CMIV. John Sandlund

Orthopedic surgery is a heavy health economy factor, in Sweden and across the globe. This project aims towards significantly better outcomes and patient safety at a significantly lower cost, through ground-breaking improvement of precision in orthopedic surgery. Higher precision is necessary to meet strong healthcare needs: less invasive surgery, more individualized care, earlier detection of complications, and more efficient resource use in the surgical workflow.

Increased Precision in Orthopedics

The need of implant surgery is increasing, partly due to the ageing population, partly due to increasing patient demands on mobility. There are, however, quality issues in orthopedics; in Sweden, for instance, care-related injuries occur at 15% of the procedures leading to an additional healthcare cost of >1 billion SEK/year.

In this project a portfolio of innovations providing ground-breaking precision improvements will be developed and validated in a close collaboration between industry, healthcare and academia. The project consortium consists of 14 organizations within these three sectors, where Sectra is the project coordinator and together with CMIV run the overall project management.

Solutions will be developed in five tracks, implant movement, patient movement, implant logistics, 3D print and pre-per-post integration, where CMIV primarily will be involved in patient movement and pre-per-post integration. Finally, the project also contains a sixth track that will ensure a patient-centric view on innovation requirements, and that will work towards making the increased precision a professional norm in orthopedics.

Close up on Patient Movement

Finding the source of a mobility problem can be difficult. More advanced diagnostic methods would be of great use, as there are many treatment options in surgery and physical therapy when you know what the cause is. The patient movement project develops a detailed analysis suitable for clinical routine based on combining CT images with camera-based motion capture technology, as well as time-resolved CT.

Hans Tropp, an orthopedic surgeon since 1990 with long experience of research in movement analysis, is project manager in the subproject.

-I have always tried to solve orthopedic problems with biomechanical methods. If you consider the movement you will get much better results in orthopedics.

In this priject a CT image of the patient’s joint is combined with a movement analysis of the patient.

-In this way we can visualize how the patient moves and how the joints are adjusting to compensate for the injury. We can study what part of the joint that is provoked when the patient feels pain.

The project is a collaboration between the orthopedic clinic in Linköping, Sectra and Qualisys.

- For me, it is very important that there are engineers in the project who are interested in clinical problems.

The subprojects in Preciis benefit from each other.

- The Preciis subprojects are so close to each other that spinoff effects are constantly being created. As an example, we can use the 3D print project to create a model from the CT images to validate our method, both the software and the method as a whole.

Fusing the Digital with the Physical

Traditionally, the orthopedic surgeon’s workflow for physical material (the implants) has been separated from the handling of digital images. A cornerstone here is to amalgamate these two areas, so that new innovative solutions can be created based on seamless couplings between digital and physical counterparts. Great opportunities are provided by modern imaging technology, which until now has not reached its full potential in orthopedic applications.

- There is a focus on production in orthopedics and often there is not much evaluation of the patient's problems available beforehand leading to more or less guessing about what the problem is. Developing methods that can diagnose and visualize patient problems is really quite important, Hans explains.

Bringing the orthopedic and radiology departments closer together is of great importance for these kinds of initiatives to thrive.

-I think it would be best to have the radiologists on board from the beginning. In fact, I would like to collaborate with a dedicated radiologist who does the image review in the same way as you have a thoracic radiologist working with the heart specialists, Hans concludes.

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