Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their ...increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes.
Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans.
227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure.
3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis.
Background
Most knee surgeons have believed during TKA neutral mechanical alignment should be restored. A number of patients may exist, however, for whom neutral mechanical alignment is abnormal. ...Patients with so-called “constitutional varus” knees have had varus alignment since they reached skeletal maturity. Restoring neutral alignment in these cases may in fact be abnormal and undesirable and would likely require some degree of medial soft tissue release to achieve neutral alignment.
Questions/purposes
We investigated what percentage of the normal population has constitutional varus knees and what are the contributing factors.
Subjects and Methods
We recruited a cohort of 250 asymptomatic adult volunteers between 20 and 27 years old for this cross-sectional study. All volunteers had full-leg standing digital radiographs on which 19 alignment parameters were analyzed. The incidence of constitutional varus alignment was determined and contributing factors were analyzed using multivariate prediction models.
Results
Thirty-two percent of men and 17% of women had constitutional varus knees with a natural mechanical alignment of 3° varus or more. Constitutional varus was associated with increased sports activity during growth, increased femoral varus bowing, an increased varus femoral neck-shaft angle, and an increased femoral anatomic mechanical angle.
Conclusions
An important fraction of the normal population has a natural alignment at the end of growth of 3° varus or more. This might be a consequence of Hueter-Volkmann’s law. Restoration of mechanical alignment to neutral in these cases may not be desirable and would be unnatural for them.
Level of Evidence
Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
We present the implementation and validation of OpenDrift, an open-source Lagrangian particle trajectory modeling framework for oil spill modeling in the coastal waters of Estonia in the Baltic Sea. ...The framework was coupled with ECMWF winds, NEMO-EST05 hydrodynamical model, and SWAN-EST wave model, and validated using six drift experiments from 2022. The sensitivity analysis revealed the importance of incorporating additional forcing factors, such as Stokes drift and currents, which generally improved the accuracy of the trajectory model compared to using wind alone. Nevertheless, the benefits of providing OpenDrift with, for example, the Stokes drift seemed to depend on whether currents are also included or not. The wind drift factors of the utilized drifters align closely with those commonly employed in oil spill modeling. Furthermore, the modeling results for hypothetical oil spills in severe weather conditions and high-risk regions emphasize the critical need for preparedness and rapid response strategies.
Display omitted
•Wind drift factors for drifters resembled those commonly used in oil spill modeling.•Additional forcing factors generally improved the skill of the trajectory model.•Interplay between different forcing factors observed.•Hypothetical spill cases emphasize importance of preparedness and fast response.
This paper investigates the performance of three different wave model source term packages in narrow fetch geometries. The packages are used to model the sea state in a complex coastal system with ...narrow fjords on the west coast of Norway. The modelling system is based on the Simulating WAves Nearshore (SWAN) wave model that is forced with winds from a nested atmospheric model and wave spectra from a regional wave model at the boundaries. The performances of the recent ST6, and two older SWAN white-capping and wind input packages, are evaluated by comparing modelled spectra and integrated wave parameters against five wave buoys. The comparison covers long-term statistics and two case studies of narrow fetch geometries (i) without swell and (ii) with swell-wind sea conditions. SWAN’s original saturation-based approach performs best in the fjord system. In narrow fetch geometry without swell, all packages overestimate the wave energy. ST6 shows the highest sensitivity to fetch geometry and local wind changes. The results indicate that the ST6 white-capping is too weak to balance its strong wind input.
•At inner fjord areas the fetch geometry has a distinct effect on model accuracy.•In exposed areas the dependence between fetch geometry and the model accuracy is weak.•The WESTH package shows the best performance in areas with mixed sea-swell conditions.•The Komen-approach performs best in the location with no exposure to open sea.•ST6 is the most sensitive to narrow fetch geometry and variations in local wind speed.
In 1879, the French surgeon Segond described the existence of a ‘pearly, resistant, fibrous band’ at the anterolateral aspect of the human knee, attached to the eponymous Segond fracture. To date, ...the enigma surrounding this anatomical structure is reflected in confusing names such as ‘(mid‐third) lateral capsular ligament’, ‘capsulo‐osseous layer of the iliotibial band’ or ‘anterolateral ligament’, and no clear anatomical description has yet been provided. In this study, the presence and characteristics of Segond's ‘pearly band’, hereafter termed anterolateral ligament (ALL), was investigated in 41 unpaired, human cadaveric knees. The femoral and tibial attachment of the ALL, its course and its relationship with nearby anatomical structures were studied both qualitatively and quantitatively. In all but one of 41 cadaveric knees (97%), the ALL was found as a well‐defined ligamentous structure, clearly distinguishable from the anterolateral joint capsule. The origin of the ALL was situated at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament, although connecting fibers between the two structures were observed. The ALL showed an oblique course to the anterolateral aspect of the proximal tibia, with firm attachments to the lateral meniscus, thus enveloping the inferior lateral geniculate artery and vein. Its insertion on the anterolateral tibia was grossly located midway between Gerdy's tubercle and the tip of the fibular head, definitely separate from the iliotibial band (ITB). The ALL was found to be a distinct ligamentous structure at the anterolateral aspect of the human knee with consistent origin and insertion site features. By providing a detailed anatomical characterization of the ALL, this study clarifies the long‐standing enigma surrounding the existence of a ligamentous structure connecting the femur with the anterolateral tibia. Given its structure and anatomic location, the ALL is hypothesized to control internal tibial rotation and thus to affect the pivot shift phenomenon, although further studies are needed to investigate its biomechanical function.
The goals of lower limb reconstruction are to restore alignment, to improve function, and to reduce pain. However, it remains unclear whether alignment of the lower limb and hindfoot are associated ...because an accurate assessment of hindfoot deformities has been limited by superposition on plain radiography. Consequently, surgeons often overlook hindfoot deformity when planning orthopaedic procedures of the lower limb. Therefore, we used weight-bearing CT to quantify hindfoot deformity related to lower limb alignment in the coronal plane.
(1) Is lower-limb alignment different in varus than in valgus hindfoot deformities for patients with and without tibiotalar joint osteoarthritis? (2) Does a hindfoot deformity correlate with lower-limb alignment in patients with and without tibiotalar joint osteoarthritis? (3) Is joint line orientation different in varus than in valgus hindfoot deformities for patients with tibiotalar joint osteoarthritis? (4) Does a hindfoot deformity correlate with joint line orientation in patients with tibiotalar joint osteoarthritis?
Between January 2015 and December 2017, one foot and ankle surgeon obtained weightbearing CT scans as second-line imaging for 184 patients with ankle and hindfoot disorders. In 69% (127 of 184 patients) of this cohort, a combined weightbearing CT and full-leg radiograph was performed when symptomatic hindfoot deformities were present. Of those, 85% (109 of 127 patients) with a median (range) age of 53 years (23 to 75) were confirmed eligible based on the inclusion and exclusion criteria of this retrospective comparative study. The Takakura classification was used to divide the cohort into patients with (n = 74) and without (n = 35) osteoarthritis of the tibiotalar joint. Lower-limb measurements, obtained from the full-leg radiographs, consisted of the mechanical tibiofemoral angle, mechanical tibia angle, and proximal tibial joint line angle. Weightbearing CT images were used to determine the hindfoot's alignment (mechanical hindfoot angle), the tibiotalar joint alignment (distal tibial joint line angle and talar tilt angle) and the subtalar joint alignment (subtalar vertical angle). These values were statistically assessed with an ANOVA and a pairwise comparison was subsequently performed with Tukey's adjustment. A linear regression analysis was performed using the Pearson correlation coefficient (r). A reliability analysis was performed using the intraclass correlation coefficient.
Lower limb alignment differed among patients with hindfoot deformity and among patients with or without tibiotalar joint osteoarthritis. In patients with tibiotalar joint osteoarthritis, we found knee valgus in presence of hindfoot varus deformity and knee varus in presence of hindfoot valgus deformity (mechanical tibiofemoral angle 0.3 ± 2.6° versus -1.8 ± 2.1°; p < 0.001; mechanical tibia angle -1.4 ± 2.2° versus -4.3 ± 1.9°; p < 0.001). Patients without tibiotalar joint osteoarthritis demonstrated knee varus in the presence of hindfoot varus deformity compared with knee valgus in presence of hindfoot valgus deformity (mechanical tibiofemoral angle -2.2 ± 2.2° versus 0.9 ± 2.4°; p < 0.001; mechanical tibia angle -1.8 ± 2.1° versus -4.3 ± 1.9°; p < 0.001). Patients with more valgus deformity in the hindfoot tended to have more tibiofemoral varus (r = -0.38) and tibial varus (r = -0.53), when tibiotalar joint osteoarthritis was present (p < 0.001). Conversely, patients with more valgus deformity in the hindfoot tended to have more tibiofemoral valgus (r = 0.4) and tibial valgus (r = 0.46), when tibiotalar joint osteoarthritis was absent (p < 0.001). The proximal joint line of the tibia had greater varus orientation in patients with a hindfoot valgus deformity compared with greater valgus orientation in patients with a hindfoot varus deformity (proximal tibial joint line angle 88.5 ± 2.0° versus 90.6 ± 2.2°; p < 0.05). Patients with more valgus deformity in the hindfoot tended to have more varus angulation of the proximal tibial joint line angle (r = 0.31; p < 0.05).
In patients with osteoarthritis of the tibiotalar joint, varus angulation of the knee was associated with hindfoot valgus deformity and valgus angulation of the knee was associated with hindfoot varus deformity. Patients without tibiotalar joint osteoarthritis exhibited the same deviation at the level of the knee and hindfoot. These distinct radiographic findings were most pronounced in the alignment of the tibia relative to the hindfoot deformity. This suggests a detailed examination of hindfoot alignment before knee deformity correction at the level of the proximal tibia, to avoid postoperative increase of pre-existing hindfoot deformity. Other differences detected between the radiographic parameters were less pronounced and varied within the subgroups. Future research could identify prospectively which of these parameters contain clinical relevance by progressing osteoarthritis or deformity and how they can be altered by corrective treatment.
Level III, prognostic study.
Abstract
Wave buoys are a popular choice for measuring sea surface waves, and there is also an increasing interest for wave information from ice-covered water bodies. Such measurements require ...cost-effective, easily deployable, and robust devices. We have developed LainePoiss (LP)—an ice-resistant and lightweight wave buoy. It calculates the surface elevation by double integrating the data from the inertial sensors of the microelectromechanical system (MEMS), and transmits wave parameters and spectra in real time over cellular or satellite networks. LP was validated through 1) sensor tests, 2) wave tank experiments, 3) a field validation against a Directional Waverider, 4) an intercomparison of several buoys in the field, and 5) field measurements in the Baltic Sea marginal ice zone. These extensive field and laboratory tests confirmed that LP performed well (e.g., the bias of
H
m
0
in the field was 0.01 m, with a correlation of 0.99 and a scatter index of 8%; the mean absolute deviation of mean wave direction was 7°). LP was also deployed with an unmanned aerial vehicle and we present our experience of such operations. One issue that requires further development is the presence of low-frequency artifacts caused by the dynamic noise of the gyroscope. For now, a correction method is presented to deal with the noise.
Significance Statement
Operational wave buoys are large and therefore expensive and inconvenient to deploy. Many commercially available devices cannot measure short waves and are not tested in ice. Our purpose was to develop an affordable wave buoy that is lightweight, ice resistant, capable of measuring short waves, and also has a longer operating life than existing research buoys. The buoy is easily deployed with a small boat or even an industrial drone, thus reducing operating costs. The buoy is accurate, and captures waves that are too short for operational wave buoys. This is relevant for coastal planning in, e.g., archipelagos and narrow fjords. We measured waves in ice in the Baltic Sea, and are planning to extend these measurements to Antarctica.
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