To have your knees about you

Much has been said and written in the last months about the knee of the most famous tennis player in my country, Rafa Nadal. Thus, I would like to write today about recent advances in knee injuries diagnosis and knee replacement.

ConforMIS personalized knee replacement

ConforMIS is making knee replacement surgery more personal, creating custom knee implants that exactly match the patient's anatomy. The company uses a technology known as rapid prototyping plus additive manufacturing, which converts a three-dimensional computer design into a physical object. A similar tool that allows personalized implant design and creation is the Materialise Mimics Innovation Suite. ConforMIS believes that such implants can help perform the knee replacement surgery more quickly, more accurately and with less traumatic effects for the patient.

The knee replacement surgery repairs damage and relieve pain in patients with severe osteoarthritis or knee injuries. The total knee replacement involves the extraction of dead cartilage and bone from the surface of the knee joint, the hip bone, the shin bone and the patella, and then replace it with an artificial joint made of a combination of metal and plastic. A partial knee replacement can also be carried out in only one part of the joint.

Typically, the surgeon chooses an artificial joint among several options of different sizes. ConforMIS, however, creates a custom implant based on data provided by images of the knee joint of the patient, with a technology that the company callas iFit. ConforMIS transformed medical images coming from a CT or MRI scanner in a three-dimensional computer model with the aid of a computer design program (CAD), and then used the 3D model as a template to manufacture the implant.

http://medgadget.com/2012/10/conformis-launches-next-generation-patient-specific-total-knee-replacement-implant-system-video.html

Use infrared to determine knee injury

Applied measurement sensors based on infrared may be used to diagnose patients with injuries in the ligaments of the knee, said Ricardo Aguilar, Biomedical Engineering student at ITESM Campus Chihuahua.

The anterior cruciate ligament injury of the knee is a recurrent injury in athletes, as well as in automobile accidents, when the knee is impacted. The biggest problem however is not the difficulty of treating the injury, but the diagnosis of the degree of damage suffered by the patient, he said.

Currently the only way to diagnose the degree of injury is to perform surgery in the patient to detect low visual appreciation tissue conditions. The biomedical research center ITESM Campus Chihuahua started since April this year an investigation coordinated by the orthopedics at Hospital Christus Muguerza del Parque, to design a measurement system which allows detecting, through an analysis of "pivochips", the gravity of the existing knee injury.

In a study based on "pivochips", sensors of an electromyograph with accelerometers owned by the Biomedical Research Laboratory are connected to the patient's injured knee, which are capable of measuring muscle behavior and the affected area during some movements by using infrared sensors, so the degree of injury can be determined without the need to perform surgery.

OR Revolution

Brainlab a step ahead?

Brainlab has launched what we could describe as a super-sized iPad (42 inches) which allows manipulating medical images among other possibilities. They have called it "Buzz Digital OR", a system that integrates all intraoperative imaging. It can be used for viewing DICOM images, but it also performs video management, routing video between sources and destinations, and includes options for fast and easy documentation of surgical procedures. The HD display comes with an integrated sound system, webcam and microphone. It can connect with a multitude of video signals and route content to multiple, full-HD displays. All data can be relayed across the hospital IP network. Like the normal iPad, it has drag and drop functionality which, for example, makes easier to navigate through the different images. 

Indeed, 2012 is being a great year for Brainlab guys since last March they succeeded in winning the coveted 'red dot award', beating over 4515 designs in an international competition. For its benefits, Curve™ inspired the experts and was awarded the "red dot award: product design". Curve incorporates the latest in medical technology. This advanced surgical navigation system for the brain and the body includes the latest software for image-guided advanced 3D displays. Curve features a great ergonomics, two multi-touch terminals, digital HD, hi-fi and wi-fi.


Brainlab Digital Buzz, copyright Brainlab

Gesture Control Technology 

TedCas, a small Spanish company, has invented a system based on Kinect technology, the Xbox game console camera, which allows gestural control of computer applications in ORs and other environments, just as Tom Cruise did in the movie "Minority Report'. The application allows surgeons to use image guidance in the computer without touching it, thus decresing the possibility of bacterial transmission. The number of people who contract an infection each year in operating rooms is around 300,000 cases per year in Spain alone. If we talk about the European Union framework, this figure rises to four million, causing public administrations to spend billions. 

The Spanish system also helps to improve process efficiency in ORs or radiation therapy rooms. Right now there are three options: to have someone managing the computer from outside the room, or the surgeon comes out to do it himself, which is a bit tedious because you have to repeat the whole process of sterilization, or the screen is within the room itself which, despite being protected, remains a risk of infection. Thus, gestural control makes easier for the surgeon to control how the medical information is displayed during the operation. 

At Sunnybrook in Toronto surgeons can now benefit Kinect system during operations, as you can see in the video below:

Source: medgadget, http://www.brainlab.com/art/3401/6/brainlab-introduces-new-multi-touch-surgical-information-hub/

Medical device destroys itself leaving no trace in the body

Imagine an electronic device that releases the drug in the area where it is needed, measure your vital signs, treats a surgical wound and once done it has done its job it melts away ... All this without leaving a trace, as if it had never been in the body. A new class of devices grouped under the name of "transient electronics" is about to start a medical revolution. The first step was just taken by a group of engineers at Tufts University, in the United States, who successfully tested one of these biodegradable devices. The experiment was done with mice that were implanted with a device designed to deliver drugs and treat an infection. Not only did the treatment work, but also it barely left remmants of its presence in the organism three weeks later. With only a few tens of nanometers thick, the new circuits are easily dissolved in either water or other body fluids without causing damage.

In the same line, Abbot lab has recently introduced a new "stent", a new type of coronary implant which is also absorved when is no longer useful. It has a less sophisticated technology than that of the electronic devices, but it works similarily. Stents are a mesh-like tube of thin metal wire which are placed inside the artery to keep them open and facilitate blood flow after a heart attack has occurred. Stents have been placed permanently for years. The absorbable one, made ​​of a material used in sutures, allowes the vessel to dilate and contract in a more natural way, as your body needs it. For example when you are running and need more blood flow. At the end of ist lifetime, the stent is complety disolved and the blood vessel remains open without any other extra support.

Sources:

http://www.bbc.co.uk/news/health-19737125

http://www.abbott.com/news-media/press-releases/abbott-announces-international-launch-of-the-absorb-bioresorbable-vascular-scaffold.htm