Development of Robotic Osteochondral Autologous Transplantation Utilizing a Novel Bone Grafting Method
Abstract
The proposed project is to develop a new robotic orthopedic surgery procedure employing a novel micro-chainsaw mechanism that can extract a preoperatively planned bone-cartilage donor for autologous transplantation to treat severe osteoarthritis. The proposed project addresses the FY21 PRMRP Topic Area of Arthritis with the area of encouragement Basic and translational research to identify treatments to mitigate and/or reverse osteoarthritis. Osteoarthritis (OA) is the degeneration of articular cartilage and subchondral bone, often leading to pain, joint stiffness, and disability. Post-traumatic osteoarthritis (PTOA) develops after a joint injury, which may be in the form of fracture, cartilage damage, acute ligament sprain, chronic ligamentous instability, or combination of these. Nearly 27 million adults aged 25 or above have a clinical diagnosis of OA. Among those, PTOA affects 5.6 million people and is the cause of about 12% of osteoarthritis of the hip, knee, and ankle in the U.S. When OA progresses to the point that conservative measures are no longer effective, then surgical treatments are performed, which may include debriding, reconstructing, or replacing the worn out joint surfaces. Osteochondral autograft transplantation (OAT) has been performed to repair such cartilage defects. Plugs of healthy cartilage with subchondral bone are extracted from non-load-bearing area and inserted into the arthritic defect. Widely performed Mosaicplasty extracts and transplants multiple small cylindrical grafts as an alternative to a full surface transplantation since no method exists to extract larger or non-cylindrical donor graft intact as it requires cutting the root-side of donor. To overcome the fundamental limitation of donor root-side access, a novel osteochondral tissue extraction method has been designed using a new transversal blade micro chainsaw. The goal of the proposed research is to enhance surgical outcome of OAT by providing a robotic procedure that can extract and transplant a custom-shape single piece autograft donor using a micro chainsaw. If a defect-specific personalized-shape autograft can be extracted safely and placed into a precisely prepared defect area, more successful intact single donor transplantation can be achieved instead of utilizing multiple small plugs. In this proof-of-concept project, we will prototype the root-side bone-cutting device integrated to a standard robotic arm and perform mockup OAT procedures using foam and animal bones. The clinical significance of the new donor extraction method is that it enables patient and defect specific treatments with robotic precision. The proposed research is highly innovative and transformative as it employs a novel surgical technique that allows precise extraction of osteochondral autograft, which has not been possible to date, and it could, if successful, transform current OAT procedure and its outcome. Furthermore, the technique can be used for other orthopedic procedures involving bone extraction such as iliac crest autografting. The proposed OAT procedure involves complex clinical and technical components to be satisfied such as transplantation compatibility with surrounding tissue, matching donor site availability, and medical image processing to plan and guide the procedure. Some are established and others are still being investigated by researchers. In this technical discovery project, we will focus on prototyping and testing the feasibility of the root-side bone cutting mechanism using a transversal blade micro chainsaw. The project consists of three specific aims: (1) Design and prototype an intact osteochondral autograft harvesting device. (2) Design and fabricate a micro-chainsaw with transversal blades. (3) Integrate with a robot arm and perform mockup procedures. Currently no method exists to cut root-side of donor for autograft transplantation for OA. This disruptive approach could impact many orthopedic procedures requi
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210171
Entities
People
- Sang-eun Song
Organizations
- United States Army
- University of Central Florida