision, optimizing functional and aesthetic outcomes. This study underscores the utility of preoperative CT in individualized surgical planning, suggesting its pivotal role in the advancement of rhinoplasty practices. Future research should explore long-term benefits and further validate these findings across diverse populations.

Abstract Background Accurate preoperative planning is crucial for successful total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The aim of this study was to compare the accuracy of an artificial intelligence-assisted three-dimensional (3D) planning system (AIHIP) with two-dimensional templates in predicting acetabular cup size in THA for DDH. Method This study retrospectively analyzed image data from 103 DDH patients who had THA between May 2019 and August 2023. AIHIP was used for 3D planning, and two-dimensional (2D) templates were used by two experienced surgeons. Accuracy was assessed by comparing predicted and actual cup sizes, and potential factors affecting accuracy were analyzed, including gender, side, BMI, and dysplasia classification. Results AIHIP had higher accuracy in predicting the acetabular cup size compared to the 2D template. Within ± 0 size, AIHIP’s accuracy was 84.1%, while the 2D template’s was 64.0% (p

BACKGROUND: The preoperative planning of traditional X-ray films is often inaccurate, which can lead to some intraoperative and postoperative complications, increase the operation time and intraoperative blood loss, and to some extent affect the surgical outcome of total hip arthroplasty. OBJECTIVE: To investigate the accuracy and effectiveness of artificial intelligence preoperative planning in total hip arthroplasty.METHODS: Sixty patients who underwent primary total hip arthroplasty on the affected side were selected. 30 of them used artificial intelligence 3D preoperative planning (trial group) and 30 used conventional X-ray film 2D preoperative planning (control group), and there were no statistically significant differences between the two groups in terms of gender, age, condition and other general data (P > 0.05). The actual intraoperative prosthesis placement and preoperative planning prosthesis matching, intraoperative operation time, intraoperative blood loss, bilateral femoral eccentric distance difference, bilateral joint eccentric distance difference and bilateral lower limb length difference, and Harris score at 3 months after operation were compared between the two groups, and the accuracy and application effect of the two preoperative plans were analyzed. RESULTS AND CONCLUSION: (1) Patients in both groups were followed up for 4-6 months postoperatively. One patient in the control group had a posterior dislocation of the prosthesis at 5 days postoperatively, which recovered after performing manual repositioning without re-dislodgement. The rest of the patients did not have postoperative complications or postoperative death. (2) Complete matching rate of the prosthesis on the acetabular side and femoral side was significantly better in the trial group than that in the control group (P < 0.05). (3) Operation time and intraoperative blood loss were significantly less in the trial group than those in the control group (P < 0.05). (4) The difference in bilateral lower limb length between the two groups was statistically significant (P < 0.05), and the difference in bilateral femoral eccentric distance and bilateral joint eccentric distance was not statistically significant (P > 0.05). (5) Harris score of patients in the trial group was significantly higher than that in the control group 3 months after operation (P < 0.05). (6) These results confirm that compared with traditional film planning, artificial intelligence preoperative planning can predict the prosthesis type more accurately, shorten the operation time, reduce intraoperative blood loss, diminish the occurrence of postoperative bilateral lower limb inequality, and accelerate postoperative recovery. [ABSTRACT FROM AUTHOR]

Background: The evolving field of rhinoplasty increasingly recognizes the importance of clinical expertise over routine preoperative nasal computed tomography (CT) for planning surgical interventions. This study evaluates the clinical utility of preoperative nasal CT in enhancing the precision of open structured rhinoplasty, focusing on both functional and aesthetic outcomes without compromising patient safety through unnecessary radiation exposure. The study aimed to assess the impact of preoperative nasal CT on surgical planning and intraoperative maneuvers. Methods: A prospective cohort study involved patients undergoing open structured rhinoplasty with or without preoperative nasal CT. Participants were divided into a study group, receiving preoperative nasal CT, and a control group, undergoing rhinoplasty without such imaging. Surgical modifications were tailored based on CT findings, with outcomes evaluated through postoperative nasal airflow and aesthetic satisfaction. Results: The study included 205 patients in the CT group and 514 in the control group, with comparable demographics. The CT group demonstrated significant improvements in nasal breathing and higher aesthetic satisfaction postoperatively, with a notable decrease in the NOSE score and an increase in the ROE score compared to the control group. Minor complications were observed in a small percentage of the CT group, showcasing a nuanced approach to addressing individual anatomical variations. Conclusions: Preoperative nasal CT in open structured rhinoplasty significantly enhances surgical precision, optimizing functional and aesthetic outcomes. This study underscores the utility of preoperative CT in individualized surgical planning, suggesting its pivotal role in the advancement of rhinoplasty practices. Future research should explore long-term benefits and further validate these findings across diverse populations. [ABSTRACT FROM AUTHOR]

Background: Accurate preoperative planning is crucial for successful total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The aim of this study was to compare the accuracy of an artificial intelligence-assisted three-dimensional (3D) planning system (AIHIP) with two-dimensional templates in predicting acetabular cup size in THA for DDH. Method: This study retrospectively analyzed image data from 103 DDH patients who had THA between May 2019 and August 2023. AIHIP was used for 3D planning, and two-dimensional (2D) templates were used by two experienced surgeons. Accuracy was assessed by comparing predicted and actual cup sizes, and potential factors affecting accuracy were analyzed, including gender, side, BMI, and dysplasia classification. Results: AIHIP had higher accuracy in predicting the acetabular cup size compared to the 2D template. Within ± 0 size, AIHIP's accuracy was 84.1%, while the 2D template's was 64.0% (p < 0.05). Within ± 1 size, AIHIP's accuracy was 95.1%, while the 2D template's was 81.1% (p < 0.05). Accuracy was unaffected by gender, side, or BMI but was by DDH classification. In subgroup analysis, AIHIP's mean absolute error (0.21 ± 0.54) was significantly lower than the 2D template's (0.62 ± 0.95) for Crowe II and Crowe III (p < 0.05). Conclusion: AIHIP is superior to 2D templates in predicting the acetabular cup size accurately for THA in DDH patients. AIHIP may be especially beneficial for Crowe II and III DDH patients, as 2D templates may not accurately predict cup size in these cases. [ABSTRACT FROM AUTHOR]

In oral and maxillofacial surgery, computer-assisted navigation technologies have been widely used to achieve intraoperative positioning. The traditional methods mainly rely on the experience of doctors and the difference between the locations of key points in the surgical area and the preoperative planning, which have certain limitations. In this paper, a new intraoperative surgical navigation framework based on mobile laser scanner is proposed, which ensures that surgery is performed accurately according to the preoperative planning. The framework mainly includes two parts. First, the real-time surface reconstruction of the anatomy should be realized during the operation. Second, the acquired image is matched to the planned image in real time. Although the most common method of surface reconstruction is to render the volume directly from raw data or render the surface from the segmented data using computed tomography/magnetic resonance (CT/MR) data, this method is too complicated for performing the real-time operation during surgery. Furthermore, a new surface registration technique is proposed for image-guided oral and maxillofacial surgery based on the point sets. To improve the registration accuracy and robustness, the point sets are modeled by Mixed Student's t-Distribution model. In the experiments, the point sets of CT data are from 10 patients with craniomaxillofacial diseases and the surface point set is from the LRS. The TRE of 10 data was less than 1 mm. Compared with the paired-point registration method and Iterative Closest Point algorithm, the results demonstrated better performance of the proposed method, the surgical situation can be displayed in real time during the surgical process, and any differences from the surgical plan can also be reflected. [ABSTRACT FROM AUTHOR]

Anatomic total shoulder arthroplasty (TSA) using a stemless prosthesis continues to increase in popularity as literature supporting their use grows. Intraoperative findings, however, may require switching from a planned stemless prosthesis to using a stemmed implant, yet literature attempting to understand the incidence and risk factors leading to this outcome is limited. The purpose of this study was to document the incidence of intraoperative change from a planned stemless implant to a stemmed prosthesis and to determine the correlation between the deltoid tuberosity index and this decision. All patients scheduled to undergo TSA with a stemless humeral prosthesis between 2018 and 2023 at a single academic institution were retrospectively reviewed. Sociodemographic data, comorbidities, and preoperative deltoid tuberosity indices (DTI) were collected for review. DTI was used as an approximation for a patient's bone mineral density. Surgeon plan for stemless TSA was verified via saved three-dimensional preoperative plans. Ninety-two patients were scheduled to undergo stemless TSA, 8 (8.70%) of which received a stemmed implant based on intraoperative findings. In all cases, the operative surgeon deemed the metaphyseal bone inadequate to facilitate use of a stemless implant. DTI was significantly higher in the stemless group relative to the stemmed group (1.55 vs. 1.37, P =.0023). Approximately 9% of planned stemless TSA were converted to stemmed TSA due to proximal humerus bone insufficiency based on surgeon assessment at time of surgery. Diminished DTI was noted to be a risk factor. Preoperative planning may be improved by including imaging parameters to assess bone sufficiency (eg, DTI). [ABSTRACT FROM AUTHOR]

As the utilization of total shoulder arthroplasty continues to grow, surgeons are facing increasingly complex reconstructive challenges both in the primary and revision settings. Proper implant positioning, particularly of the glenoid, is paramount to achieving a good result and avoiding devastating complications and early failure. Historically, surgeons have been able to use plain radiographs and 2-dimensional computed tomography (CT) for preoperative planning. Recently, preoperative planning software based on 3-dimensional CT (3D CT) has revolutionized the surgeons' ability to visualize glenoid deformity and bone stock, plan corrective procedures for abnormal version, and visualize component position. Commercially available preoperative templating software based on 3D CT has been shown to be more accurate and reliable than 2D CT in calculating glenoid version and inclination, and accurately predicts implant size. Patient-specific instrumentation can be developed from the 3D reconstruction, allowing surgeons to accurately execute the preoperative plan and implant the prosthesis to match a patient's unique anatomy. Robotic-assisted surgery, intraoperative navigation, and augmented reality technology show promise in providing real-time intraoperative feedback in order to maximize surgical accuracy and efficiency while ultimately improving patient-reported outcomes. [ABSTRACT FROM AUTHOR]

The aim of the work was to study the role of computer reconstruction and additive technologies in the planning of surgical treatment of intra-articular fractures of the distal part of the humerus in the early post-traumatic period. Materials and methods: the results of treatment of 44 patients with fractures of the distal part of the humerus aged from 22 to 65 years were studied. All patients underwent MSCT in the preoperative period. In 45.5 % (20) cases, in order to increase the effectiveness of preoperative planning, simulation osteosynthesis was performed on an individual printed model of the damaged bone. After completion of preoperative planning, all patients underwent osseous metallo-osteosynthesis in the first week after receiving the injury. In order to assess the effectiveness of the application of visualization techniques, a survey of the operating team was carried out regarding the informativeness of the conducted instrumental studies. Results. The average duration of surgical intervention among patients in the clinical group with standard preoperative planning was 105.9 ± 9.15 minutes. The average results of the survey of the surgical team after the surgical interventions in the specified clinical group were 21.2 ± 2.8 points. The average duration of surgery among patients of the second clinical group, whose preoperative planning included not only the assessment of MSCT results of the damaged segment, but also simulated osteosynthesis with the selection and application of optimal metal fixators, was 54.6 ± 7.14 minutes. The average results of the survey of the surgical team were 31.2 ± 1.7 points. Conclusions. The use of a combination of visualization technologies and 3D printing allows to reduce the time the patient spends in the operating room and increase the effectiveness of preoperative planning. Performing simulated osteosynthesis in the preoperative period allows you to develop an individual technique of repositioning bone fragments and use the optimal standard size of the cortical metal fixator with the distribution of the most favourable compression points of bone fragments. [ABSTRACT FROM AUTHOR]

Study Design: Systematic Review Objective: 3DP technology use has become increasingly more common in the field of medicine and is notable for its growing utility in spine surgery applications. Many studies have evaluated the use of pedicle screw placement guides and spine models in adult spine patients, but there is little evidence assessing its efficacy in pediatric spine patient populations. This systematic review identifies and evaluates the current applications and surgical outcomes of 3-Dimensional Printing (3DP) technology in pediatric spinal surgery. Methods: A search of publications was conducted using literature databases and relevant keywords in concordance with PRISMA guidelines. Inclusion criteria consisted of original studies, and studies focusing on the use of 3DP technology in pediatric spinal surgery. Studies with a focus on adult populations, non-deformity surgery, animal subjects, systematic or literature reviews, editorials, or non-English studies were excluded from further analysis. Results: After application of inclusion/exclusion criteria, we identified 25 studies with 3DP applications in pediatric spinal surgery. Overall, the studies found significantly improved screw placement accuracy using 3DP pedicle screw placement guides but did not identify significant differences in operative time or blood loss. All studies that utilized 3D spine models in preoperative planning found it helpful and noted an increased screw placement accuracy rate of 89.9%. Conclusions: 3DP applications and techniques are currently used in pre-operative planning using pedicle screw drill guides and spine models to improve patient outcomes in pediatric spinal deformity patients. [ABSTRACT FROM AUTHOR]

Background: The classical Wada test (cWada), performed by injecting a short-acting anesthetic through the intracarotid route, helps determine language dominance. In the cWada, adverse effects are observed in 10–30% of trials, hindering accurate assessments. In this study, we assessed the effectiveness of the super-selective Wada test (ssWada), a more selective approach for anesthetic infusion into the middle cerebral artery (MCA). Methods: We retrospectively examined the data of 17 patients with epilepsy who underwent ssWada via anesthetic injection into one M1 segment of the MCA and at least one contralateral trial. Results: The ssWada identified 12 patients with left language dominance, 3 with right language dominance, and 2 with bilateral language distribution. Nine trials on the language dominant side resulted in global aphasia for patients with left- or right language dominance. Of the 13 trials conducted on the non-dominant language side, 12 revealed intact language function and one resulted in confusion. Among these, the outcomes of global aphasia or no language impairment were confirmed in the contralateral trials. Among the 22 trials of unilateral M1 injections in patients with unilateral language dominance, 21 (95.5%) showed either global aphasia or no language impairment, indicating language dominance. Conclusions: The ssWada yields clear results, with a high rate of over 90% in determining the language dominant hemisphere with few side effects. [ABSTRACT FROM AUTHOR]

Traditional, commercially sourced patient-specific instrumentation (PSI) systems for shoulder arthroplasty improve glenoid component placement but can involve considerable cost and outsourcing delays. The purpose of this randomized controlled trial was to compare the accuracy of glenoid component positioning in anatomic total shoulder arthroplasty (aTSA) using an in-house, point-of-care, 3-dimensionally (3D) printed patient-specific glenoid drill guide vs. standard nonspecific instrumentation. This single-center randomized controlled trial included 36 adult patients undergoing primary aTSA. Patients were blinded and randomized 1:1 to either the PSI or the standard aTSA guide groups. The primary endpoint was the accuracy of glenoid component placement (version and inclination), which was determined using a metal-suppression computed tomography scan taken between 6 weeks and 1 year postoperatively. Deviation from the preoperative 3D templating plan was calculated for each patient. Blinded postoperative computed tomography measurements were performed by a fellowship-trained shoulder surgeon and a musculoskeletal radiologist. Nineteen patients were randomized to the patient-specific glenoid drill guide group, and 17 patients were allocated to the standard instrumentation control group. There were no significant differences between the 2 groups for native version (P =.527) or inclination (P =.415). The version correction was similar between the 2 groups (P =.551), and the PSI group was significantly more accurate when correcting version than the control group (P =.042). The PSI group required a significantly greater inclination correction than the control group (P =.002); however, the 2 groups still had similar accuracy when correcting inclination (P =.851). For the PSI group, there was no correlation between the accuracy of component placement and native version, native inclination, or the Walch classification of glenoid wear (P >.05). For the control group, accuracy when correcting version was inversely correlated with native version (P =.033), but accuracy was not correlated with native inclination or the Walch classification of glenoid wear (P >.05). The intraclass correlation coefficient was 0.703 and 0.848 when measuring version and inclination accuracy, respectively. When compared with standard instrumentation, the use of in-house, 3D printed, patient-specific glenoid drill guides during aTSA led to more accurate glenoid component version correction and similarly accurate inclination correction. Additional research should examine the influence of proper component position and use of PSI on clinical outcomes. [ABSTRACT FROM AUTHOR]

Surgical treatment of locally spread tumors in pelvic organs remains an urgent and complicated oncological problem. The recurrence rate after radical treatment ranges from 15.1% to 45.2%. The key to successful and safe surgical intervention lies in meticulous planning and intraoperative navigation, including the utilization of augmented reality (AR) technology. This paper presents the experience of clinically testing an AR technology application algorithm in the surgical treatment of 11 patients. The main stages of the algorithm are described. Radical operations incorporating intraoperative AR technology with favorable outcomes were performed on eight patients. One patient underwent a palliative intervention, while two patients did not undergo surgery. The testing of the algorithm for the application of AR technology in the surgical treatment of primary and recurrent pelvic tumors demonstrated both a technical possibility and reproducibility of this algorithm and the AR technology itself in clinical practice. [ABSTRACT FROM AUTHOR]

Endovascular embolization of arteriovenous malformations (AVMs) in the brain usually requires injecting liquid embolic agents (LEAs) to reduce blood flow through the malformation. In clinical procedures, the feeding artery into which the LEAs are injected, and the amount of LEAs needs to be carefully planned preoperatively. Computational fluid dynamics can simulate the injecting process of LEAs in nidus and evaluate the therapeutic effects of different procedures preoperatively. Applying a porous media model avoided the difficulties of geometric modeling of AVMs, and the complex vascular network structure within the nidus was reproduced. The multi-phase flow was applied to simulate the interaction between LEAs and blood. The viscosity of LEAs is determined by the concentration of its solute ethylene-vinyl alcohol copolymer (EVOH). The diffusion process of the solvent dimethyl sulfoxide (DMSO) was calculated by solving the species transport equation. The coagulation of LEAs was simulated by constructing the relationship between the concentration of EVOH and viscosity. The numerical simulation method of LEAs for injection and coagulation was tested on two patient-specific AVMs. The calculations predicted the flow direction of the LEAs in the nidus. The morphology of the injected LEAs could be well visualized by 3D rendering. Quantitative analysis was conducted, including flow rate changes at the feeding arteries and draining veins. The embolization process of AVMs with LEAs can be simulated by computational fluid dynamics (CFD) methods to show the therapeutic effects of different embolization procedure planning, the optimal treatment plan can be determined. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to analyse the factors associated with additional postoperative alignment changes after accurate bony correction by selecting only patients with well‐performed bony correction as planned and develop a method of incorporating significant factors into preoperative planning. Methods: Among 104 consecutive patients who underwent medial open wedge high tibial osteotomy (MOWHTO) between October 2019 and July 2022, 61 with well‐performed bony corrections were retrospectively reviewed. The major criterion for well‐performed bony correction was a difference of <1° between the simulated medial proximal tibial angle (MPTA) and the actual postoperative MPTA as measured in three dimensions. Radiographic parameters, such as the joint line convergence angle (JLCA) and joint line obliquity (JLO), were measured preoperatively and postoperatively, utilising standing and supine whole lower extremity anteroposterior, valgus and varus stress radiographs. Multiple linear regression analysis identified the factors affecting alignment changes, and a prediction model was developed. A method for applying this prediction model to preoperative planning was proposed. Results: Preoperative JLCA on standing (preJLCAstd), preoperative JLCA on 0° valgus stress radiograph (vgJLCA0), and preoperative JLO (preJLO) were significantly correlated with JLCA change (∆JLCA) (p < 0.001, p < 0.001, p = 0.006). The prediction model was estimated as ∆JLCA = 0.493 × (vgJLCA0) − 0.727 × (preJLCAstd) + 0.189 × (preJLO) − 1.587 in. (R = 0.815, modified R2 = 0.646, p < 0.001). The proposed method resulted in a reduced overcorrection rate (p = 0.003) and an improved proportion of acceptable alignments (p = 0.013). Conclusion: PreJLCAstd, vgJLCA0 and preJLO can be used to estimate ∆JLCA. PreJLO was recently identified as a significant factor associated with additional alignment changes. Utilising the proposed preoperative planning and a prediction model with these factors shows promise in calibrating postoperative alignment after MOWHTO. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

BackgroundIn recent years, 3D printing technology has made significant strides in the medical field. With the advancement of orthopedics, there is an increasing pursuit of high surgical quality and optimal functional recovery. 3D printing enables the creation of precise physical models of fractures, and customized personalized steel plates can better realign and more comprehensively and securely fix fractures. These technologies improve preoperative diagnosis, simulation, and planning for complex limb fractures, providing patients with better treatment options.Patients and methodsFive typical cases were selected from a pool of numerous patients treated with 3D printing technology combined with personalized custom steel plates at our hospital. These cases were chosen to demonstrate the entire process of printing 3D models and customizing individualized steel plates, including details of the patients' surgeries and treatment procedures. Literature reviews were conducted, with a focus on highlighting the application of 3D printing technology combined with personalized custom steel plates in the treatment of complex limb fractures.Results3D printing technology can produce accurate physical models of fractures, and personalized custom plates can achieve better fracture realignment and more comprehensive and robust fixation. These technologies provide patients with better treatment options.ConclusionThe use of 3D printing models and personalized custom steel plates can improve preoperative diagnosis, simulation, and planning for complex limb fractures, realizing personalized medicine. This approach helps reduce surgical time, minimize trauma, enhance treatment outcomes, and improve patient functional recovery.

A 73-year-old male presented with angina symptoms and was diagnosed with three-vessel coronary artery disease by use of computed tomography angiography and coronary angiography. This diagnosis necessitated coronary artery bypass grafting (CABG) surgery. A custom made AI-driven algorithm was used to generate a patient-specific three-dimensional coronary artery model from computed tomography angiography imaging data. This framework enabled precise segmentation and reconstruction of the coronary vasculature, yielding an accurate anatomical and pathological representation. Subsequently, this generated model was integrated into a novel extended reality tool for preoperative planning and intraoperative guidance in CABG surgery. Both preoperatively and intraoperatively, the tool augmented spatial orientation and facilitated precise stenosis localization, thereby enhancing the surgeon's operative proficiency. This case report underscores the utility of advanced extended reality tools in cardiovascular surgery, emphasizing their pivotal role in refining surgical planning and execution. [ABSTRACT FROM AUTHOR]