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    Veröffentlicht am, 28.08.2022

    Quantum leap in digital orthopedic surgery planning – planning in 3D

    St. Franziskus Hospital in Cologne-Ehrenfeld

    Digital surgery planning is an integral part of orthopedics – if nothing else, simply because
    of the associated automatic complete documentation. The quality and time savings are
    also much higher than planning with films and templates. Nonetheless, not all digitally
    planned surgeries lead to a satisfactory result for the patient or the surgeon. The new option
    of planning on a computer screen instead of in only two dimensions as before promises
    great benefits. Planning in 3D means all exact mechanical/geometric parameters can be
    included. This enables tangible patient-specific prostheses.

    Digital surgery planning in 3D
    The Orthopedics I Clinic at the St. Franziskus Hospital in Cologne-
    Ehrenfeld has been using digital planning for entire orthopedic
    prostheses since 2006. The mediCAD® software from the mediCAD
    Hectec company has proven itself as a two-dimensional
    planning tool. The company has been working on the development
    of the program continuously since 1994. More than 3000
    clinics and orthopedics practices around the world use it. The digital
    solution includes all planning methods, documents all processes
    correctly and covers all orthopedics surgeries – from hips
    to knees and spine, and feet and ankles. mediCAD® is certified
    and approved worldwide as a medical product. The basis is an
    implant database containing articles from more than 140 manufacturers.
    In addition to implants, surgeons also find a comprehensive
    range of osteosyntheses for planning in mediCAD®. In
    addition to the traditional proven 2D solution, mediCAD Hectec
    now also offers the corresponding 3D module components:
    mediCAD Hip® 3D, mediCAD Knee® 3D and mediCAD Spine® 3D
    are already on the market, and the planning software modules
    for shoulders and feet, and a mediCAD® web-based solution will
    follow in early 2018.

    At a glance:

    • Customized prothesis with three-dimensional planning
    • Three-dimenional planning for hip and knee
    • Unprecendeted increase in planning precision
    • Cost savings through reduction of filters and instruments
    • Automatic documentation of the planning
    • Significant reduction of intraoperative complications

    The St. Franziskus Hospital in Cologne has been relying on
    three-dimensional planning for hip surgeries with mediCAD Hip®
    3D for quite a while now and is already planning on using the all
    new mediCAD Knee® 3D module.

    Print model of a hip developed using 3D CT data

    For Chief Physician Dr. Klaus Schlüter-Brust, the increase in
    precision, which results in higher safety, is the best feature. At
    the same time, the software is so user-friendly and self-explanatory
    that even new users can very quickly create good plans.
    „After working together on three plans, an assistant physician
    can work independently,“ says Schlüter-Brust. Since planning
    takes less than five minutes, emergency surgeries can also be
    planned as precisely and safely as elective surgeries. Volumetric
    measurements, detection of abrasions and the preoperative
    and postoperative comparisons have proven to be particularly
    important and helpful functions. The measurement of the femoral
    acetabular offset, the comparison of the healthy side to the
    dysplastic side and the overall leg condition with knee surgeries
    is just as important as, for example, planning of an osteotomy
    of the knee and hip joints. As an endoprosthetics center that
    provides maximum care, the Clinic must precisely document all
    deviations from surgical plans. Using mediCAD Hip® 3D significantly
    reduces these deviations and helps avoid intraoperative
    complications. In the case of replacement of an endoprosthesis,
    the measurement of the socket antetorsion and socket inclination
    in the 3D space enables the detection of problems with the
    previous prosthesis.

    Patient-specific prosthetics
    Since early 2017, the Clinic has been using the newly developed
    version of mediCAD Hip® 3D, which allows three-dimensional
    planning. After four months of using this new planning module,
    Schlüter-Brust has a very positive overall impression. „Three-dimensional
    planning allows for an unprecedented increase in
    planning precision. It opens up the path to CT-based three-dimensional
    navigation and the selection of patient-specific prostheses.“
    The best possible prosthesis was able to be selected until now, but
    a prosthesis that is an exact match can be created in the future.
    Prosthesis manufacturers can produce a customized prosthesis
    using the three-dimensional planning data. Together with patient-
    specific cutting templates, this guarantees exact positioning of
    the prosthesis at the planned optimal position.

    3D-planning of a cement-free socket with acetabular dysplasia

    An endoprosthetics center that provides maximum care
    St. Franziskus Hospital is an academic teaching hospital with
    around 300 beds and 800 employees. In one year, an average of
    15,000 patients are hospitalized and 37,000 patients are treated
    on an outpatient basis. The Orthopedics Clinic I, headed by Chief
    Physician Dr. Klaus Schlüter-Brust, is certified as an „Endoprosthetics
    center providing maximum care.“ Around 2100 patients in 42
    beds are treated here annually. The digital planning software is
    installed on eight PCs, which the five-person team uses to digitally
    plan around 600 prosthesis surgeries per year, which are distributed
    about equally between knee and hip surgeries.

    Cost savings
    mediCAD HIP® 3D also enables postoperative control and analysis
    – an important step towards even greater safety for the patient.
    Used preoperatively, 3D planning will open up the possibility
    of dispensing with X-rays and CTs in favor of MRIs in the future.
    Three-dimensional planning enables accurate preoperative measurement
    of the patient‘s specific bone situation. This leads to
    even more precise prosthesis planning and a reduction in filters
    and instruments needed, resulting in considerable cost savings. Examples
    of the higher planning accuracy include the exact detection
    of tilt, torsion of the pelvis and the sacral slope. Schlüter-Brust is
    convinced of one thing: „Even if three-dimensional planning takes
    up to ten minutes instead of five minutes as before, the benefits for
    the surgeon and the patient more than make up for that,“ he says.
    This becomes even more clear in the case of complex operations,
    such as inversion and dysplasia surgeries or Bechterew patients.
    „Clinics that are now dealing with a choice of solutions for digital
    surgical planning should make sure that three-dimensional
    planning is included,“ says Schlüter-Brust. The mediCAD® product
    range fulfills all requirements for modern surgical planning.

    Positioning of the implants

    mediCAD Hip® 3D – the high performance tool for the hip surgeries of tomorrow
    With the new 3D module mediCAD Hip® 3D software from the mediCAD Hectec company,
    physicians will have completely new options for carrying out anatomical assessments,
    planning and measurements of hips, enabling them to achieve optimal, revision-proof
    surgery preparation.

    The most important features of this new 3D module, which was developed in close collaboration
    with hip surgery specialists, include:

    • Anatomical 3D and 2D viewing
    • Segmenting of the 3D object
    • Simple analysis of the current pathological situation
    • Transparent view as well as distance and bone contact visualization
    • Precise, simple and automatic measurement processes
    • Simple selection and positioning of implants
    • Range of Motion (ROM)
    • Customized prosthesis with detailed planning
    • Calculations of torsion
    • CT image stitching for lower radiation exposure
    • Data export for 3D printing of body areas
    Measurement of the current pathological situation with mediCAD HIP® 3D