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Total knee arthroplasties from the origin to navigation: history, rationale, indications. INTERNATIONAL ORTHOPAEDICS 2018; 43:597-604. [PMID: 29589088 DOI: 10.1007/s00264-018-3913-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/16/2018] [Indexed: 12/31/2022]
Abstract
Since the early 1970s, total knee arthroplasties have undergone many changes in both their design and their surgical instrumentation. It soon became apparent that to improve prosthesis durability, it was essential to have instruments which allowed them to be fitted reliably and consistently. Despite increasingly sophisticated surgical techniques, preoperative objectives were only met in 75% of cases, which led to the development, in the early 1990s, in Grenoble (France), of computer-assisted orthopaedic surgery for knee prosthesis implantation. In the early 2000s, many navigation systems emerged, some including pre-operative imagery ("CT-based"), others using intra-operative imagery ("fluoroscopy-based"), and yet others with no imagery at all ("imageless"), which soon became the navigation "gold standard". They use an optoelectronic tracker, markers which are fixed solidly to the bones and instruments, and a navigation workstation (computer), with a control system (e.g. pedal). Despite numerous studies demonstrating the benefit of computer navigation in meeting preoperative objectives, such systems have not yet achieved the success they warrant, for various reasons we will be covering in this article. If the latest navigation systems prove to be as effective as the older systems, they should give this type of technology a well-deserved boost.
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Validation of three-dimensional models of the distal femur created from surgical navigation point cloud data for intraoperative and postoperative analysis of total knee arthroplasty. Int J Comput Assist Radiol Surg 2017; 12:2097-2105. [DOI: 10.1007/s11548-017-1630-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
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Amerinatanzi A, Summers R, Ahmadi K, Goel VK, Hewett TE, Nyman E. A novel 3D approach for determination of frontal and coronal plane tibial slopes from MR imaging. Knee 2017; 24:207-216. [PMID: 27923624 PMCID: PMC5359038 DOI: 10.1016/j.knee.2016.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 08/31/2016] [Accepted: 10/11/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The proximal tibia is geometrically complex, asymmetrical, and variable, is heavily implicated in arthrokinematics of the knee joint, and thus a contributor to knee pathologies such as non-contact anterior cruciate ligament injury. Medial, lateral, and coronal tibial slopes are anatomic parameters that may increase predisposition to knee injuries, but the extent to which each contributes has yet to be fully realized. Previously, two-dimensional methods have quantified tibial slopes, but more reliable 3D methods may prove advantageous. AIMS (1) to explore the reliability of two-dimensional methods, (2) to introduce a novel three-dimensional measurement approach, and (3) to compare data derived from traditional and novel methods. METHODS Medial, lateral, and coronal tibial slope geometry from both knees (left and right) of one subject were obtained via magnetic resonance images and measured by four trained observers from two-dimensional views. The process was repeated via three-dimensional approaches and data evaluated for intra- and inter-rater reliability. RESULTS The conventional method presented a weaker Intraclass Correlation Coefficient (ICC) for the measured slopes (ranging from 0.43 to 0.81) while the resultant ICC for the proposed method indicated greater reliability (ranging from 0.84 to 0.97). Statistical analysis supported the novel approach for production of more reliable and repeatable results for tibial slopes. CONCLUSIONS The novel three-dimensional method for calculating tibial plateau slope may be more reliable than previously established methods and may be applicable in assessment of susceptibility to osteoarthritis, as part of anterior cruciate ligament injury risk assessment, and in total knee implant design.
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Affiliation(s)
- Amirhesam Amerinatanzi
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, The University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606, USA
| | - Rodney Summers
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, The University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606, USA
| | - Kaveh Ahmadi
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, The University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606, USA
| | - Vijay K. Goel
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, The University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606, USA
| | - Timothy E. Hewett
- Biomechanics Laboratory & Sports Medicine Center, Departments of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Edward Nyman
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, The University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606, USA,College of Health Professions, The University of Findlay, 1000 N. Main Street, Findlay, OH, 45840, USA,Corresponding Author Address: Edward Nyman, Jr., Ph.D., The University of Findlay, College of Health Sciences, 1000 N. Main Street, Findlay, OH, 45840, USA, , Phone: 419-434-5969
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Sun SP, Su HW. Full Scale 3D Preoperative Planning System of the Ankle Joint Replacement Surgery with Multimedia System. SMART SCIENCE 2016. [DOI: 10.1080/23080477.2014.11665608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zheng G, Nolte LP. Computer-Assisted Orthopedic Surgery: Current State and Future Perspective. Front Surg 2015; 2:66. [PMID: 26779486 PMCID: PMC4688391 DOI: 10.3389/fsurg.2015.00066] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/07/2015] [Indexed: 11/13/2022] Open
Abstract
Introduced about two decades ago, computer-assisted orthopedic surgery (CAOS) has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopedics and traumatology, increasing availability of different imaging modalities, and advances in analytics and navigation tools. The aim of this paper is to present the basic elements of CAOS devices and to review state-of-the-art examples of different imaging modalities used to create the virtual representations, of different position tracking devices for navigation systems, of different surgical robots, of different methods for registration and referencing, and of CAOS modules that have been realized for different surgical procedures. Future perspectives will also be outlined.
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Affiliation(s)
- Guoyan Zheng
- Institute for Surgical Technology and Biomechanics, University of Bern , Bern , Switzerland
| | - Lutz P Nolte
- Institute for Surgical Technology and Biomechanics, University of Bern , Bern , Switzerland
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Kim J, Kang DI. Partially Automated Method for Localizing Standardized Acupuncture Points on the Heads of Digital Human Models. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:483805. [PMID: 26101534 PMCID: PMC4460256 DOI: 10.1155/2015/483805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 11/29/2022]
Abstract
Having modernized imaging tools for precise positioning of acupuncture points over the human body where the traditional therapeutic method is applied is essential. For that reason, we suggest a more systematic positioning method that uses X-ray computer tomographic images to precisely position acupoints. Digital Korean human data were obtained to construct three-dimensional head-skin and skull surface models of six individuals. Depending on the method used to pinpoint the positions of the acupoints, every acupoint was classified into one of three types: anatomical points, proportional points, and morphological points. A computational algorithm and procedure were developed for partial automation of the positioning. The anatomical points were selected by using the structural characteristics of the skin surface and skull. The proportional points were calculated from the positions of the anatomical points. The morphological points were also calculated by using some control points related to the connections between the source and the target models. All the acupoints on the heads of the six individual were displayed on three-dimensional computer graphical image models. This method may be helpful for developing more accurate experimental designs and for providing more quantitative volumetric methods for performing analyses in acupuncture-related research.
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Affiliation(s)
- Jungdae Kim
- Nano Primo Research Center, Advanced Institutes of Convergence Technology, Seoul National University, Suwon 443-270, Republic of Korea
- Pharmacopuncture Medical Research Center, Korean Pharmacopuncture Institute, Seoul 157-801, Republic of Korea
| | - Dae-In Kang
- Pharmacopuncture Medical Research Center, Korean Pharmacopuncture Institute, Seoul 157-801, Republic of Korea
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Abstract
BACKGROUND Methods to improve gap balancing in total knee arthroplasty (TKA) include the development of calibrated distractors and various devices to determine the distances of the gaps. However, few studies have validated the accuracy or precision of computer navigation to determine these measurements, especially gaps created after bone cuts have been made; doing so would be important, because optimal surgical technique relies on appropriate gap spacing. QUESTIONS/PURPOSES We investigated the ability of a new image-free computer navigation surface registration protocol to measure gap distances in TKA. METHODS Eight embalmed cadaveric specimens of the lower extremity were used. A surface registration software protocol defined the most distal and posterior surface points of the femoral condyles and the navigation system measured the distance of the most distal femoral condyle point to the surface of the tibia after tibial resection. The tibial resection was perpendicular to the mechanical axis and was cut with a 7° posterior slope. The navigation system measured gaps spaced by modular spacing blocks at 5° intervals from full extension to 120° of flexion. Repeatability assessed repeated measures by one surgeon. Reproducibility was assessed by performing the same measurements after complete reregistration of the computer protocol to the cadaver bones. RESULTS The gaps measured by the computer were statistically the same as those assessed with the use of blocks with a maximum measurement error of 1 mm. Reregistration did introduce error into the measurement. The gaps changed with position of knee flexion, and there was gradual and significant stretching of the gaps with repeated measurements. CONCLUSIONS Preliminary testing shows that computer navigation can reproduce static measurements reliably and with equal accuracy as spacer blocks. We have not demonstrated that this could be applied in a dynamic setting. CLINICAL RELEVANCE This computer navigation system has sufficient precision to warrant investigation in the clinical setting for measuring gaps created during the surgical procedure.
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Petrigliano FA, Lane CG, Suero EM, Allen AA, Pearle AD. Posterior cruciate ligament and posterolateral corner deficiency results in a reverse pivot shift. Clin Orthop Relat Res 2012; 470:815-23. [PMID: 21874389 PMCID: PMC3270184 DOI: 10.1007/s11999-011-2045-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND As measured via static stability tests, the PCL is the dominant restraint to posterior tibial translation while the posterolateral corner is the dominant restraint to external tibial rotation. However, these uniplanar static tests may not predict multiplanar instability. The reverse pivot shift is a dynamic examination maneuver that may identify complex knee instability. QUESTIONS/PURPOSES In this cadaver study, we asked whether (1) isolated sectioning or (2) combined sectioning of the PCL and posterolateral corner increased the magnitude of the reverse pivot shift and (3) the magnitude of the reverse pivot shift correlated with static external rotation or posterior drawer testing. METHODS In Group I, we sectioned the PCL followed by structures of the posterolateral corner. In Group II, we sectioned the posterolateral corner structures before sectioning the PCL. We performed posterior drawer, external rotation tests, and mechanized reverse pivot shift for each specimen under each condition and measured translations via navigation. RESULTS Isolated sectioning of the PCL or posterolateral corner had no effect on the reverse pivot shift. Conversely, combined sectioning of the PCL and posterolateral corner structures increased the magnitude of the reverse pivot shift. The magnitude of the reverse pivot shift correlated with the posterior drawer and external rotation tests. CONCLUSIONS Combined sectioning of the PCL and posterolateral corner was required to cause an increase in the magnitude of the mechanized reverse pivot shift. The reverse pivot shift correlated with both static measures of stability. CLINICAL RELEVANCE Combined injury to the PCL and posterolateral corner should be considered in the presence of a positive reverse pivot shift.
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Affiliation(s)
- Frank A Petrigliano
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California Los Angeles, 10945 Le Conte Avenue, PVUB #33-55 H, Los Angeles, CA 90095, USA.
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Effect of meniscal loss on knee stability after single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2011; 19 Suppl 1:S86-93. [PMID: 21562842 DOI: 10.1007/s00167-011-1537-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 04/28/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE The menisci are known to be important secondary constraints to anterior translation of the tibia in the ACL-deficient knee. The effect of meniscal loss on knee stability as measured by the magnitude of the pivot shift following ACL reconstruction is unknown. The objective of this investigation was to determine the effect of meniscectomy on knee stability following two single-bundle ACL reconstruction strategies. MATERIALS AND METHODS A mechanized pivot shift was performed on cadaveric specimens in the ACL-intact and ACL-deficient state. Tibiofemoral translation was recorded using a surgical navigation system. The ACL was reconstructed utilizing a nonanatomic graft (n = 10) extending from the posterolateral tibial footprint to the anteromedial femoral footprint, or an anatomic anteromedial single-bundle graft extending from the anteromedial tibial footprint to the anteromedial femoral footprint (n = 10) and testing repeated. The medial or lateral meniscus was sectioned and the examination repeated. The other meniscus was sectioned and the examination subsequently repeated. RESULTS Lateral compartment translation during the pivot shift was significantly reduced following anatomic ACL reconstruction. In the nonanatomic group, lateral compartment translation increased by 9.1 mm (P < 0.001) after unicomparmental meniscectomy and 11.5 mm (P < 0.001) after bicompartmental meniscectomy. In the anatomic reconstruction group, lateral compartment translation increased by 7.6 mm (P < 0.001) after bicompartmental meniscectomy. CONCLUSION With isolated ACL injury, anatomic single-bundle ACL reconstruction controlled the pivot shift during time zero testing. However, significant increases in lateral compartment translation during the pivot shift are seen following bicompartmental meniscectomy. Nonanatomic ACL reconstruction was less effective in controlling the pivot shift at time zero testing, and significant increases in lateral compartment translation during the pivot shift were seen following both unicomparmental and bicompartmental meniscectomy.
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A mechanized and standardized pivot shifter: technical description and first evaluation. Knee Surg Sports Traumatol Arthrosc 2011; 19:707-11. [PMID: 20953761 DOI: 10.1007/s00167-010-1289-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 09/21/2010] [Indexed: 01/30/2023]
Abstract
PURPOSE The pivot shift test (PST) is a complex, multiplanar maneuver used to assess rotatory instability of the knee. The grading is subjective due to the broad range of examination techniques and lack of tibiofemoral motion quantification. The goal of this study was to develop and evaluate a mechanized device for quantitative assessment of the PST. METHODS We constructed a mechanized pivot shifter (MPS). In five cadaveric hip-to-toes specimens, the anterior cruciate ligament was resected. We used a surgical navigation system for acquisition of the tibiofemoral motion path during the PST. Two sets of measurements were obtained for the MPS and for two examiners performing the manual technique. RESULTS Mean lateral compartment translation magnitudes for each MPS measurement were 13.5 mm (σ = 6.7) and 13.6 mm (σ = 6.7). For examiner 1, 14.9 mm (σ = 6.5) and 15.7 mm (σ = 6.3). For examiner 2, 16.9 mm (σ = 6.3) and 16.1 mm (σ = 5.2). Differences were not significant (n.s.). The MPS had narrower limits of agreement than both examiner 1 and examiner 2. CONCLUSION The MPS demonstrated no significant differences in the tibiofemoral translation magnitudes compared to the manual technique. It resulted in better test-retest reliability and more consistent measurements of tibiofemoral translation when compared to manual PST. The high repeatability factor conferred by the MPS is a clinical advantage.
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Calcaneal Osteotomy Preoperative Planning System with 3D Full-Sized Computer-Assisted Technology. J Med Syst 2010; 35:755-63. [DOI: 10.1007/s10916-010-9465-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 11/18/2009] [Indexed: 11/30/2022]
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An application of principal component analysis to the clavicle and clavicle fixation devices. J Orthop Surg Res 2010; 5:21. [PMID: 20346123 PMCID: PMC3003245 DOI: 10.1186/1749-799x-5-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 03/26/2010] [Indexed: 11/24/2022] Open
Abstract
Background Principal component analysis (PCA) enables the building of statistical shape models of bones and joints. This has been used in conjunction with computer assisted surgery in the past. However, PCA of the clavicle has not been performed. Using PCA, we present a novel method that examines the major modes of size and three-dimensional shape variation in male and female clavicles and suggests a method of grouping the clavicle into size and shape categories. Materials and methods Twenty-one high-resolution computerized tomography scans of the clavicle were reconstructed and analyzed using a specifically developed statistical software package. After performing statistical shape analysis, PCA was applied to study the factors that account for anatomical variation. Results The first principal component representing size accounted for 70.5 percent of anatomical variation. The addition of a further three principal components accounted for almost 87 percent. Using statistical shape analysis, clavicles in males have a greater lateral depth and are longer, wider and thicker than in females. However, the sternal angle in females is larger than in males. PCA confirmed these differences between genders but also noted that men exhibit greater variance and classified clavicles into five morphological groups. Discussion And Conclusions This unique approach is the first that standardizes a clavicular orientation. It provides information that is useful to both, the biomedical engineer and clinician. Other applications include implant design with regard to modifying current or designing future clavicle fixation devices. Our findings support the need for further development of clavicle fixation devices and the questioning of whether gender-specific devices are necessary.
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Matsumoto T, Tsumura N, Kurosaka M, Muratsu H, Kuroda R, Ishimoto K, Tsujimoto K, Shiba R, Yoshiya S. Prosthetic alignment and sizing in computer-assisted total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2004; 28:282-5. [PMID: 15316675 PMCID: PMC3456974 DOI: 10.1007/s00264-004-0562-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Accepted: 03/31/2004] [Indexed: 10/26/2022]
Abstract
We implanted 60 posterior stabilized total knee prostheses (P.F.C. Sigma, DePuy, Warsaw, USA). In 30 cases, we used a CT-free navigation system (Vector Vision, Brain LAB, Heimstetten, Germany), and in 30 matched-paired controls, we used a conventional manual implantation. We compared postoperative long-leg radiographs in the two groups. The results revealed a significant difference in favor of navigation. In addition, we compared the preoperative anteroposterior dimension of the femoral condyle with the postoperative value. While there were no significant differences in the preoperative anteroposterior dimension of the femoral condyle between the two groups, the postoperative value in the navigation group was significantly larger than that of the preoperative value. Therefore, surgeons using navigation systems should guard against the possibility of oversizing when determining the size of the femoral component.
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Affiliation(s)
- Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Kobe, Japan.
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