Afgeronde projecten

AIF

Development of a Clinical Diagnostic System for assessing Orthopaedic Implant Stability

Projectleaders

• Prof. Rob (R.G.H.H.) Nelissen, MD, PhD
• Edward (E.R.) Valstar, MSc, PhD

Advisors

• Bart L. Kaptein, MSc, PhD
• Eric H. Garling, PhD
• PhD student
• Bart. C.G.W. Pijls, MD

Technology

Model-based RSA

Start/End Date

1/9/2008-31/08/2011

Grant giver

Capital District Health Authority

Academic partners

• Dalhousie University, Faculty of Medicine, Division of Orthopaedic Surgery, Halifax, Canada
• Commercial partners
• Halifax Biomedical Inc., Halifax, Canada
• Medis specials b.v., Leiden, The Netherlands

Abstract

A major issue in orthopaedic surgery is aseptic loosening of joint replacements. Several studies have indicated that early micromotion of the implant relative to the bone can predict future aseptic loosening and subsequent revision. Radiostereometric analysis, RSA, is the gold standard for measuring micromotion and is currently mainly used in scientific applications. The goal of the AIF-project is to explore and develop the clinical applicability of RSA in everyday orthopaedic practice.

An important aspect of this project is to further investigate migration patterns of prosthetic designs and to determine the differences between normal and abnormal micromotion. In order to complete the current knowledge regarding micromotion we also intend to study long term migration patterns and it's correlation to clinical parameters.

ARGON-OPTIMA

Artrose Research Groep Orthopedie Nederland - Outcome Predictors for TIMing of Arthroplasty

Projectleaders 

• Prof. Rob G.H.H. Nelissen MD, PhD
• Prof. Thea Vliet Vlieland, MD, PhD
• Perla Marang-van de Mheen, PhD

Collaboration 

• Alrijne ziekenhuis, Leiderdorp
• CHECK cohort
• Erasmus Medisch Centrum, Rotterdam
• HagaZiekenhuis (Den Haag)
• Medisch Centrum Haaglanden, Den Haag
• Onze Lieve Vrouwe Gasthuis (Amsterdam)
• Sint Antonius, Nieuwegein
• Sint Maartenskliniek (Nijmegen)
• Spaarne Ziekenhuis, Hoofddorp
• UMCG (Groningen)
• Viasana, Mill
• Viecuri, Venlo

Project group for methodological support 

• S.C. Cannegieter, PhD, Department of Clinical Epidemiology
• S. le Cessie, Department of Clinical Epidemiology and Department of Medical Statistics and Bioinformatics
• W.B. van den Hout, PhD, Department of Medical Decision Making

Research fellows 

• Stefanie Hofstede, MSc
• Maaike G.J. Gademan, PhD

Start/End Date 

2014 –  2017

Funding

Reumafonds   

Abstract

Although joint replacement surgery is one of the most effective interventions in osteoarthritis, the optimal timing of such surgery is crucial based on the irreversibility, invasiveness and the still limited long-term survival of the artificial joint. In addition, specific interventions might be able to satisfactory postpone the time to surgery or increase the post-operative effect of such surgery in certain cases. In 2013 a national research program,  ARGON (Artrose Research Groep Orthopedie Nederland), was started, instituted by the NOV (Netherlands Orthopaedic Association) and funded by the Reumafonds. Within this cooperative research program, the LUMC started with the ARGON-OPTIMAL study. This study aims to identify indicators for optimal timing of knee and hip replacement in patients with osteoarthritis. This will be done with the use of a comprehensive set of individual patient data from existing prospective cohorts and trials in the Netherlands and refined state of the art statistical techniques.

Aim

To identify indicators for optimal timing of knee and hip replacement in patients with osteoarthritis.

Chondrosarcoma of Bone

Project leaders

• Prof. Antonie H.M.Taminiau MD, PhD
• Prof. Pancras Hogendoorn MD, PhD
• Judith Bovee MD, PhD
• Prof. Arthur de Schepper MD, PhD
• Sander Dijkstra MD, PhD
• Carla van Rijswijk MD, PhD

Researcher

• Suzan Verdegaal MD

Technology

• In vitro studies cartilage
• Minimal invasive treatment borderline sarcoma
• Analysis MRI criteria treatment

Start/End Date

1/1/2011 - 31/12/2013

Grant giver

None

Academic partners

• Department of  Pathology LUMC
• Department of Radiology LUMC
• European Musculo Sceletal Oncology Society (EMSOS)

Abstract

Chondrotumors of bone are the most frequent bone tumors. The majority is asymptomatic and recognised by accident. In the long bones the incidence of low grade sarcoma is regardless the radiological findings very common. Because the incidence of metastasis in these low grade tumors is extremely low research is undertaken to find the treatment with minimal surgery and a high chance of cure.

Application of  local adjuvant (phenol / alcohol) on a cartilage cell layer is tested in vitro studies.  

The clinical application in combination with curettage and adjuvant is followed in an at random group of patients.

The goal is to establish the recurrences and complications and change in grading by follow up for many years clinically, histology if available and by dynamic MRI.

The second part of this study is the study for Ollier disease in the major centres devoted to bone tumors in Europe all members of the EMSOS. The collected data are screened for incidence, presentation and malignant transformation as well as treatment as prognosis.

DESSOS

Decision Support for Orthopaedics (DeSSOS)

Projectleaders

• Edward R. Valstar PhD
• Prof. Rob G.H.H. Nelissen MD, PhD

Advisors

• Bart Kaptein PhD (senior researcher, supervision)
• Eric Garling PhD (senior researcher, supervision)

PhD students

• Nienke Wolterbeek MSc (Clinical fluoroscopy assessment)
• Andre Prins (Optimisation of fluoroscopy software)

Researcher

• Thisbe van Strien MD (Time action analysis)

Technology

• Fluoroscopy
• Time-action analysis

Start/End Date

January 1 2006 – September 30 2010

Grant giver

EU (6FP)

Academic partners

• University of Southampton (coordinator of project), United Kingdom
• Charité and Julius Wolff Institute, Berlin, Germany
• Zuse Institute Berlin, Germany
• Aragón Institute of Engineering Research, University of Zaragoza
• Commercial partners
• DePuy, Finsbury, ESI Group SA

Abstract

In 2005, there were approximately 540,000 knee replacement operations in the EU, this number will continue to rise, suggesting that by 2010 this figure is expect to be close to 750,000 implants required per year. Current statistics indicate that for total knee replacement operations, for patients over 60 year old approximately 5% will require subsequent corrective operations within 10 years following initial surgery. However, for patients less than 60, approximately 10% will require revision within 10 years of surgery. As the number of younger patients (below 60) is increasing, there has been a shift in emphasis, with post-operative function and implant longevity becoming increasingly important.

The main objective of this project is to develop patient-specific biomechanical models of the knee that will be encapsulated in software that is designed to support orthopaedic surgeons to assess pre- and intra-operatively the optimal configuration and position of total knee prostheses in order to maximise the effectiveness of the procedure and therefore to offer the best possible surgical outcome.

It is imperative that any device or software that predicts, alters or influences surgical outcome is not only tested, but fully assessed and validated before it can have any direct medical application. We lead a work package that is central to the DeSSOS project to ensure the biomechanical models and software is assessed, tested and validated as far as possible against prospective clinical data. Therefore, we analyse knee kinematics of patients that are enrolled in Berlin, Southampton and Leiden using synchronised fluoroscopic registration, contact forces, muscle activity, and external movement registration.

Hip Refixation

KART

Prognostic factors for cartilage degeneration after meniscectomy and cruciate ligament injuries
A prospective observational cohort study during 10 years

Projectleaders

• Prof. Rob G.H.H. Nelissen MD, PhD
• Prof. J.L. Bloem, PhD (Radiology)

Advisors

• Prof Ian Watt, MD, PhD (Radiology)
• A. van Erkel, MD, PhD, (Radiology)
• I Meulenbelt, PhD (Molecular Genetics)
• M Kloppenburg, MD, PhD (Rheumatology)
• B.C. Stoel, PhD (Image processing)
• Prof. H. Reiber, PhD (Image processing)

PhD student

Kasper Huetink, MD

Technology

• Epidemiology
• MRI, Radiographs

Start/End Date

1/5/2006 - 1/5/2009

Grant giver

Dutch Arthritis Association (in dutch: Reumafonds)

Abstract

Large prospective studies have confirmed knee trauma to be a significant risk factor for knee osteoarthritis (OA). This fact is stressed by the fact that joint complaints account for 51% of all new cases of occupational illnesses in the Netherlands and diseases of the knee are third in importance for workman's’ compensation. On a yearly basis orthopaedic surgeons in the Netherlands perform about 35.000 meniscectomies of the knee. Although age is the strongest predictor of the development of radiographic osteoarthritis (ROA), genetic and mechanical factors (e.g. meniscus or ligament injury) have a considerable effect on progression of OA. In general a 6-fold increased relative risk for the development of ROA exists after total meniscectomy. Preventive measures even after a partial meniscectomy may prove to be cost effective if distinct, high risk, groups of patients can be identified.

In 1997 a Grant from the Dutch Insurance Council (D94-071) included 850 patients with knee complaints (mean age 31 years) in a study. All patients had physical, radiological examination (X-ray and MRI of the knee). According to criteria of the Dutch Orthopaedic Society in 510 patients arthroscopies were performed (all video- taped). At arthroscopy medial (211), lateral (115) meniscectomies were performed and 72 cruciate ligaments were present. 

Goal of the study is to evaluate risk factors for development of ROA of the knee at 8-9 years based on findings during arthroscopy and general risk factors (obesity, family, etc) in order to identify high risk groups of patients for OA after a knee injury. The latter is the basis for new studies on preventive measures for developing OA.

MXL

Enhanced patient safety by computational Modelling from clinically available X-rays to minimize the risk of overload and instability for optimized function and joint Longevity MXL

Projectleaders

• Edward R. Valstar PhD
• Bart L. Kaptein PhD
• Prof. Rob G.H.H. Nelissen MD, PhD

Advisors

• B.P.F. Lelieveldt (Div. Image processing, Dept. Radiology)

PhD students

• M.J. Nieuwenhuijse MSc (Long Term Clinical RSA and Survival Studies)
• Nienke Wolterbeek MSc (Clinical fluoroscopy assessment)

Technology

• RSA
• Fluoroscopy
• Statistical Shape Modelling

Start/End Date

January 1 2010, December 31 2012

Grant giver

EU (7FP)

Academic partners

• Charité and Julius Wolff Institute (coordinator of project), Berlin, Germany
• University of Southampton, United Kingdom
• Zuse Institute Berlin (ZIB), Germany
• Delft University of Technology, The Netherlands
• Rizolli Insitute, Bologna, Italy
• Commercial partners
• Euram, Nottingham, United Kingdom
• ESI, Rungis, France
• SCS, Reno, Italy
• Medis Specials, Leiden, The Netherlands

Abstract

The MXL project addresses the specific aims and objectives of the ICT-2009.5.2: ICT for Patient Safety call by implementing an ICT framework that provides the surgeon with quantitative data to minimize the risk of joint overload and instability, thereby preserving the joint.

The objective is to develop training and planning tools to provide the surgeon with an accurate, patient specific prediction of the outcome of joint surgery. MXL will transform the clinical management of joint surgery by implementing a combination of image processing, finite element and musculoskeletal modelling tools to provide an understanding of the individual biomechanical condition from standard clinical radiographs.

The innovative ICT framework will enable the safe management of joint surgery throughout all stages of joint degeneration, with a focus on minimizing key failure risks of surgery. Thereby, even less experienced surgeons will be enabled to identify and implement a safe surgical route to optimal functional outcome for each and every patient, be it surgery to preserve a joint afflicted by instability due to ruptured ligaments, or to replace an already degenerated joint using artificial components. The targeted ICT framework will capitalize on using standard X-ray imaging to reduce costs and avoid unnecessary disruption to the standard clinical work flow. This guarantees wide spread access for patients to this improved quality of care and addresses a key societal challenge of our ageing society.

Model-based RSA

Model-based roentgen stereophotogrammetric analysis of orthopaedic implants
Model-based RSA Software

Project leaders

• Prof. Hans J.H.C. Reiber MSc. PhD (div. Image Processing, dept. Radiology)
• Edward R. Valstar MSc. PhD

Advisors

• Berend C. Stoel PhD (div. Image Processing, dept. Radiology)
• Prof Rob G.H.H. Nelissen MD, PhD
• Emeritus Prof. Piet M. Rozing MD, PhD

Postdocs

• Bart L. Kaptein MSc. PhD
• Paul W. de Bruin MSc. PhD

Technology

Model-based RSA

Start/End Date

December 1 2001 - June 1 2006

Grant giver

Technology Foundation STW

Academic partners

Division of Image Processing, department of Radiology, LUMC

Commercial partners

Medis specials b.v.

Abstract

In today’s ageing population, degenerative diseases, such as arthrosis, and rheumatoid arthritis will occur more frequently. In the treatment of these diseases by implantation of joint prostheses, adequate bone-prosthesis fixation is of greatest importance. The quality of this fixation can be assessed very accurately from two simultaneous X-ray exposures of the joint by a method called Roentgen Stereophotogrammetric Analysis (RSA). Because of its high accuracy, evaluation studies on the fixation of prostheses can be performed in a relatively short follow-up period and in a small patient group. Therefore, exposure of large groups of patients to new, not fully validated, implants and fixation techniques (e.g. new coatings and cements) can be prevented. Thereby, the number of revisions of prostheses, as a result of poor bone-prosthesis fixation, will be reduced resulting in a decrease of healthcare expenses.

In order to calculate changes in the position and orientation of a prosthesis in these RSA studies, metallic markers are attached to the surface of the prosthesis. These markers can then be identified in the two radiographs. Since attaching markers to the prosthesis is a difficult, time-consuming and expensive procedure for the manufacturer, RSA has only been applied in a limited number of clinical studies. To make clinical RSA studies more feasible and to make RSA more widely used, an alternative RSA method should be developed, that does not require the attachment of markers to the prosthesis.

We have implemented a very first prototype of such an alternative RSA method that allows the calculation of the position and orientation of a prosthesis from only the contours of the prosthesis - as they appear in the radiographs, without markers attached to these prostheses - by comparing these contours with those obtained from a simulated projection of a three-dimensional CAD model. Due to the casting and polishing process of the prosthesis during the production process, however, the actual implant may deviate from the CAD model. As a result, we found that our model-based RSA method is less accurate than the conventional RSA method based on the prostheses with markers.

In order to increase the accuracy of the model-based RSA method, so that it can be applied in clinical research, the matching algorithms should be able to cope with contours, which are partly unreliable. Therefore, new innovative matching algorithms and contour detection algorithms will have to be developed and implemented. These new techniques will be integrated in the RSA software package that has been developed in our institute to facilitate future validation studies.

As it is essential that improvements in model-based RSA are disseminated and accepted as feasible alternatives for conventional RSA, the developed methods will be extensively validated and evaluated in the final two years of the project.

The goal of the proposed project, therefore, is to develop an RSA method with which the bone-prosthesis fixation can be studied for any standard prosthesis without any modification in its manufacturing process. This will improve the applicability of the RSA method for clinical studies. By using RSA as a validation tool, poorly designed implants and poor fixation techniques will be prevented from being marketed, resulting in an improvement of quality of life of orthopaedic patients and a reduction in healthcare expenses.

PCR

Prospective Cohort Research

Projectleader

Prof. Rob G.H.H. Nelissen MD, PhD

Advisors

• Prof Anneke Brand
• Ronald Brand. PhD (biostatistician)
• Edward Valstar, PhD
• Thea Vliet Vlieland, MD, PhD 

PhD student

Christiaan Keurentjes, MD

Technology

Epidemiology

Start/End Date

1/5/2009 –  2012

Grant giver

Dutch Arthritis Association (in dutch: Reumafonds)

Refixation Loosened Hips

Minimally invasive refixation of loosened hip prostheses

Project leaders

• Prof. Edward R. Valstar PhD
• Prof. Rob G.H.H. Nelissen MD, PhD

Postdoc

Andriy Andreykiv PhD (Biomechanical modelling) | 2008 - 2010

PhD students

• Francois (D.F.) Malan MSc (Image processing and visualisation) | 2008 - 2012
• Gert Kraaij MSc (Instrument design) | 2009 - 2013

Technology

• Biomechanical modelling
• Image processing
• Instrument design

Start/End Date

January 1 2008 - November 16 2013

Grant giver

NWO-STW (VIDI)

Academic partners

• Medical Visualisation Group, Faculty of 3mE, TU Delft
• Department of Precision and Microsystems Engineering, Faculty  TU Delft
• Department of Biomechanical Engineering, TU Delft
• Division of Image Processing, Department of Radiology, LUMC
• Clinical Physics, Department of Radiology, LUMC 

Commercial partners

• Biomet B.V. Dordrecht, The Netherlands
• Medis Medical Imaging B.V. Leiden, The Netherlands
• DEAM

Abstract

Worldwide, 150.000 hip prostheses have to be revised annually because they have become loose inside the patient’s bone. These loosened prostheses have very limited functionality, and patients experience intense pain, which makes them socially dependent. Open revision surgery is highly demanding for the patient as well as for the surgeon. Therefore, revision is impossible in 50.000 elderly patients with a poor general health condition. 

The aim of this project is to develop a reliable and generally usable minimally invasive surgical procedure in which loosened hip prostheses are refixated as an alternative for demanding open revision surgery.

The project has three major technological aspects: image processing and visualisation, biomechanical finite element modelling, and instrument design. In all three of them, we have the expertise to make innovative developments. In combination with our clinical expertise in open revision surgery and in minimally invasive surgical techniques, we will be able to come to a highly innovative surgical technique that relies on an integrated pre-operative planning platform and revolutionary new surgical instruments. We will develop novel surgical instruments that are based on mechanisms found in biology. These instruments will be used to accurately create bone cavities at well-defined positions. In turn, these cavities will be filled with cement in order to create cement anchors that stabilise and refixate the prosthesis. The optimal size and position of these anchors will be determined by patient-specific finite element models that are based on an accurate three-dimensional representation of the surgical site an d a clear segmentation of the various materials and tissues extracted from CT’s. For this, we will develop algorithms that improve the image quality and segment the different tissues. We will integrate these image processing algorithms, visualisation techniques, and patient specific biomechanical models in a highly interactive pre-operative planning environment that will assist the surgeon. 

Rotator Cuff Calcific Tendonitis

Rotator Cuff Calcific Tendonitis Needle US-guided treatment vs. Subacromial corticosteroids
– A Randomized Controlled Trial –

Project leaders

• Prof. Rob G.H.H. Nelissen, PhD
• M. Reijnierse, MD, PhD
• J. Nagels, MD

PhD students

Pieter Bas de Witte, MD, BSc

Advisors

• Prof. J.L. Bloem, MD, PhD
• A. Navas Canete, MD

Technology

• Ultrasound treatment
• Clinical scores

Start/End Date

01/09/2009– 01/09/2012

Grant giver

• Dutch Arthritis Association (in dutch: Reumafonds)
• ZonMw-Agiko

Academic partners

• Department of Orthopedics, Rijnland Hospital, Leiderdorp
• Department of Rehabilitation, LUMC, Leiden
• Department of Radiology, LUMC, Leiden

Abstract

Rationale: Calcific tendinitis (CAT) of the shoulder is frequently diagnosed in case of shoulder complaints. It is a self-limiting disease, but there is much discussion about whether or not to treat CaT and which treatment methods can be applied.

Recently, in the Dutch “Medisch Contact” journal, it was stated that ultrasound-guided needle treatment for CaT (barbotage) is more effective than conservative treatment methods in patients diagnosed with CaT. This conclusion was based on a recent article of Serafini et al. in “Radiology”: a non-randomized trial in which patients were treated with barbotage in combination with subacromial corticosteroid injections. However, treatment and inclusion criteria of the control group were unclear.

A randomized controlled trial, in which both the patient and the control group are treated with subacromial corticosteroid injections, would provide more insight in the effectiveness of barbotage-treatment in patients with CaT.

Objective: To compare short (6 weeks, 3 months) and longer term (6 months, 1 year) results of ultrasound-guided barbotage treatment combined with subacromial corticosteroid injection treatment, versus ultrasound-guided treatment with subacromial corticosteroids injection, in patients with calcific tendonitis.

Study design: Multicenter randomized controlled trial, double blinded

Study population: Patients diagnosed with CaT, referred for treatment of CaT, 18-65 years old. 

Intervention:

2 Usual care methods:
Group A: ultrasound-guided barbotage treatment combined with subacromial corticosteroid injection.
Group B: ultrasound-guided treatment with subacromial corticosteroid injection. 

Main outcome parameters:  All outcome parameters will be obtained before the intervention procedure, and at several moments in follow-up after the intervention.

Primary study parameters: Constant Shoulder Score

Secondary study parameters:

• Demographic data
• Barbotage Ultrasound parameters: signs of bursitis, other shoulder injuries, substance of the calcific depositions, aspiration (yes/no), perforation (yes/no), location of calcific depositions
• Presence of calcific depositions on standard radiographs: Gärtner score
• Clinical scores: VAS-scores for pain during motion, pain at rest and shoulder function, DASH-score, RAND-36, Western Ontario Rotator Cuff index

References

Serafini, G., Sconfienza, L. M., Lacelli, F., Silvestri, E., Aliprandi, A., and Sardanelli, F.: Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial. Radiology. 252:157-164, 2009

SISTIM

Subacromial Impingement Syndrome:
The Identification of etiologic Mechanisms (SISTIM)

Project leaders

• Prof. Rob G.H.H. Nelissen, MD, PhD
• Juriaan.H. de Groot, PhD 

PhD students

• Pieter Bas de Witte, MD, BSc
• Arjen Kolk, MD

Advisors

• Prof. J.L. Bloem, MD, PhD
• M. Reijnierse, MD, PhD
• A. Navas Canete, MD 

Technology

-

Start/End Date

01/09/2009– 01/09/2012

Grant giver

• Dutch Arthritis Association (in dutch: Reumafonds)
• ZonMw-Agiko

Academic partners

• Department of Orthopaedics, Haga Hospital, The Hague
• Department of Orthopaedics, MCH, The Hague
• Department of Orthopedics, Rijnland Hospital, Leiderdorp
• Department of Rehabilitation, LUMC, Leiden
• Department of Radiology, LUMC, Leiden

Abstract

Rationale: The subacromial impingement syndrome (SIS) is the most prevalent disorder of the shoulder in primary health care. Acromionplasty, as the main surgical treatment of SIS, is one of the most performed orthopedic surgeries.

The etiology of the primary SIS is not clearly understood, but surgical treatment is primarily focused at the extrinsic mechanism as described by Neer(1): the anterior part of the acromion painfully impinges on the subacromial tissues and therefore must be resected. Nevertheless, variable results of this frequently performed procedure have been reported (successful in 48- 90%), and there are numerous publications of successful (conservative) treatments without changing the coracoacromial shape.(1-8)

There is a lot of debate on the etiology of SIS. Several mechanisms have been described: i.e. narrowing of the subacromial space caused by cranial translation of the humerus in multidirectional instability, scapular dyskinesia, or intrinsic mechanisms such as primary degenerative tendinopathy of the rotator cuff.(9-12)

In theory, impingement (“narrowing of the subacromial space”) can be caused by several mechanisms. Our hypothesis is, that the extrinsic mechanism is only valid for a subgroup of patients; complaints of SIS can be caused by 1) a pathologic pattern of arm-scapula movements caused by a disrupted balance in muscle forces, leading to cranial translation of the humerus with respect to the scapula, or 2) narrowing of the subacromial space because of anatomic variations (i.e. a hooked acromion or humeral shape), or 3) a subacromial inflammatory reaction (i.e. caused by micro-trauma), or 4) secondary to an adjoining pathology (i.e. osteoarthritis in the acromioclavicular(AC)-joint).

Objective: Organization of distinct etiological mechanisms for symptoms clinically diagnosed as SIS, into several identifiable subgroups of patients (relative cranialisation of the humerus, structural narrowing of the subacromial space, subacromial inflammatory processes, other primary pathologies), in order to improve diagnostic and therapeutic strategies of SIS by designing concept diagnostics and treatment flow charts for each subgroup.

Hypothesis: The etiology of primary SIS is heterogeneous and the extrinsic mechanism and acromial shape play a substantial role in only a subgroup of patients. Therefore, acromionplasty is not a good treatment for at least a part of the patients clinically diagnosed with SIS. With new diagnostic methodologies, these subgroups can be identified.

Study design: Multicenter observational cohort study.

Study population: Patients clinically diagnosed with Subacromial Impingement Syndrome.

Main study parameters (categorized for etiological subgroups):

Relative cranial translation of the humerus: 3D arm-scapula motion registration (3D RoM), muscle activation parameters of shoulder and rotator cuff muscles (EMG), static acromiohumeral distance (sAH) on AP-radiographs ‘at rest’ and with exerted ab- and adduction moments (dAH), integrate bony 3D-shape with 3D RoM to describe dynamic AH (3DdAH).

Structural (bony) narrowing of the subacromial space: shape parameters of scapula (i.e. Bigliani acromion classification) and humerus, 3D kinematic analysis of scapulo-humeral motion by integration of bony 3D-shapes with 3D RoM.

Subacromial inflammatory processes and damaged tissues: MRI for rotator cuff and muscle quality (Goutallier score) and signs of bursitis, tendinitis and rotator cuff ruptures.

Other primary pathologies leading to SIS complaints: evaluation of MRI and radiographs for acromioclavicular-osteoarthritis, full thickness rotator cuff-ruptures, coracoid impingement and other subacromial pathologies.

References

Neer, C. S.: Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J. Bone Joint Surg. Am. 54:41-50, 1972.

Brox, J. I. et al.: Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome). BMJ. 307:899-903, 1993.

Morrison, D. S. et al.: Conservative Management for subacromial impingement of the shoulder. J. Shoulder. Elbow. Surg.S22, 1993.

Wirth, M. A. et al.: Nonoperative management of full-thickness tears of the rotator cuff. Orthop. Clin. North Am. 28:59-67, 1997.

Goldberg, B. A. et al.: Improvement in comfort and function after cuff repair without acromioplasty. Clin. Orthop. Relat Res.142-150, 2001.

Ketola, S. et al.: Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J. Bone Joint Surg. Br. 91:1326-1334, 2009.

Henkus, H. E. et al.: Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study. J. Bone Joint Surg. Br. 91:504-510, 2009.

Budoff, J. E. et al.: Debridement of partial-thickness tears of the rotator cuff without acromioplasty. Long-term follow-up and review of the literature. J. Bone Joint Surg. Am. 80:733-748, 1998.

Michener, L. A. et al.: Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin. Biomech. (Bristol. , Avon. ). 18:369-379, 2003.

Rathbun, J. B. et al.: The microvascular pattern of the rotator cuff. J. Bone Joint Surg. Br. 52:540-553, 1970.

Sano, H. et al.: Histologic evidence of degeneration at the insertion of 3 rotator cuff tendons: a comparative study with human cadaveric shoulders. J. Shoulder. Elbow. Surg. 8:574-579, 1999.

Uhthoff, H. K. et al.: Pathology of failure of the rotator cuff tendon. Orthop. Clin. North Am. 28:31-41, 1997.

SSM Knee

Accurate determination of wear and loosening of knee prostheses from routine radiographs.
A statistical shape model approach

Projectleaders

• Prof. Rob G.H.H. Nelissen, MD, PhD
• Bart L. Kaptein, MSc, PhD

Advisors

• Jochem Nagels, MD
• Edward R. Valstar, MSc, PhD
• Eric H. Garling, PhD
• Prof. J.H.C. Reiber, PhD (Image processing)
• Berend C. Stoel, PhD (Image processing)
• Boudewijn P.F. Leliefeldt, MSc, PhD (Image processing)
• Charl P. Botha, PhD (Med. Visualisation, Delft University of Technolgoy, Delft, The Netherlands)

PhD student

Emiel van IJsseldijk

Technology

• Statistical Shape Models
• Model-based RSA

Start/End Date

1/5/2009-1/5/2013

Grant giver

Dutch Arthritis Association (in dutch: Reumafonds)

Abstract

Yearly, 750.000 knee prostheses are placed worldwide. It is expected that these numbers will increase significantly in the near future (14% / year) due to aging societies and a trend to treat younger osteoarthritis patients with a prosthesis. At ten year postoperatively, about 10% of these prostheses has to be replaced. Mostly because of wear of the bearing and/or loosening. It is of important to detect wear and loosening of the prosthesis in time since earlier surgery might be limited to replacement of the worn bearing, thus postponing or even preventing revision surgery replacing all components.

Current visual evaluation of radiographs to detect wear and loosening of knee prostheses has large variations, reducing its validity in clinical practice.

The research goal is to improve the routine diagnosis by objectively and accurately detecting wear and/or loosening of knee prostheses from routine roentgen radiographs at an early stage, (before the patient complains about pain). To this end a computer aided diagnostic system needs to be developed.

These objective data can be used in clinical studies aiming for improving the treatment of patients with knee prostheses. In addition to this, these measurements will also be used to distinguish prostheses “at-risk” for loosening and/or wear from “stable” prostheses. By this, the visits to the out patient clinic can be differentiated: A “stable” prosthesis is checked every 5 year, while a prosthesis “at-risk” is checked every year. In the end, the reduction in the number of radiological check-ups gives more efficiency, shorter waiting lists, prevention of unnecessary radiation to the patient, and a significant reduction of the costs.

Shoulder Project

Functional analysis and improvement of the joints of the upper extremity

Project leaders

• Prof. Rob G.H.H. Nelissen

• Edward R. Valstar PhD
• Thea P.M. Vliet Vlieland MD, PhD

PhD students

• Peter Krekel MSc (Pre-operative planning)
• Daniel Suarez Venegas MSc (Biomechanical modelling)
• Frans Steenbrink (Biomechanical laboratory)

Technology

• Computer assisted surgery
• Biomechanical modelling
• Timeaction analysis

Start/End Date

January 1 2005 – December 31 2012

Grant giver

Dutch Arthritis Association (in dutch: Reumafonds)

Academic partners

• Department of Rehabilitation Medicine, LUMC
• Department of Reumatology, LUMC
• Medical Visualisation Group, Faculty of EWI, TU Delft
• Department of Precision and Microsystems Engineering, Faculty of 3mE, TU Delft
• Department of Biomechanical Engineering, Faculty of 3mE, TU Delft

Abstract

A good functional range of motion of the joints of the upper extremity is extremely important for independent ADL activities in the elderly. In this age group, the proper functioning of joints may be affected by destruction of joint cartilage, loss of muscle function by degeneration or rupture of tendons, and atrophy of muscles such as the rotator cuff in the shoulder.

Joint replacement prostheses for the upper extremity do not have the same good functional results and survival as hip and knee prostheses. Our research line is focussed on improvement of endoprostheses for the upper extremity. Towards this goal, new joint prostheses are evaluated clinically and biomechanically.

Within this project we focus on improving the outcome of total shoulder replacements, highly relevant research that fits perfectly in the internationally recognised expertise and research programme of the department of Orthopaedics. Two projects have already started: in the first project we concentrate on biomechanical modelling of the shoulder, and is intended to gain insight in optimal prosthesis design and placement, in the second project we focus on pre-operative planning of shoulder arthroplasty. In the near future, we plan to start more epidemiological oriented research on the assessment of early arthrosis.

Tomaat

Transfusion op Maat

Project leaders

• Prof Anneke Brand MD, PhD
• Prof Rob Nelissen MD, PhD

PhD Student

Cynthia So – Osman, hematologist, PhD, study coordinator

Employees

• 3 research nurses
• 1 datatypist
• 1 datamanager

Technology

Epidemiology

Start/End Date

2005 – 1/10/2010

Grant giver

• ZonMW
• Sanquin

Collaboration

• Albert Schweitzer Ziekenhuis (Dordrecht)
• Groene Hart Ziekenhuis (Gouda)
• Slotervaart Ziekenhuis (Amsterdam)

Abstract

The TOMAAT study is a randomized trial on bloodmanagement in total knee and hip prostheses patients with four arms for bloodreduction: Epo, intraoperative washed cellsaver, postoperative wounddrainage cellsaver. 2500 patients are included until December 2008

Vertebroplasty

Project leaders

• D.R. Arian van Erkel PhD
• P.D.S. Sander Dijkstra MD, PhD

PhD Student:

S.P.J. Sander Muijs MD

Start/End Date

January 2005 – December  2008

Grant giver

None

Academic partners

Department of Radiology LUMC

Abstract

Percutaneous vertebroplasty is now considered a routine procedure in treatment of painful osteoporotic vertebral compression fractures (OVCFs). The evidence of the effectiveness of the procedure is promising, but mainly based on cohort studies without control groups and a few low quality randomized controlled studies. Some or even all of the improvement in clinical outcome might however be caused by the favorable natural course of OVCF, regression to the mean of patients presenting to clinicians at the peak of their pain, or a placebo effect. The low complication rate of the procedure ranges from 1.3 to 2.5% and is mainly due to cement leakage. We prospectively analyzed the influence of the viscosity, the volume and leakage of the bone cement in relation to the quality of life. The necessity of  taking a biopsy during the vertebroplasty was evaluated.