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Cited by 14Bone and Joint DiseasesAnatomy and Medical TechnologyHip disorders and treatments

Patient-specific core decompression surgery for early-stage ischemic necrosis of the femoral head

Open access
Wang, Wei, Hu, Wei, Yang, Pei, Dang, Xiao Qian, Li, Xiao Hui, Wang, Kun Zheng·2017·PLOS ONE
DOI 10.1371/journal.pone.0175366PMC PMC5413021
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Abstract

INTRODUCTION: Core decompression is an efficient treatment for early stage ischemic necrosis of the femoral head. In conventional procedures, the pre-operative X-ray only shows one plane of the ischemic area, which often results in inaccurate drilling. This paper introduces a new method that uses computer-assisted technology and rapid prototyping to enhance drilling accuracy during core decompression surgeries and presents a validation study of cadaveric tests. METHODS: Twelve cadaveric human femurs were used to simulate early-stage ischemic necrosis. The core decompression target at the anterolateral femoral head was simulated using an embedded glass ball (target). Three positioning Kirschner wires were drilled into the top and bottom of the large rotor. The specimen was then subjected to computed tomography (CT). A CT image of the specimen was imported into the Mimics software to construct a three-dimensional model including the target. The best core decompression channel was then designed using the 3D model. A navigational template for the specimen was designed using the Pro/E software and manufactured by rapid prototyping technology to guide the drilling channel. The specimen-specific navigation template was installed on the specimen using positioning Kirschner wires. Drilling was performed using a guide needle through the guiding hole on the templates. The distance between the end point of the guide needle and the target was measured to validate the patient-specific surgical accuracy. RESULTS: The average distance between the tip of the guide needle drilled through the guiding template and the target was 1.92±0.071 mm. CONCLUSIONS: Core decompression using a computer-rapid prototyping template is a reliable and accurate technique that could provide a new method of precision decompression for early-stage ischemic necrosis.

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Crossref · 10.1371/journal.pone.0175366

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  • The translation component of registration error is significant for purposes such as robot-guided surgery, while a 2-mm error is considered to match the clinical requirement of core decompression.

    “In this experiment, the translation component of the registration error is a significant error for purposes such as robot-guided surgery, while a 2-mm error is considered to match the clinical requirement of core decompression (Wang et al. 2017).”

    From Towards 2D/3D Registration of the Preoperative MRI to Intraoperative Fluoroscopic Images for Visualisation of Bone Defects (2023) · cites this paper as Wang et al. 2017

    The Discussion (page not provided) says a 1.92-mm error between the needle tip and target was considered to meet the clinical requirement for core decompression, supporting the approximate 2-mm claim. It does not assess the translation component of registration error or its significance in robot-guided surgery; the measured error was drilling accuracy using a navigation template. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Core decompression requires acquisition of multiple intraoperative radiographs, which increases the risk of surgical complications and increases radiation exposure for both the patient and the surgical team.

    “Core decompression procedure requires the acquisition of multiple intraoperative radiographs, which increases the risk of surgical complications and increases the radiation exposure for both the patient and the surgical team (Beckmann et al. 2006; Wang et al. 2017).”

    From Towards 2D/3D Registration of the Preoperative MRI to Intraoperative Fluoroscopic Images for Visualisation of Bone Defects (2023) · cites this paper as Wang et al. 2017

    The Introduction says conventional core decompression is guided by C-arm X-ray, and the Discussion links multiple drillings to greater radiation exposure for patients and the surgical team and to surgical complications. But the paper does not say every core decompression procedure requires multiple intraoperative radiographs; it describes a template-guided procedure performed without fluoroscopy or C-arm X-ray. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Authors
Wang, W., Hu, W., Yang, P., Dang, X. Q., Li, X. H., & Wang, K. Z.
Affiliations
  • Second Affiliated Hospital of Xi'an Jiaotong University (CN)
  • Xian Yang Central Hospital (CN)
Corresponding author
Wang, Kun Zheng
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2017-05-02
Volume
12
Issue
5
Pages
e0175366
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0175366
PMC
PMC5413021
OpenAlex
W2611045770
Cited by
14
References
29
Citations by year
2026: 1 · 2025: 2 · 2022: 4 · 2021: 1 · 2020: 4 · 2019: 1 · 2018: 1
FWCI
1.80
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • The National Natural Science Foundation of China (81472068)
  • the Fundamental Research Funds for the Central Universities (xjj2014150)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone and Joint Diseases
  • Physical Sciences › Engineering › Biomedical Engineering › Anatomy and Medical Technology
  • Health Sciences › Medicine › Surgery › Hip disorders and treatments
Keywords
core decompression, osteonecrosis of the femoral head, rapid prototyping, computer-assisted surgery, drilling accuracy, cadaveric validation, surgical guides
MeSH terms
Femur Head, Femur Head Necrosis, Humans, Ischemia, Tomography, X-Ray Computed, Decompression, Surgical

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