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Sheridan GA, Abdelmalek M, Howard LC, Neufeld ME, Masri BA, Garbuz DS. Navigated Versus Conventional Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Prospective Randomized Controlled Trials. J Orthop 2024; 50:99-110. [PMID: 38187368 PMCID: PMC10770435 DOI: 10.1016/j.jor.2023.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background Recent evidence on the cost-effectiveness of technology in total knee arthroplasty (TKA) demonstrated that navigated computer-assisted methods (N-TKA) is likely to be most cost-effective in the clinical setting. The aim of the current meta-analysis is to compare radiographic, clinical and functional outcomes between conventional TKA (C-TKA) and N-TKA methods. Methods All prospective randomized controlled trials (pRCTs) comparing primary TKA performed using C-TKA and N-TKA techniques were eligible for inclusion. Radiographic outcomes included postoperative coronal, sagittal and axial component alignment. Clinical outcomes included all-cause revision and aseptic revision. Functional outcomes were analyzed when reported. A random-effects meta-analysis of all available cases was performed. This allowed for all missing data. Results Normal coronal mechanical alignment of the tibial (p < 0.001) and femoral (p = 0.001) components was achieved more frequently with N-TKA. Normal sagittal mechanical alignment of the tibial component was achieved significantly more with N-TKA (p < 0.010). There was no difference in short-term clinical survivorship (all-cause, p = 0.649; aseptic, p = 0.79) or in functional outcomes reported between groups. There was a clinically significant reduction in the mean C-TKA operative time (87 min, σ = 16.6, 95% CI 76.4-98.8) compared N-TKA (97.6 min, σ = 16.9, 95% CI 86.2-109.1) (p = 0.17). Conclusion Navigated TKA achieves superior radiographic alignment for femoral and tibial components in both the coronal and sagittal plane. Operative times are 10 min longer in the N-TKA group. Functional outcomes are similar between navigated and conventional groups. Clinical outcomes reported in Level I studies are limited to short-term follow-up so future prospective studies are required.
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Lee SS, Chang MJ, Cho JH, Oh J, Moon YW. No differences in long-term clinical outcomes and survival rate of navigation-assisted versus conventional primary mobile-bearing total knee arthroplasty: A minimum 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 2024; 32:445-453. [PMID: 38270291 DOI: 10.1002/ksa.12060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE This study aimed to compare long-term clinical and radiographic outcomes and survival rates between navigation-assisted (NAV) total knee arthroplasty (TKA) and conventional (CON) TKA using a mobile-bearing insert. METHODS From May 2008 to December 2009, 45 and 63 mobile-bearing TKA patients were enroled in the CON- and NAV-TKA groups with 146.8 months follow-up, respectively. Clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index and Knee Society Scores), radiographic outcomes (hip-knee-ankle [HKA], lateral distal femoral, medial proximal tibial, γ, and δ angles), and survivorship were compared between both groups. RESULTS The number of HKA angle outliers (more than 3 degrees or less than -3 degree) was significantly lower in the NAV-TKA group (24.4% vs. 9.5%, p = 0.036) than in the CON-TKA group. However, long-term clinical outcomes were similar between both groups. The cumulative survival rate (best-case scenario) was 98.3% in the CON-TKA group and 97.5% in the NAV-TKA group, with no significant difference between the groups (p = 0.883). CONCLUSION Long-term clinical outcomes and survival rates were similar between the two groups despite fewer outliers of postoperative lower-limb alignment in the NAV-TKA group. Excellent survival rates were observed in both groups using mobile-bearing inserts. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Ho Cho
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, South Korea
| | - Juyong Oh
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Hazratwala K, Gouk C, Wilkinson MPR, O'Callaghan WB. Navigated functional alignment total knee arthroplasty achieves reliable, reproducible and accurate results with high patient satisfaction. Knee Surg Sports Traumatol Arthrosc 2023; 31:3861-3870. [PMID: 36917248 PMCID: PMC10435654 DOI: 10.1007/s00167-023-07327-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/26/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE The decision on which technique to perform a total knee arthroplasty (TKA) has become more complicated over the last decade. Perceived limitations of mechanical alignment (MA) and kinematic alignment (KA) have led to the development of the functional alignment (FA) philosophy. This study aims to report the 2-year results of an initial patient cohort in terms of revision rate, PROMs and complications for Computer Aided Surgery (CAS) Navigated FA TKA. METHODS This paper reports a single surgeon's outcomes of 165 consecutive CAS FA TKAs. The final follow-up was 24 months. Pre-operative and post-operative patient-reported outcome measures, WOMAC and KSS, and intra-operative CAS data, including alignment, kinematic curves, and gaps, are reported. Stress kinematic curves were analysed for correlation with CAS final alignment and CAS final alignment with radiographic long-leg alignment. Pre- and post-operative CPAK and knee phenotypes were recorded. Three different types of prostheses from two manufacturers were used, and outcomes were compared. Soft tissue releases, revision and complication data are also reported. RESULTS Mean pre-operative WOMAC was 48.8 and 1.2 at the time of the final follow-up. KSS was 48.8 and 93.7, respectively. Pre- and post-operative range of motion was 118.6° and 120.1°, respectively. Pre-operative and final kinematic curve prediction had an accuracy of 91.8%. CAS data pre-operative stress alignment and final alignment strongly correlate in extension and flexion, r = 0.926 and 0.856, p < 0.001. No statistical outcome difference was detected between the types of prostheses. 14.5% of patients required soft tissue release, with the lateral release (50%) and posterior capsule (29%) being the most common. CONCLUSION CAS FA TKA in this cohort proved to be a predictable, reliable, and reproducible technique with acceptable short-term revision rates and high PROMs. FA can account for extremes in individual patient bony morphology and achieve desired gap and kinematic targets with soft tissue releases required in only 14.5% of patients. LEVEL OF EVIDENCE IV (retrospective case series review).
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Affiliation(s)
- Kaushik Hazratwala
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner Street, Pimlico, Townsville, QLD, 4812, Australia.
- Mater Health Services North Queensland Ltd, 21-37 Fulham Road, Pimlico, Townsville, QLD, 4812, Australia.
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, Townsville, QLD, 4814, Australia.
- James Cook University, 1 James Cook Drive, Townsville, QLD, 4811, Australia.
| | - Conor Gouk
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner Street, Pimlico, Townsville, QLD, 4812, Australia
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, Townsville, QLD, 4814, Australia
- Cairn Base Hospital, 165 Esplanade, Cairns, QLD, 4870, Australia
- James Cook University, 1 James Cook Drive, Townsville, QLD, 4811, Australia
| | - Matthew P R Wilkinson
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner Street, Pimlico, Townsville, QLD, 4812, Australia
- University of Tasmania, Churchill Avenue, Hobart, TAS, 7005, Australia
| | - William B O'Callaghan
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner Street, Pimlico, Townsville, QLD, 4812, Australia
- Mater Health Services North Queensland Ltd, 21-37 Fulham Road, Pimlico, Townsville, QLD, 4812, Australia
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, Townsville, QLD, 4814, Australia
- Cairn Base Hospital, 165 Esplanade, Cairns, QLD, 4870, Australia
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Yen SH, Lin PC, Wang JW. Comparison of the radiographic outcomes and total blood loss between pinless navigation and conventional method in minimally invasive total knee arthroplasty. J Orthop Surg Res 2023; 18:254. [PMID: 36978115 PMCID: PMC10043515 DOI: 10.1186/s13018-023-03534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/12/2023] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Computer-assisted surgical navigation has been used in total knee arthroplasty (TKA) procedures for years trying to the accuracy of prosthesis placement. We conducted this prospective randomized clinical trial to compare the accuracy of the radiographic parameters of the prosthesis, total blood loss (TBL), and related complications, between a new pinless navigation system (Stryker OrthoMap Express Knee Navigation) and conventional method in patients undergoing minimally invasive (MIS) TKA procedures.
Patient and methods
A consecutive series of 100 patients underwent unilateral primary TKA were randomly assigned into two groups: navigation group and convention group. The radiographic parameters of the knee implant and the alignment of lower limb were measured at 3 months after surgery. TBL was calculated according to Nadler’s method. The duplex ultrasonography of both lower limbs was performed in all patients to detect the presence of deep-vein thrombosis (DVT).
Results
Totally, 94 patients have completed the radiographic measures. Only the coronal femoral component angle in the navigation group (89.12° ± 1.83°) had significant differences from that in the convention group (90.09° ± 2.18°) (p = 0.022). There were no differences in the rate of outliers. The mean TBL in the navigation group was 841 ± 267 mL, which was similar to that in the convention group at 860 ± 266 mL (p = 0.721). Postoperative DVT risk did not differ between the two groups (2% vs. 0%, p = 0.315).
Conclusion
This pinless navigation TKA showed a comparable acceptable alignment compared with conventional MIS-TKA. There were no differences regarding postoperative TBL between the two groups.
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Navigated and Robot-Assisted Technology in Total Knee Arthroplasty: Do Outcome Differences Achieve Minimal Clinically Important Difference? J Arthroplasty 2022; 37:1562-1569. [PMID: 35367335 DOI: 10.1016/j.arth.2022.03.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 03/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In total knee arthroplasty (TKA), computer-assisted navigation (N-TKA) and robotic-assisted methods (RA-TKA) are intended to increase precision of mechanical and component alignment. However, the clinical significance of published patient-reported outcome measure (PROM) differences in comparison to conventional TKA (C-TKA) is unknown. METHODS A systematic review was performed to identify all studies reporting perioperative PROMs for either primary N-TKA or RA-TKA with a C-TKA comparison cohort with a minimum 1-year follow-up. Relative improvements in PROMs for the two cohorts were compared to published minimal clinically important difference (MCID) values. RESULTS After systematic review, 21 studies (N = 3,214) reporting on N-TKA and eight studies (N = 1,529) reporting on RA-TKA met inclusion criteria. Eighteen of 20 studies (90%) reported improved radiographic outcomes with N-TKA relative to C-TKA; five of five studies reported improved radiographic outcomes with RA-TKA relative to C-TKA. Five of 21 studies (24%) reported statistically significant greater improvements in clinical PROMs for N-TKA relative to C-TKA, whereas only two (10%) achieved clinical significance relative to MCID on a secondary analysis. One of 8 studies (13%) reported statistically significant greater improvements in PROMs for RA-TKA relative to C-TKA, whereas none achieved clinical significance relative to MCID on a secondary analysis. No studies reported a significant difference in revision rates. CONCLUSION While most studies comparing RA-TKA and N-TKA with C-TKA demonstrate improved radiographic alignment outcomes, a minority of studies reported PROM differences that achieve clinical significance. Future studies should report data and be interpreted in the context of clinical significance to establish patient and surgeon expectations for emerging technologies.
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Herndon CL, McCormick KL, Gazgalis A, Bixby EC, Levitsky MM, Neuwirth AL. Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review. Arthroplast Today 2021; 11:239-251. [PMID: 34692962 PMCID: PMC8517286 DOI: 10.1016/j.artd.2021.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/08/2021] [Accepted: 08/29/2021] [Indexed: 12/16/2022] Open
Abstract
Background The Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the P value in evaluation of randomized clinical trial (RCT) outcomes. These metrics are defined as the number of patients needed to change the significance level of an outcome. The purpose of this study was to calculate these metrics for published RCTs in total joint arthroplasty (TJA). Methods We performed a systematic review of RCTs in TJA over the last decade. For each study, we calculated the FI (for statistically significant outcomes) or Reverse Fragility Index (for nonstatistically significant outcomes) for all dichotomous, categorical outcomes. We also used the Pearson correlation coefficient to evaluate publication-level variables. Results We included 104 studies with 473 outcomes; 92 were significant, and 381 were nonstatistically significant. The median FI was 6 overall and 4 and 7 for significant and nonsignificant outcomes, respectively. There was a positive correlation between FI and sample size (R = 0.14, P = .002) and between FI and P values (R = 0.197, P = .000012). Conclusions This study is the largest evaluation of FI in orthopedics literature to date. We found a median FI that was comparable to or higher than FIs calculated in other orthopedic subspecialties. Although the mean and median FIs were greater than the 2 recommended by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines to demonstrate strong evidence, a large percentage of studies have an FI < 2. This suggests that the TJA literature is on par or slightly better than other subspecialties, but improvements must be made. Level of Evidence Level I; Systematic Review.
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Affiliation(s)
- Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Kyle L McCormick
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Anastasia Gazgalis
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Elise C Bixby
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew M Levitsky
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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7
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Ekhtiari S, Gazendam AM, Nucci NW, Kruse CC, Bhandari M. The Fragility of Statistically Significant Findings From Randomized Controlled Trials in Hip and Knee Arthroplasty. J Arthroplasty 2021; 36:2211-2218.e1. [PMID: 33390336 DOI: 10.1016/j.arth.2020.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Fragility Index (FI) is a method for evaluating the robustness of statistically significant findings from randomized controlled trials (RCTs) beyond the P value in trials with dichotomous outcomes. The FI is defined as the number of patients in one arm of a trial that would have to have a different outcome to change the results of the trial from statistically significant to nonsignificant. This review assessed the FI in arthroplasty RCTs. METHODS A systematic search was conducted in MEDLINE, Embase, and Web of Science for RCTs related to primary total joint arthroplasty (TJA) from 2010 to 2020. Trials with a statistically significant dichotomous primary outcome were included. The FI was calculated using Fisher's exact test to determine how many events would need to be reversed to change a study from statistically significant to nonsignificant. RESULTS A total of 34 RCTs were included. The median sample size was 103 patients (range 24-791). The median FI was 1 (range 0-45), meaning that reversing the outcome of just one patient in either treatment group of each trial would change it from a significant to a nonsignificant result. CONCLUSION Hip and knee arthroplasty RCTs with statistically significant dichotomous outcomes in TJA are fragile. The median FI in TJA is lower than the FI in any of the other previously reported orthopedic subspecialties. Fragility is another reason to be cautious when conducting or interpreting small trials, and to continue to strive toward large trials to answer important questions in TJA. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aaron M Gazendam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicholas W Nucci
- Northern Ontario School of Medicine, Department of Medicine, Lakehead University, Thunder Bay, Ontario, Canada
| | - Colin C Kruse
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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8
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Keuntje-Perka S, von Roth P, Worlicek M, Koch M, Alt V, Kaiser M. Pinless Navigation in Unicompartmental Knee Arthroplasty. J Clin Med 2021; 10:jcm10112422. [PMID: 34070715 PMCID: PMC8198384 DOI: 10.3390/jcm10112422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose: In contrast to total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) is a true resurfacing procedure, as none of the ligaments are replaced or released, and the pre-arthritic leg alignment is the major goal. As such, the alignment of the tibial component plays a crucial role in postoperative knee function and long-term survival. Pinless navigation has shown reliable results in total knee arthroplasty. To the best of our knowledge, the use of pinless navigation has not been investigated for UKA. Therefore, the present study investigated whether implantation of the tibial component in 3° varus, which is closer to the anatomical axis, is feasible with a pinless optical navigation system. Methods: 60 patients with the diagnosis of an unicompartmental arthritis, were eligible for UKA and treated with implantation in 3° varus alignment of the tibial component. Two groups were established. In the treatment group the tibial component was aligned using a pinless navigation technique. In the control group, a conventional extramedullary alignment guide was used. A clinical and radiographic follow up took place within 1 year of operation. Results: 57 Patients were eligible for analysis. No clinical incidents were noted in the follow up period. The desired target value, the position of the tibial component, was accurately achieved with an average of 3° medial inclination using the pinless navigation as well as using the conventional technique. Mean incision to suture time was negligible between the two techniques. The mean suture time was 43.2 min with pinless navigation and 42.7 min with the conventional technique. Conclusions: With pinless navigation in UKA, a method was presented that made it possible to achieve sled prosthesis alignment at the level of a high-volume surgeon. These results were achieved with an irrelevant increase of surgical time and without placement of pins.
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Affiliation(s)
- Sarah Keuntje-Perka
- Sporthopaedicum Straubing, Medical Care Center, 94135 Straubing, Germany; (S.K.-P.); (P.v.R.); (M.K.)
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.K.); (V.A.)
| | - Philipp von Roth
- Sporthopaedicum Straubing, Medical Care Center, 94135 Straubing, Germany; (S.K.-P.); (P.v.R.); (M.K.)
| | - Michael Worlicek
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.K.); (V.A.)
- Correspondence:
| | - Matthias Koch
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.K.); (V.A.)
| | - Volker Alt
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.K.); (V.A.)
| | - Moritz Kaiser
- Sporthopaedicum Straubing, Medical Care Center, 94135 Straubing, Germany; (S.K.-P.); (P.v.R.); (M.K.)
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.K.); (V.A.)
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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Xu X, Liu P, Yuan Z, Wang D, Lu Q, Zhang Z, Jiang Q, Shi D. Comparison of a novel handheld accelerometer-based navigation system and conventional instrument for performing distal femoral resection in total knee arthroplasty: a randomized controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:659. [PMID: 31930060 DOI: 10.21037/atm.2019.10.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This prospective study aimed to compare the efficacy of a novel, hand-held, accelerometer-based navigation system (i-JOIN knee navigation system) for distal femoral resection in total knee arthroplasty (TKA) with conventional instrument. Methods A multi-center, double-blinded, randomized controlled trial (RCT) was conducted. A total of 79 consecutive patients scheduled for primary TKA were enrolled and divided into navigation group (39 patients) and conventional group (40 patients). Post-operative mechanical and component position were evaluated through full-leg weight bearing X-ray. Pre-operatively and 1 week post-operatively, adverse events were recorded. Intraoperative surgical time and blood loss were also recorded. Results The mean outlier of 180° neutral mechanical axis was 1.60° (SD 1.11°) in navigation group and 2.30° (SD 2.06°) in conventional group (P=0.0917). Thirty-eight patients (97.4%) in navigation group and 35 patients (87.5%) in conventional group had an alignment which was ≤3°away from the neutral mechanical axis (P=0.2007). α angle between the navigation group and conventional group was not statistically different (89.81° vs. 89.76°, P>0.05), as well as adverse events rate post-operatively. The operative time of navigation group was significantly longer than that of control group (114.54±35.34 vs. 100.33±28.38 min, P=0.0493), whereas the intraoperative blood loss was not significantly different. Conclusions i-JOIN knee navigation system had equivalent results for distal femoral resection in TKA compared with the conventional technique.
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Affiliation(s)
- Xingquan Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.,Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing 210093, China
| | - Peilai Liu
- Qilu Hospital of Shandong University, Jinan 250012, China
| | - Zhenfeng Yuan
- Liaocheng People's Hospital, Liaocheng 252000, China
| | - Dawei Wang
- Liaocheng People's Hospital, Liaocheng 252000, China
| | - Qunshan Lu
- Qilu Hospital of Shandong University, Jinan 250012, China
| | - Zhe Zhang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.,Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing 210093, China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.,Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing 210093, China
| | - Dongquan Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.,Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing 210093, China
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11
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Moo IH, Chen JYQ, Chau DHH, Tan SW, Lau ACK, Teo YS. Similar radiological results with accelerometer-based navigation versus conventional technique in total knee arthroplasty. J Orthop Surg (Hong Kong) 2019; 26:2309499018772374. [PMID: 29747561 DOI: 10.1177/2309499018772374] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Zimmer iASSIST system is an accelerometer-based, portable navigation device for total knee arthroplasty (TKA) that does not require the use of a large console for alignment feedback as required in computer-assisted surgery. The purpose of this study was to determine the accuracy of the accelerometer-based system in component positioning and overall mechanical alignment. METHODS Two groups of 30 patients each with primary osteoarthritis underwent TKA using either conventional method or Zimmer iASSIST navigation in 2013 was retrospectively studied. Patients were matched according to body mass index (BMI), gender and age. A senior arthroplasty surgeon performed all the operation using the same surgical approach. Perioperative and post-operative regimens were the same. All patients had standardized radiographs performed post-operatively to determine the lower limb mechanical alignment and component placement. RESULTS There was no difference between the two groups for age, BMI, gender, side of operated knee and preoperative mechanical axis ( p > 0.05). There was no difference in the proportion of outliers for mechanical axis ( p = 0.38), coronal femoral angle ( p = 0.50), coronal tibia angle ( p = 0.11), sagittal femoral angle ( p = 0.28) and sagittal tibia angle ( p = 0.33). The duration of surgery, post-operative drop in haemoglobin level and transfusion incidence did not show statistically significant differences between the two groups ( p > 0.05). CONCLUSIONS Our article showed that iASSIST was safe and remains a useful tool to restore mechanical axis. However, our data demonstrated no difference in lower limb alignment and component placement between the TKA that used accelerometer-based system and those that underwent conventional method.
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Affiliation(s)
- Ing How Moo
- Department of Orthopaedics Surgery, Changi General Hospital, Singapore, Singapore
| | | | | | - See Wei Tan
- Department of Orthopaedics Surgery, Changi General Hospital, Singapore, Singapore
| | | | - Yee Sze Teo
- Department of Orthopaedics Surgery, Changi General Hospital, Singapore, Singapore
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12
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Ulivi M, Orlandini LC, Meroni V, Castoldi D, Lombardo MDM, Peretti GM. Intraoperative validation of bone cut accuracy of a pinless smart touch-screen navigation system device in total knee arthroplasty. Int J Med Robot 2019; 15:e2030. [PMID: 31379057 DOI: 10.1002/rcs.2030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/19/2019] [Accepted: 07/28/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE Primary objective in most of the published literature on computer-assisted total knee arthroplasty (TKA) has so far been the comparison of axial alignment and components position, obtained either through navigation systems or through conventional instrumentation. We have found no studies aimed at assessing the intraoperative reliability of a navigation system in relation to bone cuts height. Aim of our study was therefore to establish bone cut accuracy of a pinless navigation system. METHODS From January 2014 to February 2016, 44 consecutive patients requiring total knee replacement (TKR) were enrolled in a prospective study. Primary end point of the study was to assess the accuracy of the DASH iPOD TOUCH Navigation System (Brainlab AG, Feldkirchen, Germany) by measuring the real thickness of both tibial and femoral osteotomies. We compared the data indicated by the navigation system with the intraoperative anatomical measurements done with the aid of a caliper. In addition, the radiographic alignment was compared with the data derived from the navigator. RESULTS The device proved to be precise. Differences between the two methods of measurement are distributed over a millimeter range. Radiological measurements showed that 95.5% of tibial components were within the range of 3° varus/valgus; same results were obtained by the navigation system; instead, 90.1% of femoral components were within the range of 3° varus/valgus based on the radiological measurement, whereas according to the navigation system, 86.4% were in this range. CONCLUSIONS The DASH iPOD TOUCH Navigation System is a precise and reliable instrument to assist in TKA navigation.
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Affiliation(s)
| | | | | | - Daniele Castoldi
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | | | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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13
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Loh B, Chen JY, Yew AKS, Pang HN, Tay DKJ, Chia SL, Lo NN, Yeo SJ. The accuracy of a hand-held navigation system in total knee arthroplasty. Arch Orthop Trauma Surg 2017; 137:381-386. [PMID: 28120025 DOI: 10.1007/s00402-016-2612-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study aims to evaluate the effectiveness of a new hand-held navigation system. The authors of this study hypothesize that this navigation system will improve overall lower limb alignment and implant placement without causing a delay in surgery. PATIENTS AND METHODS Two hundred consecutive patients diagnosed with tricompartmental osteoarthritis and underwent total knee arthroplasty by a senior surgeon were included in this study. One hundred patients underwent TKA using the hand-held navigation system, while the other 100 patients underwent TKA using the conventional technique. The primary outcomes of this study were the overall alignment of the lower limb and the position of the components. This was determined radiologically using the: (1) Hip-Knee-Ankle angle (HKA) for lower limb alignment; (2) Coronal Femoral-Component angle (CFA); and (3) Coronal Tibia-Component angle (CTA) for component position. Normal alignment was taken as 180° ± 3° for the HKA and 90° ± 3° for both the CFA and CTA. RESULTS For the CFA, the proportion of outliers was 7 and 17% in the hand-held navigation and conventional group, respectively (p = 0.030). For the HKA and CTA, there was no difference in the proportion of outliers between the two groups. The duration of surgery was 73 ± 9 min and 87 ± 15 min in the hand-held navigation and conventional group, respectively (p < 0.001). CONCLUSION This hand-held navigation system is an effective intraoperative tool for reducing the proportion of outliers for femoral implant placement as well as the duration of surgery. The authors conclude that it can be considered for use to check femoral implant placement intra-operatively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Bryan Loh
- Department of Orthopaedic Surgery, Singapore General Hosptial, The Academia, 20 College Road, Singapore, 169856, Singapore.
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hosptial, The Academia, 20 College Road, Singapore, 169856, Singapore.
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hosptial, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hosptial, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hosptial, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hosptial, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hosptial, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hosptial, The Academia, 20 College Road, Singapore, 169856, Singapore
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Jiang L, Chen JY, Chong HC, Chia SL, Lo NN, Yeo SJ. Clinical outcomes of computer-assisted total knee arthroplasty using pinless navigation. J Orthop Surg (Hong Kong) 2017; 25:2309499016684319. [PMID: 28117632 DOI: 10.1177/2309499016684319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aims to evaluate the 2-year post-operative clinical outcomes of patients undergoing total knee arthroplasty (TKA) with computer-assisted surgery (CAS) using the pinless BrainLAB® VectorVision® Knee 2.5 Navigation System versus standard CAS. A retrospective case-control study of 200 patients who underwent TKA with CAS from 2008 to 2012 was conducted. Patients in the pinless arm underwent a shorter duration of surgery compared to the standard CAS arm with 72 ± 13 min and 83 ± 11 min, respectively ( p < 0.001), with improvement in Oxford Knee Score from 34 ± 8 to 18 ± 5 and 34 ± 9 to 18 ± 5, respectively, without statistically significant differences in clinical outcomes at 2 years.
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Affiliation(s)
- Lei Jiang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hwei-Chi Chong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Liow MHL, Goh GSH, Pang HN, Tay DKJ, Lo NN, Yeo SJ. Computer-assisted stereotaxic navigation improves the accuracy of mechanical alignment and component positioning in total knee arthroplasty. Arch Orthop Trauma Surg 2016; 136:1173-80. [PMID: 27349233 DOI: 10.1007/s00402-016-2483-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study reports on a novel computer-assisted stereotaxic navigation (CASN) system that attempts to combine the accuracy of computer navigation with familiarity of conventional methods. We hypothesize that CASN would improve mechanical alignment and component positioning when compared to conventional instrumentation. MATERIALS AND METHODS 145 patients (192 knees) retrospectively matched for age, BMI, gender and pre-operative scores, underwent total knee arthroplasty (TKA) using CASN (n = 92) or conventional instrumentation (n = 100). Pre- and post-operative radiological alignment [Acceptable ranges: mechanical axis (MA) 0° ± 3°, coronal femoral-component angle (CFA) and coronal tibia-component angle (CTA) 90° ± 3°] and clinical outcomes (Knee Society Scores, Oxford Knee Score and Short Form-36) at 6 months were examined. RESULTS The CASN group had significantly improved mean MA (1.9° ± 1.4°, versus 2.8° ± 2.0° in the conventional group, p = 0.001), CFA (1.6° ± 1.3°, versus 2.1° ± 1.5° in the conventional group, p = 0.035) and CTA (1.6° ± 1.2°, versus 2.1° ± 1.5° in the conventional group, p = 0.024). 91.3 % of knees in the CASN group were within 3° of a neutral mechanical axis, versus 74 % in the conventional group (p < 0.001). The duration of surgery was significantly longer in the CASN group (84 ± 22 vs 73 ± 15 min, p = 0.001) and cost an additional USD 850 per operation. There were no significant differences in clinical outcomes or satisfaction rates at 6 months post-operatively (p > 0.05). CONCLUSIONS CASN improved TKA mechanical alignment and component positioning, however, resulted in longer and costlier surgery with no benefits in short-term functional outcomes, despite providing familiarity to surgeons accustomed to conventional instrumentation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore. .,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, 02114, Massachusetts, USA.
| | - Graham Seow-Hng Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Hee-Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
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