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Session: Poster session II
Session starts: Thursday 24 January, 16:00

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Marjolein van der Krogt (1) Lab. of Biomechanical Engineering, University of Twente, PO Box 217, 7500 AE Enschede; 2) Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, Amsterdam)
Bart Koopman (Lab. of Biomechanical Engineering, University of Twente, PO Box 217, 7500 AE Enschede)
Vivian Weerdesteyn (Radboud University Medical Center, Nijmegen)
Roel Wirix-Speetjens (Materialise NV, Leuven, Belgium)
Søren Tørholm (AnyBody Technology A/S, Aalborg, Denmark)
Robert Sitnik (Warsaw University of Technology, Warsaw, Poland)
Thomas Feilkas (Brainlab, Munich, Germany)
Nico Verdonschot (1) Lab. of Biomechanical Engineering, University of Twente, PO Box 217, 7500 AE Enschede, 2) Radboud University Medical Center, Nijmegen)

Abstract:
The burden of musculoskeletal diseases and prosthetic revision operations is huge and increasing rapidly with the aging population. For patients that require a major surgical intervention, procedures are unsafe, uncertain in outcome and have a high complication rate. The goal of the European project TLEMsafe is to create a software-based pre-operative surgical navigation system that helps the surgeon to predict the functional outcome of his/her patient after severe musculoskeletal surgery. TLEMsafe is dedicated to generating semi-automated 3-D image-analyzing tools to simulate the musculoskeletal system. The patient-specific parameters are fed into models with which the patient-specific functional outcome can be predicted. The surgeon can identify within the model what the changes will be (e.g. due to the removal of a muscle in a tumor patient) and the functional effect of this intervention can be calculated. Once the surgeon is satisfied with the operative plan, it is fed into a computer navigation system. During the first 24 months of the project, functional measurements were performed and MRI scans were made of ten healthy subjects and of two pilot patients. These scans are currently analyzed and software is developed to extract personalized parameters from the images. Cadaver experiments were performed in which muscle attachment points and muscle volumes were measured to enable validation of MRI-based personification of musculoskeletal models. Currently, we are measuring tumor and hip revision patients in order to create their personalized models and to predict functional outcome. By measuring their actual functional outcome we will be able to validate our predictions. Furthermore, a virtual pre-planning toolbox is generated, which allows the surgeon to operate on the virtual patient; the output is coupled to the Brainlab computer navigation system. Finally, special output software is developed to quantify functional outcome in a way that is surgically and clinically relevant. In conclusion, we have made considerable progress in patient-specific modeling; we have generated a surgeon friendly virtual pre-planner; and a way to quantify the outcome of the calculations in a clinically relevant manner. Next steps are to focus on the validity of personalized musculoskeletal models and to assess the pre- and post-operative functionality of patients and their adaptive capacity during the recovery period after severe musculoskeletal surgery. Acknowledgement: The TLEMsafe Project (http://www.tlemsafe.eu/) is financially supported under the Seventh Framework Programme (FP7) of the European Commission.