Fully automated workflow for the design of patient-specific orthopaedic implants: application to total knee arthroplasty

Arthroplasty is commonly performed to treat joint osteoarthritis, reducing pain and improving mobility. While arthroplasty has known several technical improvements, a significant share of patients are still unsatisfied with their surgery. Personalised arthroplasty improves surgical outcomes however current solutions require delays, making it difficult to integrate in clinical routine. We propose a fully automated workflow to design patient-specific implants, presented for total knee arthroplasty, the most widely performed arthroplasty in the world nowadays. The proposed pipeline first uses artificial neural networks to segment the proximal and distal extremities of the femur and tibia. Then the full bones are reconstructed using augmented statistical shape models, combining shape and landmarks information. Finally, 77 morphological parameters are computed to design patient-specific implants. The developed workflow has been trained using 91 CT scans of lower limb and evaluated on 41 CT scans manually segmented, in terms of accuracy and execution time. The workflow accuracy was $0.4\pm0.2mm$ for the segmentation, $1.2\pm0.4mm$ for the full bones reconstruction, and $2.8\pm2.2mm$ for the anatomical landmarks determination. The custom implants fitted the patients' anatomy with $0.6\pm0.2mm$ accuracy. The whole process from segmentation to implants' design lasted about 5 minutes. The proposed workflow allows for a fast and reliable personalisation of knee implants, directly from the patient CT image without requiring any manual intervention. It establishes a patient-specific pre-operative planning for TKA in a very short time making it easily available for all patients. Combined with efficient implant manufacturing techniques, this solution could help answer the growing number of arthroplasties while reducing complications and improving the patients' satisfaction.

Dynamic multi feature-class Gaussian process models

In model-based medical image analysis, three features of interest are the shape of structures of interest, their relative pose, and image intensity profiles representative of some physical property. Often, these are modelled separately through statistical models by decomposing the object's features into a set of basis functions through principal geodesic analysis or principal component analysis. This study presents a statistical modelling method for automatic learning of shape, pose and intensity features in medical images which we call the Dynamic multi feature-class Gaussian process models (DMFC-GPM). A DMFC-GPM is a Gaussian process (GP)-based model with a shared latent space that encodes linear and non-linear variation. Our method is defined in a continuous domain with a principled way to represent shape, pose and intensity feature classes in a linear space, based on deformation fields. A deformation field-based metric is adapted in the method for modelling shape and intensity feature variation as well as for comparing rigid transformations (pose). Moreover, DMFC-GPMs inherit properties intrinsic to GPs including marginalisation and regression. Furthermore, they allow for adding additional pose feature variability on top of those obtained from the image acquisition process; what we term as permutation modelling. For image analysis tasks using DMFC-GPMs, we adapt Metropolis-Hastings algorithms making the prediction of features fully probabilistic. We validate the method using controlled synthetic data and we perform experiments on bone structures from CT images of the shoulder to illustrate the efficacy of the model for pose and shape feature prediction. The model performance results suggest that this new modelling paradigm is robust, accurate, accessible, and has potential applications including the management of musculoskeletal disorders and clinical decision making

Dynamic multi-object Gaussian process models: A framework for data-driven functional modelling of human joints

Statistical shape models (SSMs) are state-of-the-art medical image analysis tools for extracting and explaining features across a set of biological structures. However, a principled and robust way to combine shape and pose features has been illusive due to three main issues: 1) Non-homogeneity of the data (data with linear and non-linear natural variation across features), 2) non-optimal representation of the $3D$ motion (rigid transformation representations that are not proportional to the kinetic energy that move an object from one position to the other), and 3) artificial discretization of the models. In this paper, we propose a new framework for dynamic multi-object statistical modelling framework for the analysis of human joints in a continuous domain. Specifically, we propose to normalise shape and dynamic spatial features in the same linearized statistical space permitting the use of linear statistics; we adopt an optimal 3D motion representation for more accurate rigid transformation comparisons; and we provide a 3D shape and pose prediction protocol using a Markov chain Monte Carlo sampling-based fitting. The framework affords an efficient generative dynamic multi-object modelling platform for biological joints. We validate the framework using a controlled synthetic data. Finally, the framework is applied to an analysis of the human shoulder joint to compare its performance with standard SSM approaches in prediction of shape while adding the advantage of determining relative pose between bones in a complex. Excellent validity is observed and the shoulder joint shape-pose prediction results suggest that the novel framework may have utility for a range of medical image analysis applications. Furthermore, the framework is generic and can be extended to n$>$2 objects, making it suitable for clinical and diagnostic methods for the management of joint disorders.