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Robb H, Scrimgeour G, Boshier P, Przedlacka A, Balyasnikova S, Brown G, Bello F, Kontovounisios C. The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review. Surg Endosc 2022; 36:5907-5920. [PMID: 35277766 PMCID: PMC9283150 DOI: 10.1007/s00464-022-09176-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/24/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND 3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption. Therefore, the authors undertook a scoping review to clarify the current and future roles of 3D modelling in oesophagogastric surgery, highlighting gaps in the literature and implications for future research. METHODS A scoping review protocol was developed using a comprehensive search strategy based on internationally accepted guidelines and tailored for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). This is available through the Open Science Framework (osf.io/ta789) and was published in a peer-reviewed journal. Included studies underwent screening and full text review before inclusion. A thematic analysis was performed using pre-determined overarching themes: (i) surgical training and education, (ii) patient education and engagement, and (iii) operative planning and surgical practice. Where applicable, subthemes were generated. RESULTS A total of 56 papers were included. Most research was low-grade with 88% (n = 49) of publications at or below level III evidence. No randomised control trials or systematic reviews were found. Most literature (86%, n = 48) explored 3D reconstruction within operative planning. These were divided into subthemes of pre-operative (77%, n = 43) and intra-operative guidance (9%, n = 5). Few papers reported on surgical training and education (14%, n = 8), and were evenly subcategorised into virtual reality simulation (7%, n = 4) and anatomical teaching (7%, n = 4). No studies utilising 3D modelling for patient engagement and education were found. CONCLUSION The use of 3D reconstruction is in its infancy in oesophagogastric surgery. The quality of evidence is low and key themes, such as patient engagement and education, remain unexplored. Without high quality research evaluating the application and benefits of 3D modelling, oesophagogastric surgery may be left behind.
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Affiliation(s)
- Henry Robb
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Piers Boshier
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Anna Przedlacka
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Gina Brown
- Imperial College London, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Christos Kontovounisios
- Imperial College London, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
- Chelsea Westminster NHS Foundation Trust, London, UK.
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Dong Z, Li Y, Tian H. [Research progress on comparison of the application effects between personal specific instrumentation and computer-assisted navigation surgery in total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1492-1498. [PMID: 34779179 DOI: 10.7507/1002-1892.202104048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the application effects between personal specific instrumentation (PSI) and computer-assisted navigation surgery (CAS) in total knee arthroplasty (TKA). Methods The literature comparing the application effects of PSI and CAS in TKA in recent years was widely consulted, and the difference between PSI-TKA and CAS-TKA in operation time, lower limb alignment, blood loss, and knee function were compared. Results Compared to CAS-TKA, PSI-TKA simplifies operation procedures and shortens operation time but probably has worse lower limb alignment. It is still controversial in comparison of perioperative blood loss and knee function between two techniques. Conclusion PSI-TKA and CAS-TKA both have advantages and disadvantages, and their differences need to be confirmed by further high-quality clinical trial.
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Affiliation(s)
- Ziyang Dong
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, P.R.China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, P.R.China
| | - Yang Li
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, P.R.China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, P.R.China
| | - Hua Tian
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, P.R.China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, P.R.China
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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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Computer navigation for total knee arthroplasty achieves better postoperative alignment compared to conventional and patient-specific instrumentation in a low-volume setting. Orthop Traumatol Surg Res 2018; 104:971-975. [PMID: 29704634 DOI: 10.1016/j.otsr.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Procedure volume is an important determinant of total knee arthroplasty (TKA) outcomes. We aimed to determine whether computer navigation or patient-specific instrumentation (PSI) would improve postoperative alignment in a low-volume setting. HYPOTHESIS PSI for TKA achieves better limb and implant alignment compared to conventional TKA and to computer navigated TKA. MATERIALS AND METHODS This is a retrospective cohort study of 385 primary TKAs (Women=59%. Mean age=67years. Mean BMI=30.1kg/m2), which were performed using conventional instrumentation (n=117; 30%), computer navigation (n=209; 54%), or patient-specific instrumentation (n=59; 15%) in a low-volume center (<50 TKAs/year). The risk of postoperative leg and implant mechanical alignment outliers in the coronal plane (>3° from neutral), average alignment and operation time were assessed. RESULTS The risk of postoperative mechanical alignment outliers (>3°) was reduced by 89% in the navigated group (4% outliers) compared to the conventional group (35%) (RR=0.11; p<0.0001). No significant improvement was observed in the PSI group (27%) (RR=0.91; p=0.772). The risk of postoperative femoral component coronal alignment outliers was reduced by 63% in the navigated group (11%) compared to the conventional group (31%) (RR=0.37; p=0.018). No significant reduction in outliers was observed in the PSI group (32%) (RR=1.08; p=0.816). There was a reduction in the risk of tibial component coronal malalignment of 66% in the navigated group (5%) compared to the conventional group (13%) (RR=0.33; p=0.070). There was a two-fold increase in the risk of tibial component alignment outliers in the PSI group (29%) (RR=1.94; p=0.110). DISCUSSION Computer navigation improved postoperative alignment in TKA. No evidence of improved alignment was seen with patient-specific instrumentation. The routine use of patient-specific instrumentation in low-volume centers is not supported by the currently available data. TYPE OF STUDY Retrospective cohort study. Level IV.
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No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation. Knee Surg Sports Traumatol Arthrosc 2018; 26:2788-2796. [PMID: 29071356 DOI: 10.1007/s00167-017-4741-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/02/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE AND HYPOTHESIS Patient-specific instrumentation (PSI) uses 3D preoperative imaging to produce individualized cutting blocks specific to patients' anatomy and according to the preoperative plan with the aim to reduce the number of mechanical leg alignment (MLA) outliers, to improve implant positioning and to decrease surgery time. The primary purpose of this study was to investigate the efficacy of a specific PSI in comparison with standard instrumentation (SI) in reducing the number of MLA outliers. It was hypothesized that the number of MLA outliers would be significantly lower in the PSI group. METHODS A multicenter randomized controlled trial was implemented. There were 59 patients in the PSI group and 66 in the SI group. The absolute number of outliers outside the ± 3° target neutral MLA was compared between the groups with a Chi-square test. As secondary outcomes, the Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were compared between the groups preoperatively and at 90-day follow-up. RESULTS There were 15 (26.3%) MLA outliers in the PSI group and 8 (12.3%) in the SI group. The number of outliers was not independent from the group ( X2 (1) = 3.8, p = 0.04; Relative risk = 1.5). Preoperatively, there were no significant differences between the groups when comparing their KSS and KOOS sub-scores. At 90 days postoperatively, the patients in the SI group showed better KOOS-Quality of Life (KOSS-QOL) in comparison with the PSI group (p < 0.0001). CONCLUSION The use of PSI did not significantly reduce the number of MLA outliers in comparison with SI. There were no differences when comparing the achieved mean MLA of both groups. LEVEL OF EVIDENCE Level I, prospective randomized controlled trial.
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Bizzozero P, Bulaid Y, Flecher X, Ollivier M, Parratte S, Argenson JN. Morphometric Tibial Implant Decreases Posterior Overhang Rate and Improves Clinical Outcomes: Results of a Prospective, Matched Controlled Study. J Arthroplasty 2018; 33:2804-2809. [PMID: 29748070 DOI: 10.1016/j.arth.2018.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/04/2018] [Accepted: 04/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tibial implant's positioning in total knee arthroplasty (TKA) requires a compromise between implant's rotation and bone coverage. We hypothesized that morphometric tibial trays (MTTs) would improve implant positioning and clinical outcomes as compared with symmetrical tibial trays. METHODS Thirty-three patients were included prospectively according to the following criteria: age from 18 to 85 years, body mass index <35 kg/m2, and posterostabilized cemented TKA performed for primary arthritis. Patients were matched for age, gender, body mass index, and preoperative international knee society (IKS) scoring system and Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score, in a 1:1 fashion with patients from a prospectively collected database receiving a symmetrical tibial tray TKA. Tibial implant's rotation, bone coverage, and the percentage of patients with a posterior overhang (PO) >3 mm were assessed using computerized tomography. The IKS and the KOOS were compared at 3-year follow-up. RESULTS Bone coverage (90% vs 88%, P = .07) and rotation (mean difference 0.7 ± 3°; P = .69) were not different between the 2 groups. The percentage of patient with a PO was lower in the morphologic group (2/33 vs 14/33, P = .01, odds ratio = 10.3 [2.12-50.24]). Functional scores were superior in the morphometric group: IKS (mean difference 20 ± 21 points; P = .0005), mainly due to a difference in the IKS pain subscore (mean difference 11 ± 15 points; P = .0002). According to the multivariate analysis, an MTT had a positive, independent effect on IKS pain (P = .006) and KOOS pain subscores (P = .03) at the last follow-up. CONCLUSION The use of an MTT in TKA did not modify the tibial implant position in the axial plane; however, it decreased implant's posterior overhang and improved functional scores. The clinical improvement was mainly found on pain scores.
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Affiliation(s)
- Paul Bizzozero
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Yassine Bulaid
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Xavier Flecher
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Sébastien Parratte
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Jean-Noel Argenson
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
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Alvand A, Khan T, Jenkins C, Rees JL, Jackson WF, Dodd CAF, Murray DW, Price AJ. The impact of patient-specific instrumentation on unicompartmental knee arthroplasty: a prospective randomised controlled study. Knee Surg Sports Traumatol Arthrosc 2018; 26:1662-1670. [PMID: 28831554 PMCID: PMC5966491 DOI: 10.1007/s00167-017-4677-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Patient-specific instrumentation (PSI) has been proposed as a means of improving surgical accuracy and ease of implantation during technically challenging procedures such as unicompartmental knee arthroplasty (UKA). The purpose of this prospective randomised controlled trial was to compare the accuracy of implantation and functional outcome of mobile-bearing medial UKAs implanted with and without PSI by experienced UKA surgeons. METHODS Mobile-bearing medial UKAs were implanted in 43 patients using either PSI guides or conventional instrumentation. Intra-operative measurements, meniscal bearing size implanted, and post-operative radiographic analyses were performed to assess component positioning. Functional outcome was determined using the Oxford Knee Score (OKS). RESULTS PSI guides could not be used in three cases due to concerns regarding accuracy and registration onto native anatomy, particularly on the tibial side. In general, similar component alignment and positioning was achieved using the two systems (n.s. for coronal/sagittal alignment and tibial coverage). The PSI group had greater tibial slope (p = 0.029). The control group had a higher number of optimum size meniscal bearing inserted (95 vs 52%; p = 0.001). There were no differences in OKS improvements (n.s). CONCLUSION Component positioning for the two groups was similar for the femur but less accurate on the tibial side using PSI, often with some unnecessarily deep resections of the tibial plateau. Although PSI was comparable to conventional instrumentation based on OKS improvements at 12 months, we continue to use conventional instrumentation for UKA at our institution until further improvements to the PSI guides can be demonstrated. LEVEL OF EVIDENCE Therapeutic, Level I.
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Affiliation(s)
- Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD, UK.
| | - Tanvir Khan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD UK
| | - Cathy Jenkins
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD UK
| | - Jonathan L. Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD UK
| | - William F. Jackson
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD UK
| | | | - David W. Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD UK
| | - Andrew J. Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD UK
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Zhu M, Chen JY, Chong HC, Yew AKS, Foo LSS, Chia SL, Lo NN, Yeo SJ. Outcomes following total knee arthroplasty with CT-based patient-specific instrumentation. Knee Surg Sports Traumatol Arthrosc 2017; 25:2567-2572. [PMID: 26410097 DOI: 10.1007/s00167-015-3803-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 09/16/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE A 24-month prospective follow-up study was carried out to compare perioperative clinical outcomes, radiographic limb alignment, component positioning, as well as functional outcomes following total knee arthroplasty (TKA) between patient-specific instrumentation (PSI) and conventional instrumentation (CI). METHODS Ninety consecutive patients, satisfying the inclusion and exclusion criteria, were scheduled to undergo TKA with either PSI or CI. A CT-based PSI was used in this study, and a senior surgeon performed all surgeries. Patients were clinically and functionally assessed preoperatively, 6 and 24 months post-operatively. Perioperative outcomes were also analysed, including operating time, haemoglobin loss, the need for blood transfusion, length of hospitalisation, and radiographic features. RESULTS At 24-month follow-up, clinical and functional outcomes were comparable between the two groups. PSI performed no better than CI in restoring lower limb mechanical alignment or improving component positioning. There were no differences in operating time, haemoglobin loss, transfusion rate, or length of hospitalisation between PSI and CI. CONCLUSION No significant clinical benefit could be demonstrated in using PSI over CI after 24 months, and routine use of PSI is not recommended in non-complicated TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Meng Zhu
- Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Hwei Chi Chong
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Leon Siang Shen Foo
- Island Orthopaedic Consultants, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, Singapore, 228510, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
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Drexler M, Backstein D, Studler U, Lakstein D, Haviv B, Schwarzkopf R, Rutenberg TF, Warschawski Y, Rath E, Kosashvili Y. The medial border of the tibial tuberosity as an auxiliary tool for tibial component rotational alignment during total knee arthroplasty (TKA). Knee Surg Sports Traumatol Arthrosc 2017; 25:1736-1742. [PMID: 27017213 DOI: 10.1007/s00167-016-4072-7] [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: 08/30/2015] [Accepted: 03/01/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE The objective of this study was to quantify the amount of ensuing internal rotation of the tibial component when positioned along the medial border of the tibial tubercle, thus establishing a reproducible intraoperative reference for tibial component rotational alignment during total knee arthroplasty (TKA). METHODS The angle formed from the tibial geometric centre to the intersection of both lines from the middle of the tibial tuberosity and its medial border was measured in 50 patients. The geometric centre was determined on an axial CT slice at 10 mm below the lateral tibial plateau and transposed to a slice at the level of the most prominent part of the tibial tuberosity. Similar measurements were taken in 25 patients after TKA, in order to simulate the intraoperative appearance of the tibia after making its proximal resection. RESULTS This angle was found to be similar (n.s.) in normal and post-TKA tibiae [median 20.4° (range 15°-24°) vs. 20.7° (range 16°-25°), respectively]. In 89.3 % of the patients, the angle ranged from 17° to 24°. No statistical difference (p n.s.) was found between women and men in both normal [median -20.7° (range 16°-25°) vs. 19.9° (range 15°-24°)] and post-TKA tibiae [median 21.4° (range 19°-24°) vs. 20° (range 16°-25°)]. CONCLUSION This study found that in 90 % of the patients, the medial border of the tibial tuberosity is internally rotated 17°-24° in relation to the line connecting the middle of the tuberosity to the tibial geometric centre. Since this anatomical landmark may be more easily identifiable intraoperatively than the commonly used "medial 1/3", it can provide a better quantitative reference point and help surgeons achieve a more accurate tibial implant rotational position. LEVEL OF EVIDENCE Cohort and case control studies, Level III.
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Affiliation(s)
- Michael Drexler
- Tel-Aviv Sourasky Medical Center, Tel Aviv University, Waitzman 6 St, 6423906, Tel Aviv, Israel.
| | - David Backstein
- Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Ueli Studler
- Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Dror Lakstein
- Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Barak Haviv
- Hasharon Campus, Rabin Medical Center Hospital, Derech Ze'ev Jabotinsky 39, 4941492, Petah Tikva, Israel
| | - Ran Schwarzkopf
- Department of Orthopaedics, NYU Langone Medical Center Hospital for Joint Diseases, New York, NY, 10003, USA
| | - Tal Frenkel Rutenberg
- Tel-Aviv Sourasky Medical Center, Tel Aviv University, Waitzman 6 St, 6423906, Tel Aviv, Israel
| | - Yaniv Warschawski
- Tel-Aviv Sourasky Medical Center, Tel Aviv University, Waitzman 6 St, 6423906, Tel Aviv, Israel
| | - Ehud Rath
- Tel-Aviv Sourasky Medical Center, Tel Aviv University, Waitzman 6 St, 6423906, Tel Aviv, Israel
| | - Yona Kosashvili
- Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
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Abstract
Recent studies have challenged the long-held notion that neutral mechanical alignment after total knee arthroplasty leads to optimal function and survivorship. The ideal alignment for function and survivorship may actually be different. Kinematic alignment, where components are implanted to re-create the natural flexion/extension axis of the knee, may lead to improved functional results. Residual varus alignment may not adversely impact survivorship provided the tibial component is implanted in neutral alignment.
Cite this article: Lording T, Lustig S, Neyret P. Coronal alignment after total knee arthroplasty. EFORT Open Rev 2016;1:12-17. doi: 10.1302/2058-5241.1.000002.
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Affiliation(s)
- Timothy Lording
- Melbourne Orthopaedic Group and The Alfred Hospital, Australia
| | - Sébastien Lustig
- Albert Trillat Center, Groupement Hospitalier Nord, Université Lyon 1, France
| | - Philippe Neyret
- Albert Trillat Center, Groupement Hospitalier Nord, Université Lyon 1, France
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Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. Knee Surg Sports Traumatol Arthrosc 2016; 24:3410-3417. [PMID: 26801783 DOI: 10.1007/s00167-016-3983-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 01/05/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE Medial opening wedge high tibial osteotomy (MOW HTO) is now a successful operation with a range of indications, requiring an individualised approach to the choice of intended correction. This manuscript introduces the concept of surgical accuracy as the absolute deviation of the achieved correction from the intended correction, where small values represent greater accuracy. Surgical accuracy is compared in a randomised controlled trial (RCT) between gap measurement and computer navigation groups. METHODS This was a prospective RCT conducted over 3 years of 120 consecutive patients with varus malalignment and medial compartment osteoarthritis, who underwent MOW HTO. All procedures were planned with digital software. Patients were randomly assigned into gap measurement or computer navigation groups. Coronal plane alignment was judged using the mechanical tibiofemoral angle (mTFA), before and after surgery. Absolute (positive) values were calculated for surgical accuracy in each individual case. RESULTS There was no significant difference in the mean intended correction between groups. The achieved mTFA revealed a small under-correction in both groups. This was attributed to a failure to account for saw blade thickness (gap measurement) and over-compensation for weight bearing (computer navigation). Surgical accuracy was 1.7° ± 1.2° (gap measurement) compared to 2.1° ± 1.4° (computer navigation) without statistical significance. The difference in tibial slope increases of 2.7° ± 3.9° (gap measurement) and 2.1° ± 3.9° (computer navigation) had statistical significance (P < 0.001) but magnitude (0.6°) without clinical relevance. CONCLUSION Surgical accuracy as described here is a new way to judge achieved alignment following knee osteotomy for individual cases. This work is clinically relevant because coronal surgical accuracy was not superior in either group. Therefore, the increased expense and surgical time associated with navigated MOW HTO is not supported, because meticulously conducted gap measurement yields equivalent surgical accuracy. LEVEL OF EVIDENCE I.
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Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study. HSS J 2016; 12:224-234. [PMID: 27703415 PMCID: PMC5026651 DOI: 10.1007/s11420-015-9484-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 12/01/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery. QUESTIONS/PURPOSES The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV). METHODS After IRB approval, 49 consecutive PSI TKAs (40 patients) were matched based on preoperative characteristics to 49 NAV TKAs (40 patients) performed by a single surgeon. A blinded observer measured alignment on digital radiographs. Operating room records were reviewed for procedure times. Two-tailed paired sample t tests and McNemar's test were used as appropriate. Alpha level was 0.05 for all tests. RESULTS Preoperative cohort characteristics were not different. Mean postoperative long-leg mechanical alignment was within ±1° of neutral for both groups, although statistically different (p = 0.026). There were no other significant differences in coronal alignment. PSI exhibited significantly greater posterior tibial slope (4.4°) compared to NAV (2.7°) (p = 0.004); PSI resulted in significantly more outliers (>6°; p = 0.004). Procedure time for unilateral TKAs was lower for PSI (74.4 min) compared to that for NAV (80.6 min; p = 0.023). CONCLUSION NAV and PSI technologies provided excellent coronal plane alignment. NAV was better for sagittal tibial slope, while PSI procedure times were shorter for unilateral TKA. The impact of these technologies on patient-reported outcomes and TKA survivorship is controversial and should be the focus of future research.
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Ollivier M, Parratte S, Lunebourg A, Argenson JN. Reply to the Letter to the Editor: The John Insall Award: No Functional Benefit After Unicompartmental Knee Arthroplasty Performed With Patient-specific Instrumentation: A Randomized Trial. Clin Orthop Relat Res 2016; 474:274-5. [PMID: 26472586 PMCID: PMC4686512 DOI: 10.1007/s11999-015-4593-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Matthieu Ollivier
- grid.5399.60000000121764817Department of Orthopedics and Traumatology, Institute for Locomotion, St Marguerite Hospital, Aix-Marseille University, 270 Boulevard Sainte Marguerite, 13274 Marseille, France
| | - Sebastien Parratte
- grid.5399.60000000121764817Department of Orthopedics and Traumatology, Institute for Locomotion, St Marguerite Hospital, Aix-Marseille University, 270 Boulevard Sainte Marguerite, 13274 Marseille, France
| | - Alexandre Lunebourg
- grid.5399.60000000121764817Department of Orthopedics and Traumatology, Institute for Locomotion, St Marguerite Hospital, Aix-Marseille University, 270 Boulevard Sainte Marguerite, 13274 Marseille, France
| | - Jean-Noel Argenson
- grid.5399.60000000121764817Department of Orthopedics and Traumatology, Institute for Locomotion, St Marguerite Hospital, Aix-Marseille University, 270 Boulevard Sainte Marguerite, 13274 Marseille, France
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