Advanced Surgical Simulation Processes in the Correction of Skeletal Defects and Deformities

Musculoskeletal Disorder Clinical Trial

— SIMULA  

Official title:

Advanced Surgical Simulation Processes in the Correction of Skeletal Defects and Deformities

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06380530
• Other study ID #: SIMULA
• Status: Not yet recruiting
• Phase: N/A
• Start date: May 2024
• Est. completion date: May 2029

Study information

• Verified date: April 2024
• Source: Istituto Ortopedico Rizzoli
• Contact: Grazia Chiara Menozzi
• Phone: 0516366
• Email: graziachiara.menozzi[@]ior.it
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Virtual Surgical Planning (VSP), Computer-Aided Surgical Simulation (CASS) for bone corrections, and the customization of implants and devices through 3D printing, known as Patient-Specific Instruments (PSI) and Graft-Specific Instruments (GSI), are assuming increasingly central roles in orthopedic clinical and surgical practice.

One area witnessing notable advancement is the treatment of musculoskeletal disorders (MMS) in children, adolescents, and young adults. These disorders involve severe and rare abnormalities in skeletal formation and development across three-dimensional planes, often affecting multiple limbs. Managing such deformities is complex, challenging to standardize, and prone to unpredictable clinical, radiographic, and functional outcomes.

The application of 3D modeling and printing technologies offers a deeper understanding of deformities and facilitates improved prediction, precision, reproducibility, and safety in surgical interventions.

The Musculoskeletal Apparatus Network (RAMS Network) centers are equipped with advanced 3D laboratories for surgical simulation and planning, aligned with the overarching goal of improving surgery quality through "in-silico" medicine (ISM) principles.

At present, numerous complex surgeries involving Virtual Surgical Planning (VSP) and sterilizable 3D-printed Patient-Specific Instruments (PSI) and/or Graft-Specific Instruments (GSI) are being simulated and performed at the Rizzoli Institute. Preliminary data from previous protocols indicate a significant reduction in surgical time with the implementation of VSP and the utilization of PSI and GSI.

The aim of this study is to enhance the current process of simulating, planning, and designing surgical support tools within 3D Printing Point-of-Care (3D POC) facilities. To achieve this, it is imperative to expand case volumes and systematically organize, categorize, and standardize simulation and planning procedures.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 100
• Est. completion date: May 2029
• Est. primary completion date: May 2028
• Accepts healthy volunteers: No
• Gender: All
• Age group: 2 Years to 40 Years

Eligibility

Inclusion Criteria:

• Diagnosis of musculoskeletal disease (MSD) of the limbs;

• Need for mono- or polyaxial correction by one or more osteotomies;

• Presence of specific consent to participate in the trial;

Exclusion Criteria:

• Patients who refuse to participate in the study

• Patients who do not undergo radiological follow-up examinations for VSP or for whom the radiological record is insufficient to conduct VSP;

• Patients who undergo different interventions for correction of MSD (growth modulation interventions by epiphysiodesis and hemiepiphysiodesis, progressive correction by external circular/hexapodal fixation);

• Pregnant or lactating women

Related Conditions & MeSH terms

• Congenital Abnormalities
• Musculoskeletal Abnormalities
• Musculoskeletal Diseases
• Musculoskeletal Disorder

Intervention

Procedure:
• Deformity correction
Surgeries to correct bone defomity, supported by the use of preoperative planning and/or patient-specific instruments

Locations

Country	Name	City	State
Italy	IRCCS Istituto Ortopedico Rizzoli	Bologna	BO
Italy	Istituto Giannina Gaslini	Genova
Italy	Galeazzi Orthopedic Institute	Milano
Italy	Policlinico San Matteo	Pavia
Italy	Istituto Nazionale Tumori Regina Elena	Roma
Italy	Ospedale Pediatrico Bambino Gesù	Roma
Italy	Istituto Clinico Humanitas	Rozzano	MI

Sponsors (7)

Lead Sponsor	Collaborator
Istituto Ortopedico Rizzoli	Galeazzi Orthopedic Institute, Istituto Clinico Humanitas, Istituto Giannina Gaslini, Istituto Nazionale Tumori Regina Elena, Ospedale Pediatrico Bambino Gesù, Policlinico San Matteo

Country where clinical trial is conducted

Italy, 

References & Publications (27)

"3D-MALF II: 'Innesti ossei personalizzati mediante analisi tridimensionale nelle deformità scheletriche in età pediatrica' - CE AVEC: 301/2022/Sper/IOR."

"3D-MALF: 'Modelli 3D-printing nel planning preoperatorio del paziente pediatrico affetto da malformazioni congenite. Studio pilota.' - CE AVEC: 356/2018/Sper/IOR".

Alessandri G, Frizziero L, Santi GM, Liverani A, Dallari D, Vivarelli L, Di Gennaro GL, Antonioli D, Menozzi GC, Depaoli A, Rocca G, Trisolino G. Virtual Surgical Planning, 3D-Printing and Customized Bone Allograft for Acute Correction of Severe Genu Varum in Children. J Pers Med. 2022 Dec 12;12(12):2051. doi: 10.3390/jpm12122051. — View Citation

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Archunan MW, Petronis S. Bone Grafts in Trauma and Orthopaedics. Cureus. 2021 Sep 4;13(9):e17705. doi: 10.7759/cureus.17705. eCollection 2021 Sep. — View Citation

Benedetti MG, et al. Prot. CHILD-DEROT. 'Studio pilota per la pianificazione del trattamento alterazioni torsionali dell'arto inferiore nei bambini affetti da paralisi cerebrale infantile mediante valutazione integrata morfologica e funzionale.' CE AVEC 718/2021/Oss/IOR. 30/09/2021.

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Depaoli A, Menozzi GC, Di Gennaro GL, Ramella M, Alessandri G, Frizziero L, Liverani A, Martinelli D, Rocca G, Trisolino G. The Flipping-Wedge Osteotomy: How 3D Virtual Surgical Planning (VSP) Suggested a Simple and Promising Type of Osteotomy in Pediatric Post-Traumatic Forearm Deformity. J Pers Med. 2023 Mar 19;13(3):549. doi: 10.3390/jpm13030549. — View Citation

Dorsey ER. The new platforms of health care. NPJ Digit Med. 2021 Jul 15;4(1):112. doi: 10.1038/s41746-021-00478-5. — View Citation

F. Osti et al., "CT conversion workflow for intraoperative usage of bony models: From DICOM data to 3D printed models," Applied Sciences (Switzerland), vol. 9, no. 4, Feb. 2019, doi: 10.3390/app9040708.

Frizziero L, Santi GM, Leon-Cardenas C, Donnici G, Liverani A, Papaleo P, Napolitano F, Pagliari C, Di Gennaro GL, Stallone S, Stilli S, Trisolino G, Zarantonello P. In-House, Fast FDM Prototyping of a Custom Cutting Guide for a Lower-Risk Pediatric Femoral Osteotomy. Bioengineering (Basel). 2021 May 26;8(6):71. doi: 10.3390/bioengineering8060071. — View Citation

Frizziero L, Santi GM, Leon-Cardenas C, Ferretti P, Sali M, Gianese F, Crescentini N, Donnici G, Liverani A, Trisolino G, Zarantonello P, Stallone S, Di Gennaro GL. Heat Sterilization Effects on Polymeric, FDM-Optimized Orthopedic Cutting Guide for Surgical Procedures. J Funct Biomater. 2021 Nov 19;12(4):63. doi: 10.3390/jfb12040063. — View Citation

G. Durastanti, C. Belvedere, M. Ruggeri, D. M. Donati, B. Spazzoli, and A. Leardini, "A Pelvic Reconstruction Procedure for Custom-Made Prosthesis Design of Bone Tumor Surgical Treatments," Applied Sciences 2022, Vol. 12, Page 1654, vol. 12, no. 3, p. 1654, Feb. 2022, doi: 10.3390/APP12031654.

G. Pravettoni and S. Triberti, "A 'P5' Approach to Healthcare and Health Technology," P5 eHealth: An Agenda for the Health Technologies of the Future, pp. 3-17, 2020, doi: 10.1007/978-3-030-27994-3_1.

Grassi FR, Grassi R, Vivarelli L, Dallari D, Govoni M, Nardi GM, Kalemaj Z, Ballini A. Design Techniques to Optimize the Scaffold Performance: Freeze-dried Bone Custom-made Allografts for Maxillary Alveolar Horizontal Ridge Augmentation. Materials (Basel). 2020 Mar 19;13(6):1393. doi: 10.3390/ma13061393. — View Citation

L. Frizziero et al., "An innovative and cost-advantage cad solution for cubitus varus surgical planning in children," Applied Sciences (Switzerland), vol. 11, no. 9, May 2021, doi: 10.3390/app11094057.

L. Frizziero et al., "Computer-aided surgical simulation for correcting complex limb deformities in children," Applied Sciences (Switzerland), vol. 10, no. 15, Aug. 2020, doi: 10.3390/app10155181.

L. Frizziero et al., "Effectiveness assessment of CAD simulation in complex orthopedic surgery practices," Symmetry (Basel), vol. 13, no. 5, May 2021, doi: 10.3390/sym13050850.

L. Frizziero et al., "New Methodology for Diagnosis of Orthopedic Diseases through Additive Manufacturing Models," Symmetry 2019, Vol. 11, Page 542, vol. 11, no. 4, p. 542, Apr. 2019, doi: 10.3390/SYM11040542.

L. Frizziero et al., "Paediatric orthopaedic surgery with 3D printing: Improvements and cost reduction," Symmetry (Basel), vol. 11, no. 10, Oct. 2019, doi: 10.3390/sym11101317.

Pop B, Fetica B, Blaga ML, Trifa AP, Achimas-Cadariu P, Vlad CI, Achimas-Cadariu A. The role of medical registries, potential applications and limitations. Med Pharm Rep. 2019 Jan;92(1):7-14. doi: 10.15386/cjmed-1015. Epub 2019 Jan 15. — View Citation

R. Michaels et al., "3D printing in surgical simulation: emphasized importance in the COVID-19 pandemic era," https://doi.org/10.2217/3dp-2021-0009, vol. 5, no. 1, pp. 5-9, May 2021, doi: 10.2217/3DP-2021-0009.

Raza M, Murphy D, Gelfer Y. The effect of three-dimensional (3D) printing on quantitative and qualitative outcomes in paediatric orthopaedic osteotomies: a systematic review. EFORT Open Rev. 2021 Feb 1;6(2):130-138. doi: 10.1302/2058-5241.6.200092. eCollection 2021 Feb. — View Citation

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Vivarelli L, Govoni M, Attala D, Zoccali C, Biagini R, Dallari D. Custom Massive Allograft in a Case of Pelvic Bone Tumour: Simulation of Processing with Computerised Numerical Control vs. Robotic Machining. J Clin Med. 2022 May 15;11(10):2781. doi: 10.3390/jcm11102781. — View Citation

* Note: There are 27 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Cost analysis	The cost analysis will entail evaluating expenses associated with various components, including imaging required for planning, production of 3D-printed instrumentation such as PSIs and GSIs, and bone grafts. Additionally, human costs for planning will be considered. Surgical-related costs will be assessed by comparing them with those of traditional surgeries to gauge the cost-effectiveness of the procedure, taking into account the achieved correction and the necessity for additional procedures.	At baseline (day 0)
Primary	Achieved skeletal corrections	Assessment of achieved skeletal corrections compared to planned corrections, measured on standard radiographs or CT scans depending on the type of deformity corrected	At baseline (day 0)
Primary	Achieved skeletal corrections	Assessment of achieved skeletal corrections compared to planned corrections, measured on standard radiographs or CT scans depending on the type of deformity corrected	After 1 year
Secondary	Operating room times	Operating room times for each planned procedure	At baseline (day 0)
Secondary	Fluoroscopy times	Fluoroscopy times for each planned procedure	At baseline (day 0)
Secondary	Blood loss	Blood loss for each patient	At baseline (day 0)
Secondary	Intra- and peri-operative complications	Intra- and peri-operative complications for each patient	At baseline (day 0)
Secondary	Suitability of PSIs	Suitability of PSIs in relation to the planned surgery	At baseline (day 0)
Secondary	Suitability of GSIs	Suitability of GSIs, if needed, in relation to the planned surgery	At baseline (day 0)
Secondary	Suitability of bone graft	Suitability of bone graft, if needed, in relation to the planned surgery	At baseline (day 0)
Secondary	Clinical-functional outcome	Clinical-functional outcome will be assessed by preoperative and one-year follow-up administration of the Pediatric Outcome Data Collection Instrument (PODCI) questionnaire for pediatric patients or the Short Form Health Survey 36 (SF-36) for young adults	At baseline (day 0)
Secondary	Clinical-functional outcome	Clinical-functional outcome will be assessed by preoperative and one-year follow-up administration of the Pediatric Outcome Data Collection Instrument (PODCI) questionnaire for pediatric patients or the Short Form Health Survey 36 (SF-36) for young adults	After 1 year

External Links

•   Customized Bone Allografts by 3D-printing (3D-MALF 2 protocol)