TLEMsafe consortium has been carefully established to contain the expertise that is required to create a breakthrough in the usage of mathematical models in clinical practice, in order to improve safety of surgery and predictable functional outcome for patients that undergo severe surgery on their musculo-skeletal system. The starting point of TLEMsafe project is the recently developed Twente Lower Extremity Model (TLEM) which will undergo rigid validation under multiple circumstances.

Underlying theoretical activity and metabolic activities built in the TLEM model will be validated using extensive measurements on healthy subjects performed in Work Package 1. In addition, a marker-free structured light based measurement method will be further developed and tested on the healthy subjects, in order to allow to measure kinematics on the patients without the requirement of reflective markers.

Traditionally, musculo-skeletal models are based on an ‘average’ model and scaled in a simple way, using for example the height and weight of the patient, to generate a so-called patient-specific model. However, this is a highly doubtful manner as individuals musculo-skeletal characteristics may differ considerably. In Work Package 2, state-of-the art 3-D image analyses techniques to extract important muscuslo-skeletal parameters will be developed and validated, in order to create patient-specific models.

In Work Package 3, subject-specific models will be created based on results obtained in WP1 and WP2, and their capacity to predict a different functional outcome for different individuals will be demonstrated. In addition, the subject-specific model predictions will be compared with several parameters (glucose metabolism, oxygen consumption...) measured in WP1.

Work Package 4 will be dedicated to generate an interactive link between the muscuslo-skeletal model and the surgeon. Using virtual reality algorithms and 3-D visualization techniques, the surgeon will be able to modify the musculo-skeletal system of the patient to simulate his surgical operation plan.

In Work Package 5, functional measurements of the patients will performed before and after surgery. The kinematics measurements will be done using the new marker-free structured light based method developed and validated in WP1.

In Work Package 6, functional effect of the surgical intervention will be quantified, based on the measurements performed in WP5. Moreover, differences between real patient measurements and expected patient-specific model predictions will be quantified, so that the adaptive capacity of patients after surgery can therefore be implemented in the musculo-skeletal model.

Generally, functional predictions of the TLEM model are in a mathematical form, and as such not useable for surgeons. Therefore, in Work Package 7 a pre- and post-surgery processing feature will be created, ‘hiding’ the complex mathematical formulations, in order to allow the surgeons to clinically interpret the results of the simulated surgical interventions.

In Work Package 8, a computer navigation module will be developed to export the optimal surgical plan selected by the surgeon, after performing an interactive surgical session on the muscuslo-skeletal model of the patient. The selected operative plan will feed into the surgical navigation system, in order to guide the surgeon through the surgery in a step-wise manner. This will allow him to perform the surgery exactly as pre-operatively planned.

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