Use of Hausdorff Distance and Computer Modelling to Evaluate Virtual Surgical Plans with Three-Dimensional Printed Guides against Freehand Techniques for Navicular Bone Repair in Equine Orthopaedics

Abstract

Objective The aim of this study was to evaluate the surgical execution of a virtual surgical plan (VSP) with three-dimensional (3D) guides against a freehand approach in the equine navicular bone using an automated in silico computer analysis technique.

Study Design Eight pairs of cadaveric forelimb specimens of adult horses were used in an ex vivo experimental study design with in silico modelling. Limbs received either a 3.5 mm cortical screw according to a VSP or using an aiming device. Using computed tomography and computer segmentation, a comparison was made between the executed screw and the planned screw using the Hausdorff distance (HD).

Results Navicular bone mean HD registration error was –0.06 ± 0.29 mm. The VSP with 3D printing demonstrated significantly superior accuracy with a mean deviation of 1.19 ± 0.42 mm compared with aiming device group (3.53 ± 1.24 mm, p = 0.0018). The VSP group was 5.0 times more likely to result in a mean aberration of less than 1.0 mm (95% confidence interval, 0.62–33.4). A 3.5 mm screw with an optimal entry point can have a maximum deviation angle of 3.23 ± 0.07, 2.70 ± 0.06 and 2.37 ± 0.10 degrees in a proximal, dorsal and palmar direction respectively, prior to violating one of the cortical surfaces.

Conclusion Procedures performed using the 3D guides have a high degree of accuracy, with minimal mean deviations (<1 mm and <1 degree) of a VSP compared with those using the conventional aiming device. The use of VSP and the HD for evaluation of orthopaedic surgeries and outcome measures shows promise for simplifying and improving surgical accuracy.

Keywords

three-dimensional - virtual surgical plan - computer modelling - orthopaedic surgery - equine

Authors' Contributions

A.H.B. performed the final computer analysis and finalized the manuscript and figures. He contributed to conception of study, study design, acquisition of data, data analysis and interpretation, and drafting/revising and approving the submitted manuscript and is publically accountable for relevant content. H.C.K. performed the segmentation and initial computer matching of the navicular bones and the initial manuscript draft. She acquired the data, performed data analysis and interpretation, and drafted/revised and approved the submitted manuscript. E.E.P. performed the surgeries and the original study. He acquired the data and approved the submitted manuscript. A.J.M. was one of the authors with the initial thoughts to develop the manuscript and reviewed the final version. She contributed to conception of study, data analysis and interpretation, drafting /revising and approving the submitted manuscript.

Publication History

Received: 10 August 2020

Accepted: 01 December 2020

Article published online:
13 January 2021

• References

• 1 Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online 2016; 15 (01) 115
• 2 Hoekstra H, Rosseels W, Sermon A, Nijs S. Corrective limb osteotomy using patient specific 3D-printed guides: a technical note. Injury 2016; 47 (10) 2375-2380
• 3 Mulford JS, Babazadeh S, Mackay N. Three-dimensional printing in orthopaedic surgery: review of current and future applications. ANZ J Surg 2016; 86 (09) 648-653
• 4 Oxley B. A 3-dimensional-printed patient-specific guide system for minimally invasive plate osteosynthesis of a comminuted mid-diaphyseal humeral fracture in a cat. Vet Surg 2018; 47 (03) 445-453
• 5 Worth AJ, Crosse KR, Kersley A. Computer-assisted surgery using 3D printed saw guides for acute correction of antebrachial angular limb deformities in dogs. Vet Comp Orthop Traumatol 2019; 32 (03) 241-249
• 6 Lynch AC, Davies JA. Percutaneous tibial fracture reduction using computed tomography imaging, computer modelling and 3D printed alignment constructs: a cadaveric study. Vet Comp Orthop Traumatol 2019; 32 (02) 139-148
• 7 Kamishina H, Sugawara T, Nakata K. et al. Clinical application of 3D printing technology to the surgical treatment of atlantoaxial subluxation in small breed dogs. PLoS One 2019; 14 (05) e0216445
• 8 Dobbe JGG, Strackee SD, Schreurs AW. et al. Computer-assisted planning and navigation for corrective distal radius osteotomy, based on pre- and intraoperative imaging. IEEE Trans Biomed Eng 2011; 58 (01) 182-190
• 9 Vroemen JC, Dobbe JGG, Strackee SD, Streekstra GJ. Positioning evaluation of corrective osteotomy for the malunited radius: 3-D CT versus 2-D radiographs. Orthopedics 2013; 36 (02) e193-e199
• 10 de Preux M, Vidondo B, Koch C. Influence of a purpose-built frame on the accuracy of computer-assisted orthopedic surgery of equine extremities. Vet Surg 2020; 49 (07) 1367-1377
• 11 de Preux M, Klopfenstein Bregger MD, Brünisholz HP, Van der Vekens E, Schweizer-Gorgas D, Koch C. Clinical use of computer-assisted orthopedic surgery in horses. Vet Surg 2020; 49 (06) 1075-1087
• 12 Hall EL, Baines S, Bilmont A, Oxley B. Accuracy of patient-specific three-dimensional-printed osteotomy and reduction guides for distal femoral osteotomy in dogs with medial patella luxation. Vet Surg 2019; 48 (04) 584-591
• 13 Carwardine DR, Gosling MJ, Burton NJ, O'Malley FL, Parsons KJ. Three-dimensional-printed patient-specific osteotomy guides, repositioning guides and titanium plates for acute correction of antebrachial limb deformities in dogs. Vet Comp Orthop Traumatol 2021; 34 (01) 43-52
• 14 Gygax D, Lischer C, Auer JA. Computer-assisted surgery for screw insertion into the distal sesamoid bone in horses: an in vitro study. Vet Surg 2006; 35 (07) 626-633
• 15 Andritzky J, Rossol M, Lischer C, Auer JA. Comparison of computer-assisted surgery with conventional technique for the treatment of axial distal phalanx fractures in horses: an in vitro study. Vet Surg 2005; 34 (02) 120-127
• 16 Toni C, Oxley B, Clarke S, Behr S. Accuracy of placement of pedicle screws in the lumbosacral region of dogs using 3D-printed patient-specific drill guides. Vet Comp Orthop Traumatol 2021; 34 (01) 53-58
• 17 Hamilton-Bennett SE, Oxley B, Behr S. Accuracy of a patient-specific 3D printed drill guide for placement of cervical transpedicular screws. Vet Surg 2018; 47 (02) 236-242
• 18 Perez-Jimenez E, Biedrzycki AH, Morton AJ, McCarrel TM. Three-dimensional printed guides for surgical planning and treatment of sagittal fractures of the equine navicular bone. Vet Surg 2020(in press)
• 19 Ma B, Kunz M, Gammon B, Ellis RE, Pichora DR. A laboratory comparison of computer navigation and individualized guides for distal radius osteotomy. Int J CARS 2014; 9 (04) 713-724
• 20 Van den Broeck J, Wirix-Speetjens R, Vander Sloten J. Preoperative analysis of the stability of fit of a patient-specific surgical guide. Comput Methods Biomech Biomed Eng 2015; 18: 38-47
• 21 Huttenlocher DP, Rucklidge WJ, Klanderman GA. Comparing images using the Hausdorff distance under translation. IEEE Trans Pattern Anal Mach Intell 1993; 15 (09) 850-863
• 22 Caiti G, Dobbe JGG, Strijkers GJ, Strackee SD, Streekstra GJ. Positioning error of custom 3D-printed surgical guides for the radius: influence of fitting location and guide design. Int J CARS 2018; 13 (04) 507-518
• 23 van Dixhoorn ID, Meershoek LS, Huiskes R, Schamhardt HC. A description of the motion of the navicular bone during in vitro vertical loading of the equine forelimb. Equine Vet J 2002; 34 (06) 594-597
• 24 van de Kraats EB, Penney GP, Tomazevic D, van Walsum T, Niessen WJ. Standardized evaluation methodology for 2-D-3-D registration. IEEE Trans Med Imaging 2005; 24 (09) 1177-1189
• 25 Figl M, Weber C, Assadian O. et al. Splint sterilization--a potential registration hazard in computer-assisted surgery. J Oral Maxillofac Surg 2012; 70 (04) 966-971