Tsuyoshi Koyama

Safety of autologous bone marrow-derived mesenchymal stem cell transplantation for cartilage repair in 41 patients with 45 joints followed for up to 11 years and 5 months.

Among autologous somatic stem cells, bone marrow‐derived mesenchymal stem cells (BMSCs) are the most widely used worldwide to repair not only mesenchymal tissues (bone, cartilage) but also many other kinds of tissues, including heart, skin, and liver. Autologous BMSCs are thought to be safe because of the absence of immunological reaction and disease transmission. However, it is possible that they will form tumours during long‐term follow‐up. In 1988, we transplanted autologous BMSCs to repair articular cartilage, which was the first such trial ever reported. Subsequently we performed this procedure in about 40 patients. Demonstration that neither partial infections nor tumours appeared in these patients provided strong evidence for the safety of autologous BMSC transplantation. Thus, in this study we checked these patients for tumour development and infections. Between January 1998 and November 2008, 41 patients received 45 transplantations. We checked their records until their last visit. We telephoned or mailed the patients who had not visited the clinics recently to establish whether there were any abnormalities in the operated joints. Neither tumours nor infections were observed between 5 and 137 (mean 75) months of follow‐up. Autologous BMSC transplantation is a safe procedure and will be widely used around the world. Copyright

3D reconstruction of a femoral shape using a parametric model and two 2D fluoroscopic images

In medical diagnostic imaging, an X-ray CT scanner or a MRI system have been widely used to examine 3D shapes or internal structures of living organisms or bones. However, these apparatuses are generally very expensive and of large size. A prior arrangement is also required before an examination, and thus, it is not suitable for an urgent fracture diagnosis in emergency treatment. This paper proposes a method to estimate a patient-specific 3D shape of a femur from only two fluoroscopic images using a parametric femoral model. Firstly, we develop a parametric femoral model by statistical analysis of a number of 3D femoral shapes created from CT images of 51 patients. Then, the pose and shape parameters of the parametric model are estimated from two 2D fluoroscopic images using a distance map constructed by the level set method. Experiments using synthesized images and fluoroscopic images of a phantom femur are successfully carried out and the usefulness of the proposed method is verified.

Tailor-made surgical guide based on rapid prototyping technique for cup insertion in total hip arthroplasty.

A surgical guide made by the rapid prototyping (RP) technique for cup insertion in total hip arthroplasty might be useful to avoid malalignment of the cup, which indicates postoperative complications.

Tailor-made Surgical Guide Reduces Incidence of Outliers of Cup Placement

Malalignment of the cup in total hip arthroplasty (THA) increases the risks of postoperative complications such as neck cup impingement, dislocation, and wear. We asked whether a tailor-made surgical guide based on CT images would reduce the incidence of outliers beyond 10° from preoperatively planned alignment of the cup compared with those without the surgical guide. We prospectively followed 38 patients (38 hips, Group 1) having primary THA with the conventional technique and 31 patients (31 hips, Group 2) using the surgical guide. We designed the guide for Group 2 based on CT images and fixed it to the acetabular edge with a Kirschner wire to indicate the planned cup direction. Postoperative CT images showed the guide reduced the number of outliers compared with the conventional method (Group 1, 23.7%; Group 2, 0%). The surgical guide provided more reliable cup insertion compared with conventional techniques.Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

A Novel Laser Guidance System for Alignment of Linear Surgical Tools: Its Principles and Performance Evaluation as a Man-Machine System

A novel laser guidance system that uses dual laser beam shooters for the alignment of linear surgical tools is presented. In the proposed system, the intersection of two laser planes generated by dual laser shooters placed at two fixed locations defines the straight insertion path of a surgical tool. The guidance information is directly projected onto the patient and the surgical tool. Our assumption is that a linear surgical tool has cylindrical shape or that a cylindrical sleeve is attached to the tool so that the sleeve and tool axes are aligned. The guidance procedure is formulated mainly using the property that the two laser planes are projected as two parallel straight lines onto the cylindrical tool surface if and only if the cylinder axis direction is the same as the direction of the intersection of the two laser planes. Unlike conventional augmented reality systems, the proposed system does not require the wearing of glasses or mirrors to be placed between the surgeon and patient. In our experiments, a surgeon used the system to align wires according to the alignment procedure, and the overall accuracy and alignment time were evaluated. The evaluations were considered not to be simply of a mechanical system but of a man-machine system, since the performance depends on both the system accuracy and the surgeons perceptual ability. The evaluations showed the system to be highly effective in providing linear alignment assistance.

Computer-Assisted Preoperative Planning for Reduction of Proximal Femoral Fracture Using 3-D-CT Data

This paper describes procedures for repositioning calculations of fractured bone fragments using 3-D-computed tomography (CT), aimed at preoperative planning for computer-guided fracture reduction of the proximal femur. Fracture boundaries of the bone fragments, as ldquofracture lines (FLs),rdquo and the mirror-transformed contralateral femur shape extracted from 3-D-CT were used for repositioning of the fragments. We first describe a method for extracting FLs based on 3-D curvature analysis and then formulate repositioning methods based on registration of bone fragments using the following three constraints: 1) contralateral (CL) femur shape; 2) FLs; and 3) both CL femur shape and fracture lines, as ldquoboth constraintsrdquo. We performed experiments using CT datasets from five simulated and four real patients with proximal femoral fracture. We evaluated the rotation error in reposition calculations and the contact ratio between repositioned fragment boundaries, which are crucial for the recovery of proper functional axes and bone adhesion of fragments, respectively. Experimental results showed that good accuracy and stability were attainable when registration using both constraints was performed after registration using the fracture-line constraint. On average, 6.0deg plusmn0.8deg in rotation error and 89% plusmn 3% in contact ratio were obtained without providing precise initial values.

Fluoroscopic Bone Fragment Tracking for Surgical Navigation in Femur Fracture Reduction by Incorporating Optical Tracking of Hip Joint Rotation Center

A new method for fluoroscopic tracking of a proximal bone fragment in femoral fracture reduction is presented. The proposed method combines 2-D and 3-D image registration from single-view fluoroscopy with tracking of the head center position of the proximal femoral fragment to improve the accuracy of fluoroscopic registration without the need for repeated manual adjustment of the C-arm as required in stereo-view registrations. Kinematic knowledge of the hip joint, which has a positional correspondence with the femoral head center and the pelvis acetabular center, allows the position of the femoral fragment to be determined from pelvis tracking. The stability of the proposed method with respect to fluoroscopic image noise and the desired continuity of the fracture reduction operation is demonstrated, and the accuracy of tracking is shown to be superior to that achievable by single-view image registration, particularly in depth translation.

Application of 3D-MR image registration to monitor diseases around the knee joint.

To estimate the accuracy and consistency of a method using a voxel‐based MR image registration algorithm for precise monitoring of knee joint diseases.

Development of the needle insertion robot for percutaneous vertebroplasty

Percutaneous Vertebroplasty (PVP) is an effective and less invasive medical treatment for vertebral osteoporotic compression fractures. However, this operative procedure is quite difficult because an arcus vertebra, which is narrow, is needled with accuracy, and an operators hand is exposed to X-ray continuously. We have developed a needle insertion robot for Percutaneous Vertebroplasty. Its experimental evaluation on the basic performance of the system and needle insertion accuracy are presented. A needle insertion robot is developed for PVP. This robot can puncture with accuracy and an operator does not need to be exposed to X-ray. The mechanism of the robot is compact in size (350 mm x D 400 mm x H270 mm, weight: 15 kg) so that the robot system can be inserted in the space between C-arm and the patient on the operating table. The robot system is controlled by the surgical navigation system where the appropriate needle trajectory is planned based on pre-operative three-dimensional CT images. The needle holding part of the robot is X-ray lucent so that the needle insertion process can be monitored by fluoroscopy. The position of the needle during insertion process can be continuously monitored. In vitro evaluation of the system showed that average position and orientation errors were less than 1.0 mm and 1.0 degree respectively. Experimental results showed that the safety mechanism called mechanical fuse released the needle holding disk properly when excessive force was applied to the needle. These experimental results demonstrated that the developed system has the satisfactory basic performance as needle insertion robot for PVP.

Multidetector-CT evaluation of bone substitutes remodeling after revision hip surgery

We evaluated remodeling of grafted bone substitutes after revision hip arthroplasty using serial examinations of multidetector-row computed tomography imaging. Ten patients (12 hips) had cementless revision surgery with grafting of beta-tricalcium phosphate granules and pastelike calcium phosphate cement in bone defects around the femoral component. At 3 weeks and 1 year postoperatively, the patients were evaluated using multidetector-row computed tomography imaging with a metal artifact minimizing protocol. New bone formation and changes in volume of beta-tricalcium phosphate and calcium phosphate cement were measured. At 1 year postoperatively, beta-tricalcium phosphate had decreased more than calcium phosphate cement. The residual volumes of calcium phosphate cement and beta-tricalcium phosphate were 78% (range, 37%-96%) and 30% (range, 10%-62%) of the initial grafted volume, respectively. The volume of the new bone that formed after absorption of beta- tricalcium phosphate was 34% (range, 11%-76%) of the initial beta-tricalcium phosphate volume. Use of cement in prior operations was an unfavorable factor in graft remodeling after revision surgery. Multidetector-row computed tomography is a promising tool for evaluating bone stock restoration of patients and influential factors of bone remodeling, and for clarifying remodeling patterns of various bone substitutes.Level of Evidence: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.