Advances in Computer Assisted Mosaic Arthroplasty

软骨退化是一个普遍的问题，主要发生在膝盖，脚踝和肩膀。对于年轻活跃的患者，早期软骨置换可以大大提高生活质量，并可以延迟或消除对人工关节置换的最终需求，为加拿大医疗保健系统节省大量资金。镶嵌式关节成形术是一种外科手术，其中软骨和骨塞从关节的非承重区域移植到软骨缺损部位。我们在以前的研究中已经表明，计算机辅助镶嵌关节成形术（CAMA）比传统镶嵌关节成形术具有更好的临床效果。拟议的研究，这将培养四个研究生和三个本科生，将开发计算机算法和用户界面，以提高CAMA在三个领域的交付：1。几乎所有的计算机辅助手术都涉及患者的CT或MRI扫描，然后是术前计划阶段，然后是手术。我们将CAMA的扫描和计划阶段整合到手术本身中：外科医生将在术中使用跟踪关节镜探头扫描软骨表面，使用计划算法制定手术计划，并使用计算机跟踪和指导执行计划。这可以减少等待时间，并可以减少患者暴露于电离辐射。2.对于关节镜CAMA，我们将为外科医生提供增强现实引导显示，手术计划叠加在实时关节镜视频上，显示在患者旁边的显示器上。这将减少外科医生的认知负担，并可能使手术更有可能成功。3. CAMA工具引导的一种方法使用患者特定的引导器，其在3D打印机上制造;它们的底侧与患者的软骨表面紧密贴合，并且它们的顶侧包含用于引导手术工具的孔。我们将开发一种计算机算法，自动设计的指南，编码操作员的隐藏的启发式知识和节省大量的操作时间比目前的手动方法。

Cartilage degeneration is a widespread problem which occurs predominantly in the knee, ankle, and shoulder. For younger, active patients, early cartilage replacement can result in a much improved quality of life and can delay or eliminate the eventual need for prosthetic joint replacement, with substantial savings to the Canadian healthcare system. Mosaic arthroplasty is a surgical procedure in which plugs of cartilage and bone are transplanted from non-load-bearing areas of the joint to the site of the cartilage defect. We have shown in previous research that computer-assisted mosaic arthroplasty (CAMA) results in better clinical outcomes than conventional mosaic arthroplasty. The proposed research, which will train four graduate and three undergraduate students, will develop computer algorithms and user interfaces to improve the delivery of CAMA in three areas: 1. Almost all computer-assisted operations involve a patient CT or MRI scan, followed by a pre-operative planning stage, followed by the operation. We will collapse the scanning and planning stages of CAMA into the operation itself: The surgeon will intraoperatively scan the cartilage surface with a tracked arthroscope probe, will use a planning algorithm to develop a surgical plan, and will execute the plan using computer tracking and guidance. This can reduce waiting times and can reduce patient exposure to ionizing radiation. 2. For arthroscopic CAMA, we will provide the surgeon with an augmented reality guidance display, where the surgical plan is superimposed on the live arthroscope video, shown on a display beside the patient. This will reduce the cognitive burden on the surgeon and may make the success of the operation more likely. 3. One method of CAMA tool guidance uses patient-specific guides, which are manufactured on a 3D printer; their bottom side fits tightly to the patient's cartilage surface and their top side contains holes to guide the surgical tools. We will develop a computer algorithm that designs the guides automatically, encoding the operator's hidden heuristic knowledge and saving substantial operator time over the current manual method.