Clinical Evaluation and Cost-effectiveness Analysis of 3D Digital Surgery in Traumatology

Not Applicable

Recruiting

• Conditions: Radius; Deformity; Hip Osteoarthritis; Hip Arthritis; Hip Arthropathy; Spine Injury; Radius; Anomaly; Vertebra; Degeneration; Vertebral Fracture; Hip Prosthesis Infection; Spinal Fusion
• Interventions: Procedure: patients treated using 3D technology and Patient-Specific Instrumentation; Procedure: Patients treated with conventional surgery, without using 3D technology

• Registration Number: NCT06603831
• Lead Sponsor: Corporacion Parc Tauli

Brief Summary

Digital surgery, in combination with patient specific instrumentation (PSI) is being used more and more in traumatology due to its proven benefits and applications. Nowadays, medical case planning and an optimal preparation before surgery are still a challenge for surgeons. This lack of preparation is translated into longer surgical procedures, potential complications, unnecessary sterilization of materials and a high number of fluoroscopies. 2D techniques such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and X-rays remain essential for medical planning, however, in many cases, a 3D visualization is needed to achieve better results, especially in complex cases.The use of personalized medical instruments such as surgical guides has proven to increase clinical accuracy, assuring a better correction of bone deformities, and allowing a more precise location of implants and screw positioning. Furthermore, the use of 3D-printed patient-specific prosthesis can lead to better clinical outcomes as they reduce the number of complications as well as they present a longer lifespan compared to conventional generic implants.Despite the potential of 3D technology in the medical field, there is still a lack of robust studies that compares clinical benefits between digital surgery and conventional 2D surgery, and its economic impact is still unknown. Thus, the investigators propose this randomized, prospective and multi-center clinical study to evaluate the use of 3D technology in traumatology. The aim of this project is to prove that digital surgery is a cost-effective methodology and therefore it should be adopted by the public health system as a gold standard procedure.

Detailed Description

3D technology is increasingly being used, especially in orthopaedic surgery and traumatology as it allows to define specific objects and to understand structures and system dynamics. From patient TC images and using a biomedical engineering software, an exact 3D virtual model of the anatomical region can be created, enabling visualization, planning and simulation of the entire surgery. Besides, this software allows to design custom-made surgical guides (that precisely define cutting zones and screw positioning) as well as personalized implants that perfectly fit the patient's anatomy. After that, Patient-Specific Instrumentation can be manufactured using 3D printers and biocompatible materials and they can be sterilized to be used in the operating room.

While personalized surgical guides increase surgical precision and surgeon satisfaction, personalized implants have shown to generate better clinical outcomes, both short and long term. Despite of the benefits that 3D technology can generate in the medical field, most surgeons still opt for conventional 2D planning techniques, free-hand surgeries and generic implants use. This results in a non-standardized and variable procedure that heavily depends on the surgeon´s experience and in many cases, the obtained results deviate from the initial goals. Scientific evidence shows that a lack of precision is strictly related to clinical complications. Poor alignment of the implants can cause damage to internal structures, increases chances of dislocations, fractures and osteolysis as well as reduces the prosthetic component lifespan. That translates into patient suffering from chronic pain, reduced functionality and an increased number of reinterventions.

Regardless of the potential and several applications of 3D technology, there´s still a lack of clinical evidence, and the economic impact is still unknown. This methodology is increasingly being used as a routine medical process in many institutions but still raises concerns regarding costs, specially when considering its use in the public health system. Although digital surgery has a wide variety of associated expenses such as hardware and software cost, equipment maintenance and 3D-specialised engineers, the cost of 3D technology has significantly decreased in the past few years and it can potentially generate economic benefits compared to the standard methodology due to the optimization of the surgical process; shorter surgeries, reduced number of unnecessary sterilized materials, reduced number of fluoroscopies during surgery and less medical complications and revisions.

Thus, a large-scale study is still needed to demonstrate: 1) clinical benefits that 3D technology can generate compared to conventional surgery and 2) thoroughly analyse its economic impact to determine if it's a cost-effective methodology. For this reason, a multi-centre, randomized and prospective study is proposed to evaluate digital surgery's clinical results and to perform a cost-effectiveness analysis in order to obtain enough scientific evidence to be able to escalate the use of 3D technology in all public health institutions.

This clinical trial is a pragmatic study that will evaluate the efficacy and effectiveness of 3D technology in 3 different surgical procedures; distal radius osteotomy, acetabular arthroplasty and spinal arthrodesis.

Study Timeline

• Study First Submitted: 2024-07-22
• Study First Submitted QC: 2024-09-16
• Study First Posted: 2024-09-19
• Study Start: 2024-10-21
• Status Verified: 2024-11
• Last Update Submitted: 2024-11-08
• Last Update Posted: 2024-11-12
• Primary Completion: 2027-12-31
• Study Completion: 2027-12-31

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 180

Inclusion Criteria

• Patients that requires one of the following surgical procedures / interventions: Radius osteotomy due to non-articular metaphyseal malunion Complex acetabular arthroplasty Thoracic-lumbar spine arthrodesis.

-Patients that can understand the clinical study and that are able to read, understand and sign the consent form

Exclusion Criteria

• Patients that are not able to read, understand or sign the consent form.
• Patients that can't or have no support to complete the clinical trial.
• Patients with complex deformities or complications that would require mandatory personalized digital surgery treatment

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
3D digital surgery group	patients treated using 3D technology and Patient-Specific Instrumentation	-
2D conventional surgery group	Patients treated with conventional surgery, without using 3D technology	-

Primary Outcome Measures

Name	Time	Method
Accuracy of implants location, screw positioning and correction angles in regards the previous clinical planning and positioning reference standards.	CT will be performed before surgery and after 21 days of surgery. From this CT, positioning and correction measurements will be obtained in the lab and accuracy will be deduced.	CT scan will be performed before and after surgery. Digital Planning will be performed in all cases to determine the right positioning of implants and screws (and deformity angle correction if needed) that the surgeon should achieve. Implant location and screw positioning from post-surgery CT will be measured and accuracy will be obtained by comparing the final positioning and correction with the previous planning and goals. Positioning and corrections measurements in post-surgery CT Scan will also be compared to positioning reference standards to determine the number of cases where the reference safe zone positioning and corrections have been achieved in both, digital and conventional surgery.

Secondary Outcome Measures

Name	Time	Method
Demographic	During patient recruitment
Pain of patient that undergoes any of the surgical procedures studied in this trial before and after surgery assessed by BPI-SF	This outcome will be measured before surgery, 21 days after surgery and 12 months after surgery	Pain will be assessed by BPI-SF before and after surgery and results will be compared between digital and conventional surgery to determine if there are significant results in these clinical outcomes.
Quality of life of patients that undergoes any of the surgical procedures studied in this trial before and after surgery will be assessed by SF-36 questionnaire	This outcome will be measured before surgery, 21 days after surgery and 12 months after surgery	Quality of life will be assessed by SF-36 before and after surgery and results will be compared between digital and conventional surgery to determine if there are significant results in these clinical outcomes.
Quality of life of patients that undergoes any of the surgical procedures studied in this trial before and after surgery will be assessed by EQ5D-5L questionnaire	This outcome will be measured before surgery, 21 days after surgery and 12 months after surgery	Quality of life will be assessed by EQ5D-5L before and after surgery and results will be compared between digital and conventional surgery to determine if there are significant results in these clinical outcomes.
Functionality and pain for patients that undergoes radial osteotomy will be assessed by the specific PROM questionnaire PRWE	This outcome will be measured before surgery, 21 days after surgery and 12 months after surgery	PRWE it's a patient reported outcome measures (PROMs) designed to measure wrist pain and disability in activities of daily living used for specific wrist problems
Functionality and pain for patients that undergoes hip arthroplasty will be assessed by the specific PROM questionnaire HOOS	This outcome will be measured before surgery, 21 days after surgery and 12 months after surgery	HOOS it's a patient reported outcome measures (PROMs) designed to evaluate symptoms and limitations for patients with hip pain.
Functionality and pain for patients that undergoes spinal arthrodesis will be assessed by the specific PROM questionnaire Oswerty scale	This outcome will be measured before surgery, 21 days after surgery and 12 months after surgery	Oswerty scale it's a patient reported outcome measure (PROMs) designed to evaluate pain and disability for patients that undergo arthrodesis and it's the gold standard of low back functional outcome tools.
Number of doctors and professionals that are present in the operating room	During surgery	Outcome associated with surgery cost
surgical time. Length of time for the whole surgical intervention	During surgery	Outcome associated with surgery cost
Post-operative time. Length of time for the whole post-operative procedure.	up to 1 day	Outcome associated with surgery cost
number of surgical sets and sterilized material that has been used during surgery	During surgery	Outcome associated with surgery cost
Complications that the patient can suffer during surgery	During surgery	Any incidence that can happen to the patient during the whole intervention
Amount of fluoroscopies measured in fluoroscopy scan time that is used during surgery	During surgery	measure the amount of fluoroscopies that the surgeon needed during the intervention.
number of medical follow-up visits or hospital resources	1 year	medical visits that the patient needs after surgery. this outcome is associated with cost.

Trial Locations

Locations (1)

Hospital Parc Taulí; 🇪🇸 Sabadell, Barcelona, Spain