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Chirurgie orthopédique assistée par ordinateur : application au traitement de l'arthrose du genou

Abstract : Osteoarthritis is a real public health problem. More than ten million people are affected by osteoarthritis in France and 35 million in the United States. Knee Osteoarthritis represents 35% of the total number of osteoarthritis with more than 1.3 million patients in Europe. Today, there are several solutions to treat knee osteoarthritis depending on the degenerative nature of the disease : from conservative surgical treatment, such as High tibia Osteotomy (HTO), to prosthetic surgical treatment, such as Total Knee arthroplasty (TKA). The long-term success of these interventions is (1) the control of the lower limb alignment, during the intervention, which can be obtained by measuring the HKA angle between the hip, the knee and the ankle centers, and (2) the surgical planning allowing the preparation of the intervention, and for instance, the definition of the optimal cuts for the placement of a knee prosthesis based on the 3D model of the patient bone obtained from computerized tomography (CT) or MRI. We were interested, first, in the study and evaluation, in a clinical context, of the accuracy and precision of the methods used in computer-assisted orthopedic surgery for the localization of the hip center. We have thus proposed a new minimally invasive method especially adapted to HTO. We were interested, then, to the segmentation methods allowing the extraction of the knee bony surface from MRI for the surgical planning. We have also proposed a new automatic approach based on active shape models (ASM). Given the very encouraging results, the integration of our contributions in the clinical routine could, potentially, improve the medical benefits for the treatment of knee osteoarthritis.
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Submitted on : Monday, January 22, 2018 - 2:25:59 PM
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Zoheir Dib. Chirurgie orthopédique assistée par ordinateur : application au traitement de l'arthrose du genou. Médecine humaine et pathologie. Université de Bretagne occidentale - Brest, 2017. Français. ⟨NNT : 2017BRES0070⟩. ⟨tel-01689758⟩

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