Computer Assisted Mosaic Arthroplasy: A Pilot Study and Animal Trial

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URL: http://hdl.handle.net/1974/7632

Abstract

Mosaic Arthroplasty is a well-accepted surgical approach to treating focal cartilage defects of the knee. However, the task of creating the mosaic of osteochondral grafts that optimally restores the cartilage surface is technically demanding. Conventional techniques require the surgeon to reconstruct a complex, three-dimensional surface by eye and experience only. There is evidence that this type of procedure is sensitive to technique: grafts that are transplanted proud of the native cartilage surface tend to show evidence of cartilage fissuring and fibrillation prematurely.

Two computer-assisted techniques (navigation by optical tracking and guidance by patient-specific templates) were investigated to determine whether they would have a beneficial effect on surgical execution, and whether any differences in execution had any correlation to surgical outcome. The experimental work can be broken into two parts: an in vitro study that compared the accuracy of execution of an optically navigated group versus a template guided group, and an in vivo animal trial that compared both computer assisted techniques to the conventional, non-assisted approach.

The results of the pilot study indicated that, while there were higher errors in the individual measures of position, orientation, and plug depth in the optically navigated group, there was no significant difference in the overall fidelity of the geometric surface produced between the two groups. The results of the animal trial indicated that both computer assisted techniques produced morphological results that were superior to the conventional technique. The two computer-assisted techniques also showed a significantly better treatment effect as seen by their higher histological scoring. Furthermore, a significant linear correlation was found between morphological results and histological score. Overall, the experiments demonstrated that surgeons and patients could potentially benefit from the use of computer-assisted techniques in the short term. Further work is required to prove long-term beneficial effect.

Cited Works (14)

Year	Entry
2003	Chen C-T, Bhargava M, Lin PM, Torzilli PA. Time, stress, and location dependent chondrocyte death and collagen damage in cyclically loaded articular cartilage. J Orthop Res. September 2003;21(5):888-898.
1998	Soltz MA, Ateshian GA. Experimental verification and theoretical prediction of cartilage interstitial fluid pressurization at an impermeable contact interface in confined compression. J Biomech. October 1998;31(10):927-934.
2003	Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R. Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint: a prospective, comparative trial. J Bone Joint Surg. February 2003;85A(2):185-192.
1997	Buckwalter JA, Mankin HJ. Articular cartilage, II: degeneration and osteoarthrosis, repair, regeneration, and transplantation. J Bone Joint Surg. April 1997;79A(4):612-632.
1982	Mankin HJ. The response of articular cartilage to mechanical injury. J Bone Joint Surg. March 1982;64A(3):460-466.
1992	Besl PJ, McKay ND. A method for registration of 3-D shapes. IEEE Trans Pattern Anal Mach Intell. February 1992;14(2):239-256.
1987	Arun KS, Huang TS, Blostein SD. Least-squares fitting of two 3-D point sets. IEEE Trans Pattern Anal Mach Intell. 1987;9(5):698-700.
1999	Flannery CR, Hughes CE, Schumacher BL, Tudor D, Aydelotte MB, Kuettner KE, Caterson B. Articular cartilage superficial zone protein (SZP) is homologous to megakaryocyte stimulating factor precursor and is a multifunctional proteoglycan with potential growth-promoting, cytoprotective, and lubricating properties in cartilage metabolism. Biochem Biophys Res Commun. January 27, 1999;254(3):535-541.
1997	Poole CA. Articular cartilage chondrons: form, function and failure. J Anat. 1997;191(1):1-13.
2009	Oentoro A. A System for Computer-Assisted Surgery With Intraoperative CT Imaging [Master's thesis]. Queen's University; August 2009.
2000	Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, Kington RS, Lane NE, Nevitt MC, Zhang Y, Sowers M, McAlindon T, Spector TD, Poole AR, Yanovski SZ, Ateshian G, Sharma L, Buckwalter JA, Brandt KD, Fries JF. Osteoarthritis: new insights, I: the disease and its risk factors. Ann Intern Med. October 17, 2000;133(8):635-646.
1996	Wong M, Wuethrich P, Eggli P, Hunziker E. Zone-specific cell biosynthetic activity in mature bovine articular cartilage: a new method using confocal microscopic stereology and quantitative autoradiography. J Orthop Res. May 1996;14(3):424-432.
1986	Radin EL, Rose RM. Role of subchondral bone in the initiation and progression of cartilage damage. Clin Orthop Relat Res. December 1986;213:34-40.
1994	Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. NEJM. October 6, 1994;331(14):889-895.