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Nozaki A, Imai N, Funayama K, Horigome Y, Suzuki H, Minato I, Kobayashi K, Kawashima H. Accuracy of ZedView, the Software for Three-Dimensional Measurement and Preoperative Planning: A Basic Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1030. [PMID: 37374236 DOI: 10.3390/medicina59061030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: In the field of orthopedic surgery, novel techniques of three-dimensional shape modeling using two-dimensional tomographic images are used for bone-shape measurements, preoperative planning in joint-replacement surgery, and postoperative evaluation. ZedView® (three-dimensional measurement instrument and preoperative-planning software) had previously been developed. Our group is also using ZedView® for preoperative planning and postoperative evaluation for more accurate implant placement and osteotomy. This study aimed to evaluate the measurement error in this software in comparison to a three-dimensional measuring instrument (3DMI) using human bones. Materials and Methods: The study was conducted using three bones from cadavers: the pelvic bone, femur, and tibia. Three markers were attached to each bone. Study 1: The bones with markers were fixed on the 3DMI. For each bone, the coordinates of the center point of the markers were measured, and the distances and angles between these three points were calculated and defined as "true values." Study 2: The posterior surface of the femur was placed face down on the 3DMI, and the distances from the table to the center of each marker were measured and defined as "true values." In each study, the same bone was imaged using computed tomography, measured with this software, and the measurement error from the corresponding "true values" was calculated. Results: Study 1: The mean diameter of the same marker using the 3DMI was 23.951 ± 0.055 mm. Comparisons between measurements using the 3DMI and this software revealed that the mean error in length was <0.3 mm, and the error in angle was <0.25°. Study 2: In the bones adjusted to the retrocondylar plane with the 3DMI and this software, the average error in the distance from the planes to each marker was 0.43 (0.32-0.58) mm. Conclusion: This surgical planning software could measure the distance and angle between the centers of the markers with high accuracy; therefore, this is very useful for pre- and postoperative evaluation.
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Affiliation(s)
- Asami Nozaki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Norio Imai
- Division of Comprehensive Musculoskeletal Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kazuhisa Funayama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Yoji Horigome
- Division of Comprehensive Musculoskeletal Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hayato Suzuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Izumi Minato
- Department of Orthopedic Surgery, Niigata Rinko Hospital, Niigata 950-0051, Japan
| | - Koichi Kobayashi
- School of Health Sciences, Faculty of Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
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Sariali E, Moussellard HP. Surgical epicondylar axis is not orthogonal to the femoral mechanical knee axis in valgus knees with primary osteoarthritis: Three-dimensional analysis according to knee coronal alignment in 112 patients. Knee 2022; 39:91-99. [PMID: 36182830 DOI: 10.1016/j.knee.2022.08.011] [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: 09/03/2021] [Revised: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND During total knee arthroplasty (TKA), most surgeons align the femoral component along the surgical epicondylar axis (SEA) considering it as orthogonal to the femoral mechanical axis. However, it is still unclear how SEA coronal alignment varies according to the native coronal knee alignment. The main goal of this study was to analyze the SEA orientation according to the native coronal knee morphotype. METHODS A total of 112 patients underwent a three-dimensional (3D) -planning-based TKA. The SEA was then determined by locating the epicondyles on 3D models. The 3D femoral and tibial mechanical axes were marked and the femoral (FMA) and tibial (TMA) mechanical angles were measured. The native HKA angle was measured as FMA + TMA. The SEA orientation angles were measured in the coronal (SEA-α) and axial (SEA-β) plane. SEA orientation was compared between the valgus, neutral, and varus knees. RESULTS The mean SEA-α angle was 90.2 ± 3° and the mean axial SEA-β angle was 92.2 ± 1.3°. The SEA-α angle was significantly higher in the valgus group compared with the neutral group (92.3 ± 2.9°, 90 ± 2.9°, P = 0.0009) whereas there was no significant difference in the SEA-α angle between the varus and the neutral group (89.7 ± 2.3°, 90 ± 2.9°, P = 0.32). CONCLUSIONS In contrast to the neutral and varus knees, the SEA was not orthogonal to the femoral mechanical axis in patients undergoing TKA for primary osteoarthritis. Our results suggest adapting the coronal alignment of the femoral component during TKA, while maintaining an average 2° valgus in valgus knees. By contrast, with varus and neutral knees, our data support the use of a mechanical alignment.
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Affiliation(s)
- Elhadi Sariali
- Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, AP-HP, F-75013 Paris, France.
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Gauci MO. Patient-specific guides in orthopedic surgery. Orthop Traumatol Surg Res 2022; 108:103154. [PMID: 34838754 DOI: 10.1016/j.otsr.2021.103154] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/10/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023]
Abstract
The interest of patient-specific guides (PSGs) lies in reliable intraoperative achievement of preoperative planning goals. They are a form of instrumentation optimizing intraoperative precision and thus improving the safety and reproducibility of surgical procedures. Clinical superiority, however, has not been demonstrated. The various steps from design to implementation leave room for error, which needs to be known and controlled by the surgeon who is responsible for final outcome. Instituting large-scale patient-specific surgery requires management systems for guides and innovative implants which cannot be a simple extension of current practices. We shall approach the present state of knowledge regarding PSGs via 5 questions: (1) What is a PSG? Single-use instrumentation produced after preoperative planning, aiming exclusively to optimize procedural exactness. (2) How to use and assess PSGs in orthopedic surgery? Strict rules of use must be adhered to. Any deviation from the predefined objective is, necessarily, an error that must be identified as such. (3) Do PSGs provide greater surgical exactness? The contribution of PSGs varies greatly between procedures. Exactness is enhanced in the spine, in osteotomies around the knee and in bone-tumor surgery. In the shoulder, their contribution is seen only in complex cases. Data are sparse for hip replacement, and controversial for knee replacement. (4) What are the expected benefits of PSGs? As well as improving exactness, PSGs allow a lower radiation dose and shorter operating time. They also enable junior surgeons to train in techniques otherwise reserved to hyperspecialists. (5) How to include PSGs in everyday practice? As well as their potential clinical interest, PSGs involve deep changes in organization, equipment provision and economic model. LEVEL OF EVIDENCE: V; expert opinion.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Unité de Recherche Clinique Côte d'Azur (UCA), Hôpital Pasteur II, 30, voie Romaine, 06000 Nice, France.
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Osteoarthritic and non-osteoarthritic patients show comparable coronal knee joint line orientations in a cross-sectional study based on 3D reconstructed CT images. Knee Surg Sports Traumatol Arthrosc 2022; 30:407-418. [PMID: 34564737 PMCID: PMC8866364 DOI: 10.1007/s00167-021-06740-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Recently introduced total knee arthroplasty (TKA) alignment strategies aim to restore the pre-arthritic alignment of an individual patient. The native alignment of a patient can only be restored with detailed knowledge about the native and osteoarthritic alignment as well as differences between them. The first aim of this study was to assess the alignment of a large series of osteoarthritic (OA) knees and investigate whether femoral and tibial joint lines vary within patients with the same overall lower limb alignment. The secondary aim was to compare the alignment of OA patients to the previously published data of non-OA patients. This information could be useful for surgeons considering implementing one of the new alignment concepts. MATERIAL Coronal alignment parameters of 2692 knee OA patients were measured based on 3D reconstructed CT data using a validated planning software (Knee-PLAN®, Symbios, Yverdon les Bains, Switzerland). Based on these measurements, patients' coronal alignment was phenotyped according to the functional knee phenotype concept. These phenotypes represent an alignment variation of either the overall alignment, the femoral joint line orientation or the tibial joint line orientation. Each phenotype is defined by a specific mean and covers a range of ± 1.5° from this mean. Mean values and distribution among the phenotypes are presented and compared between two populations (OA patients of this study and non-OA patients of a previously published study) as well as between HKA subgroups (varus, valgus and neutral) using t tests and Chi-square tests (p < 0.05). RESULTS Femoral and tibial joint lines varied within patients with the same overall lower limb alignment. A total of 162 functional knee phenotypes were found (119 males, 136 females and 94 mutual phenotypes). Mean values differed between the OA and non-OA population, but differences were small (< 2°) except for the overall alignment (e.g. HKA). The distribution of OA and non-OA patients among the phenotypes differed significantly, especially among the limb phenotypes. CONCLUSION Differences between OA and non-OA knees are small regarding coronal femoral and tibial joint line orientation. Femoral and tibial joint line orientation of osteoarthritic patients can, therefore, be used to estimate their native coronal alignment and plan an individualized knee alignment. LEVEL OF CLINICAL EVIDENCE III.
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Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ, Herbert RD, de Campos TF, Steffens D. Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression. J Arthroplasty 2021; 36:3993-4002.e37. [PMID: 34275710 DOI: 10.1016/j.arth.2021.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely considered a successful intervention for osteoarthritis and other degenerative knee diseases. This study addresses the need for a high-quality meta-analysis that outlines the clinical course of pain and function post-TKA. METHODS The review included prospective cohort studies assessing pain or function of patients undergoing primary TKA at baseline (preoperatively) and at least 2 additional time points including one at least 12 months postoperatively. Two reviewers independently screened references, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. The time course of recovery of pain and function was modeled using fractional polynomial meta-regression. RESULTS In total, 191 studies with 59,667 patients were included, most with low risk of bias. The variance-weighted mean pain score (/100, 0 = no pain) was 64.0 (95% confidence interval [CI] 60.2-67.7) preoperatively, 24.1 (95% CI 20.3-27.9) at 3 months, 20.4 (95% CI 16.7-24.0) at 6 months, and 16.9 (95%CI 13.6-20.3) at 12 months, and remained low (10.1; 95% CI 4.8-15.4) at 10 years postoperatively. The variance-weighted mean function score (/100, 0 = worst function) was 47.1 (95% CI 45.7-48.4) preoperatively, 72.8 (95% CI 71.3-74.4) at 3 months, 76.3 (95% CI 74.7-77.8) at 6 months, and 78.1 (95%CI 76.4-79.7) at 12 months. Function scores were good (79.7; 95% CI 77.9-81.5) at 10 years postoperatively. CONCLUSION Patients undergoing primary TKA can expect a large and rapid but incomplete recovery of pain and function in the first postoperative year. At 10 years, the gains in pain scores may still remain while there is an improvement in function.
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Affiliation(s)
- Said Mohamad Sayah
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Tarcisio F de Campos
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Jenny JY, Bercovy M, Cazenave A, Gaillard T, Châtain F, Jolles BE, Rouvillain JL, Saragaglia D. No difference in 13-year survival after medial pivot or central pivot mobile bearing total knee arthroplasty. A propensity matched comparative analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3648-3653. [PMID: 33165636 DOI: 10.1007/s00167-020-06355-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The present study was designed to evaluate the long-term results (more than 10 years) of mobile bearing total knee arthroplasty (TKA) and to compare the survival of medial pivot axis (MPA) and central pivot axis (CPA) TKAs. The primary hypothesis was that the 10- to 15-year survival rate of MPA TKAs will be better than CPA TKAs. METHODS A national, multicenter, retrospective study was performed in France. In this case-control design, 1154 TKAs were paired into the CPA group (control group: 577 cases) and MPA group (study group: 577 cases) based on a logistic regression analysis of age, gender, body mass index and severity of the coronal deformity, defining the propensity score for each case. Final survival information follow-up was obtained for 946 cases (82%). RESULTS There was no significant difference between the control and study groups for any baseline data. Twenty-two prosthetic revisions (2%) were performed for mechanical reasons during the follow-up period. There was no significant difference between the 13-year survival rates of CPA (98%) and MPA (97%) TKAs. There was no significant difference between groups in their final Oxford and Knee Society scores. CONCLUSION Our findings do not support the assumption that medialization of the pivot axis of a mobile bearing TKA improves clinical results or survival. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jean-Yves Jenny
- University Hospital Strasbourg, CCOM, 10 avenue Baumann, 67400, Illkirch, France.
| | - Michel Bercovy
- Clinique Arago, 187A Rue Raymond Losserand, 75014, Paris, France
| | - Alain Cazenave
- Institut CALOT, Department of Orthopedic Surgery, 52 rue du Dr Calot, 62600, Berck-sur-Mer, France
| | - Thierry Gaillard
- Polyclinique du Beaujolais, 120 Ancienne Route de Beaujeu, 69400, Arnas, France
| | - Frédéric Châtain
- Pole Santé Axone, 75 Avenue Gabriel Péri, 38400, Saint-Martin-d'Hères, France
| | - Brigitt E Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Avenue Louis-Ruchonnet 57, 1003, Lausanne, Switzerland.,Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Route Cantonale, 1015, Lausanne, Switzerland
| | - Jean-Louis Rouvillain
- Department of Orthopaedic and Trauma Surgery, Hôpital Zobda Quitman, 97261, Fort-de-France, France
| | - Dominique Saragaglia
- Department of Osteoarthritis and Sport Surgery, Traumatology of the Limbs, Grenoble-Alpes South Teaching Hospital, 38130, Echirolles, France
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Shetty V, Wagh Y, Karade V, Maurya A, Parihar M, Shekhar S, Tandel J. CT-Based 3D Reconstruction of Lower Limb Versus X-Ray-Based 3D Reconstruction: A Comparative Analysis and Application for a Safe and Cost-Effective Modality in TKA. Indian J Orthop 2021; 55:1150-1157. [PMID: 34824715 PMCID: PMC8586399 DOI: 10.1007/s43465-021-00456-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/05/2021] [Indexed: 02/04/2023]
Abstract
AIM Patient Specific Instrumentation (PSI) with 3D bone models have been used to improve the outcomes of Total Knee Arthroplasty (TKA). The PSI, however, needs a CT (Computed tomography)/MRI scan to reproduce a bone-based model. However, CT is not a routine imaging method in the TKA and has challenges such as high radiation exposure and increased investigation cost. Any technology or software which could accurately recreate 3D bone models using X-ray would be a cheaper and safer tool. This study is based on one such technology (XrayTo3D®) using X-ray to 3D as an alternative to other image-based 3D bone models and PSI available in the market. This study compares the accuracy of XrayTo3D® versus a Conventional CT to 3D, in the reconstruction of lower limb bones (femur and tibia). METHOD In an analysis of 45 lower limbs, 11 anatomical parameters were measured [Medial Proximal Tibial Angle-MPTA, Tibial(T)-torsion, T-slope, T-length, Mechanical Lateral Distal Femoral Angle (mLDFA), F-version, F-length, Distal femoral Medio lateral width (F-ML), Distal Femoral Antero Posterior (F-AP), Proximal Tibia Antero Posterior (T-AP), Proximal Tibia Medio Lateral (T-ML) based on landmarks selected by three orthopaedic surgeons(numbers of the authors superscript), on two groups of 3D models, one reconstructed using XrayTo3D® and the other using CT. Mean and standard-deviation values were measured for all the parameters in both the groups. Statistical association between both the groups was measured by Pearson's correlation coefficient. Two-sided t tests of the mean values were calculated to compare the two measurement methods. The interobserver reproducibility within each group was measured by the intraclass correlation coefficient (ICC). Point-to-surface (P2S) error, in the distal femur and proximal tibia regions of the models reconstructed using XrayTo3D®, were also measured. RESULTS For all the 11 parameters, no statistically significant difference was found between the 2 groups (p > 0.05). Pearson's correlation coefficients for all the parameters were not significant. The interobserver reproducibility was ranging from 0.90 to 1.00 and 0.90 to 1.00 for the XrayTo3D® and CT groups, respectively. The mean P2S distance was 1.0 mm in distal femur and 1.1 mm in proximal tibia which was within the acceptable limits. CONCLUSION The reconstruction accuracy of the XrayTo3D® is an accurate, safe and cost effective as compared to a CT-based method.
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Affiliation(s)
- Vivek Shetty
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
| | - Yash Wagh
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
| | - Vikas Karade
- Department of Society of Innovation and Entrepreneurship (SINE), Algosurg Inc., Society of Innovation and Entrepreneurship (SINE), IIT-Bombay, Room no. 501, 5th floor, A3, Raunak Park, Thane West, Mumbai, Maharashtra 400606 India
| | - Amit Maurya
- Department of Society of Innovation and Entrepreneurship (SINE), Algosurg Inc., Society of Innovation and Entrepreneurship (SINE), IIT-Bombay, Room no. 501, 5th floor, A3, Raunak Park, Thane West, Mumbai, Maharashtra 400606 India
| | - Mangal Parihar
- Department of Orthopedics, Mangal Anand Hospital, 48, Swastik Park Building, Sion Trombay Road, Chembur East, Mumbai, Maharashtra 400071 India
| | - Sajeev Shekhar
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
| | - Jignesh Tandel
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
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Tanifuji O, Mochizuki T, Yamagiwa H, Sato T, Watanabe S, Hijikata H, Kawashima H. Comparison of post-operative three-dimensional and two-dimensional evaluation of component position for total knee arthroplasty. Knee Surg Relat Res 2021; 33:21. [PMID: 34256872 PMCID: PMC8278642 DOI: 10.1186/s43019-021-00106-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the post-operative three-dimensional (3D) femoral and tibial component positions in total knee arthroplasty (TKA) by the same co-ordinates' system as for pre-operative planning and to compare it with a two-dimensional (2D) evaluation. MATERIALS AND METHODS Sixty-five primary TKAs due to osteoarthritis were included. A computed tomography (CT) scan of the femur and tibia was obtained and pre-operative 3D planning was performed. Then, 3D and 2D post-operative evaluations of the component positions were performed. KneeCAS (LEXI, Inc., Tokyo, Japan), a lower-extremity alignment assessment system, was used for the 3D post-operative evaluation. Standard short-knee radiographs were used for the 2D post-operative evaluation. Differences between the pre-operative planning and post-operative coronal and sagittal alignment of components were investigated and compared with the results of the 3D and 2D evaluations. RESULTS According to the 3D evaluation, the difference between the pre-operative planning and actual post-operative sagittal alignment of the femoral component and the coronal and sagittal alignments of the tibial component were 2.6° ± 1.8°, 2.2° ± 1.8° and 3.2° ± 2.4°, respectively. Using the 2D evaluation, they were 1.9° ± 1.5°, 1.3° ± 1.2° and 1.8° ± 1.4°, making the difference in 3D evaluation significantly higher (p = 0.013, = 0.003 and < 0.001). For the sagittal alignment of the femoral component and the coronal and sagittal alignment of the tibial component, the outlier (> ± 3°) ratio for the 3D evaluation was also significantly higher than that of the 2D evaluation (p < 0.001, = 0.009 and < 0.001). CONCLUSIONS The difference between the pre-operative planning and post-operative component alignment in the 3D evaluation is significantly higher than that of the 2D, even if the same cases have been evaluated. Two-dimensional evaluation may mask or underestimate the post-operative implant malposition. Three-dimensional evaluation using the same co-ordinates' system as for pre-operative planning is necessary to accurately evaluate the post-operative component position.
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Affiliation(s)
- Osamu Tanifuji
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Hiroshi Yamagiwa
- Department of Orthopedic Surgery, Saiseikai Niigata Hospital, Niigata, Japan
| | - Takashi Sato
- Department of Orthopedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Satoshi Watanabe
- Department of Orthopedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Hiroki Hijikata
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
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Watanabe S, Akagi R, Shiko Y, Ono Y, Kawasaki Y, Ohdera T, Ohtori S, Sasho T. Intra- and inter-observer reliability of implant positioning evaluation on a CT-based three-dimensional postoperative matching system for total knee arthroplasty. BMC Musculoskelet Disord 2021; 22:363. [PMID: 33865360 PMCID: PMC8053298 DOI: 10.1186/s12891-021-04228-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background The evaluation of postoperative total knee arthroplasty (TKA) alignment mainly relies on measurement data obtained from plain radiographs. The aim of this retrospective observational study was to document the intra- and inter-observer reliability in assessment of TKA component positioning after surgery using a three-dimensional (3D) computed tomography (CT) image matching system. Methods Fourteen knees from 14 patients who received primary TKA were included, and images were analyzed by blinded readers not associated with the surgeries. The examiner digitized the reference points according to defined landmarks, and the designated size component was superimposed to the 3D reconstructed CT model for measurement. In addition to the evaluation of implant position against the coronal and sagittal lower limb mechanical axes that were defined based on bony landmarks, implant position against axes connecting implant-based reference points that are easier to indicate was evaluated. Results The overall intra- and inter-observer reliabilities determined by the intraclass correlation coefficients (ICC) of the implant alignment measurement for both femoral and tibial components were good (ICC > 0.60), except in the direction of femoral flexion and extension, for both mechanical and implant-based axes. The difference between implant alignment measurements according to the traditional mechanical axis and the implant-based axis ranged between means of 0.08o and 1.70o and were statistically significantly different. Conclusions The postoperative evaluation of implant position in the coronal and sagittal planes using 3D-CT image matching is reliable and has good reproducibility except for the sagittal alignment assessment of the femoral component. The measured implant position according to the traditional mechanical axis and the implant-based axis were slightly but significantly different.
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Affiliation(s)
- Shotaro Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.,Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Yoshimasa Ono
- Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Toshihiro Ohdera
- Fukuoka Orthopaedic Hospital, 2-10-50 Yanagouchi, Minami-ward, Fukuoka-city, Fukuoka, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.,Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
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10
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Three-dimensional assessment of lower limb alignment: Reference values and sex-related differences. Knee 2020; 27:428-435. [PMID: 31806504 DOI: 10.1016/j.knee.2019.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/17/2019] [Accepted: 11/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Three-dimensional (3D) preoperative planning and assisted surgery is increasingly popular in deformity surgery and arthroplasty. Reference ranges for 3D lower limb alignment are needed as a prerequisite for standardized analysis of alignment and preoperative planning in 3D, but are not yet established. METHODS On 60 3D bone models of the lower limbs based on computed tomography data, fifteen parameters per leg were assessed by standardized validated 3D analysis. Distribution parameters and differences between sexes were evaluated. Reference values were generated by adding/subtracting one standard deviation from the mean. RESULTS Women had a significantly lower mean mechanical lateral distal femoral angle compared with men (86.4 ± 2.1° vs. 87.8 ± 2.0°; P < .05) and significantly lower mean joint line convergence angle (-2.5 ± 1.4° vs. -1.3 ± 1.2; P < .01), but higher mean hip knee ankle angle (178.9 ± 1.9° vs. 177.8 ± 2.3°; P < .05) and mean femoral torsion (18.2 ± 9.5° vs. 13.2 ± 6.4°; P < .05), resulting in a tendency towards valgus alignment and vice versa for men. Differences in mean medial proximal tibial angle were not significant. The mean mechanical axis deviation from the tibial knee joint center was 6.9 ± 7.3 mm medial and 1.4 ± 16.1 mm ventral without significant differences between sexes. CONCLUSIONS We describe total and sex-related reference ranges for all alignment relevant axes and joint angles of the lower limb. There are sex-related differences in certain alignment parameters, which should be considered in analysis and surgical planning.
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Jenny JY, Saragaglia D, Bercovy M, Cazenave A, Gaillard T, Châtain F, Jolles B, Rouvillain JL. Inconsistent relationship between body weight/body mass index prior to total knee arthroplasty and the 12-year survival. Knee 2019; 26:1372-1378. [PMID: 31635946 DOI: 10.1016/j.knee.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/06/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The primary hypothesis was that body weight (BW) and body mass index (BMI) significantly impact the long-term survival rate after implantation of a mobile bearing total knee arthroplasty (TKA). METHODS A national, multicentric, retrospective study was performed in France. A total of 1604 TKAs were included. The 10-year follow-up was documented, and the influence of BW and BMI on the survival rate was assessed. RESULTS There was a significant influence of the BW on the 12-year survival rate for any reason and for infection; but this influence was not proportional to the BW or BMI. There was no significant influence of the BMI on the 12-year survival rate for any reason, for any mechanical reason or for infection. CONCLUSION Our results suggest that a higher BMI should not be considered as a risk factor for revision for mechanical purpose if a mobile bearing TKA with confirming design is implanted.
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Affiliation(s)
- Jean-Yves Jenny
- University Hospital Strasbourg, Pôle Locomax, 1 Avenue Molière, Strasbourg, France.
| | - Dominique Saragaglia
- Department of Osteoarthritis and Sport Surgery, Traumatology of the Limbs, Grenoble-Alpes South Teaching Hospital, Echirolles, France
| | - Michel Bercovy
- Clinique Arago, 187A Rue Raymond Losserand, Paris, France
| | - Alain Cazenave
- Institut CALOT, Department of Orthopedic Surgery, 52 rue du Dr Calot, Berck-sur-Mer, France
| | - Thierry Gaillard
- Polyclinique du Beaujolais, 120 Ancienne Route de Beaujeu, Arnas, France
| | - Frédéric Châtain
- Pole Santé Axone, 75 Avenue Gabriel Péri, Saint-Martin-d'Hères, France
| | - Brigitte Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Avenue Louis-Ruchonnet 57, Lausanne, Switzerland; Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Route Cantonale, Lausanne, Switzerland
| | - Jean-Louis Rouvillain
- Department of Orthopaedic and Trauma Surgery, Hôpital Zobda Quitman, Fort-de-France, France
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12
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Gemalmaz HC, Sarıyılmaz K, Ozkunt O, Sungur M, Kaya I, Dikici F. Postoperative mechanical alignment analysis of total knee replacement patients operated with 3D printed patient specific instruments: A Prospective Cohort Study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:323-328. [PMID: 30853398 PMCID: PMC6819789 DOI: 10.1016/j.aott.2019.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/06/2019] [Accepted: 02/05/2019] [Indexed: 01/25/2023]
Abstract
Objective Total knee replacement (TKR) is a surgical treatment for final stage gonarthrosis. The lifespan of the prosthetic implants used in TKR surgery is a major interest for the orthopaedic research community.Previously, proper implant alignment of the implants has been advocated for longevity of the TKR surgery. Recently, patient-specific (PSI) instruments have been proposed to improve the mechanical alignment of the TKR by permitting better implant positioning over conventional TKR surgery. The aim of this study is to compare the mechanical alignment results of patients operated with PSIs and conventional instruments. Methods Two groups of 20 patients chosen in a quasi-random manner have been compared in this study. In the first group femoral distal and tibial osteotomies were made by a PSI which was produced by the patients' computed tomography scans. All osteotomies in the control group were made with the TKR set's routine instruments by conventional means. Patients' preoperative and postoperative mechanical femorotibal angles (mFTA), femoral coronal angles (FCA), tibial coronal angles (TCA) were measured and the number of outliers which showed more than 3° of malalignment were counted in both groups for comparison. Results The average postoperative mFTA was found to be 2.09° for the PSI group and in was found to be 2.84° for the control which was not statistically significant. The comparison of postoperative FCA and TCA also did not show significant difference between the groups. The number of outliers showing more than 3° of malalignment per group were found to be 1 out of 20 (5%) for the PSI group and 7 out of 20 (35%) for the control which was statistically significant. Conclusion In this study patient-specific instrumentation provided significantly better mechanical alignment compared to conventional TKR for the frequency of outlier cases with malalignment beyond 3°. PSI proved no significant difference when the groups were compared for mFTA, FCA and TCA. Our findings support that PSI may improve TKR alignment by improving the ratio of the outlier patients with marked malalignment. Level of Evidence Level III, Therapeutic Study.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/instrumentation
- Arthroplasty, Replacement, Knee/methods
- Female
- Humans
- Knee Prosthesis
- Male
- Middle Aged
- Osteoarthritis, Knee/surgery
- Patient-Specific Modeling
- Printing, Three-Dimensional
- Prospective Studies
- Prosthesis Failure
- Prosthesis Fitting/instrumentation
- Prosthesis Fitting/methods
- Surgery, Computer-Assisted/methods
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Halil Can Gemalmaz
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Kerim Sarıyılmaz
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Health Sciences, Istanbul, Turkey.
| | - Okan Ozkunt
- Medipol University, Sefakoy Hospital, Istanbul, Turkey.
| | - Mustafa Sungur
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Health Sciences, Istanbul, Turkey.
| | - Ibrahim Kaya
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Health Sciences, Istanbul, Turkey.
| | - Fatih Dikici
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
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13
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Yiasemidou M, Glassman D, Jayne D, Miskovic D. Is patient-specific pre-operative preparation feasible in a clinical environment? A systematic review and meta-analysis. Comput Assist Surg (Abingdon) 2019; 23:57-68. [PMID: 30497290 DOI: 10.1080/24699322.2018.1495266] [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] [Indexed: 10/27/2022] Open
Abstract
Technical difficulty of an operation is associated with patient and disease characteristics, indicating the necessity for surgeons to exercise patient-specific preparation. Such methods have been shown to be effective in the simulation suite, however, application in a real clinical environment has been sporadic. This systematic review attempts to answer if patient-specific preparation in challenging surgical procedures is feasible. A systematic review of OvidMedline, Embase and all Evidence Based Medicine review databases, was conducted in search of studies who described surgical rehearsals in all specialties. Following the application of defined inclusion and exclusion criteria relevant data were extracted and summarised. Descriptive synthesis was performed for all included studies and meta-analysis of data was applied when possible. Of fourty-nine studies included, thirty-seven were case-series, ten were non-randomised comparative trials and two randomised controlled trials. Accuracy of applied methods ranged from 66.7 to 100% and a good outcome was seen in 60-100% of operations. Meta-analysis of studies comparing rehearsals to real procedures (same patients) showed that simulated procedures were significantly faster than real ones (SMD = -1.56 [-2.19, -0.93] p < 0.00001) but were similar in other outcomes (fluoroscopy time: SMD = -0.1 [-0.63, 0.42] p = 0.7, fluoroscopy volume: SMD = -0.43[-0.97, 0.11], p = 0.12). Meta-analysis of studies comparing pre-operative rehearsals to standard treatment (two distinct groups of patients), demonstrated that real procedures were performed quicker if pre-operative rehearsal took place (SMD = -0.47 [-0.79, -0.16], P = 0.003) but the immediate clinical outcome was similar for practiced and not practiced operations (SMD =0.03[-0.23, 0.29], p = 0.82). Current evidence suggests that patient-specific pre-operative preparation is feasible and safe and decreases operational time.
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Affiliation(s)
- Marina Yiasemidou
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
| | | | - David Jayne
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
| | - Danilo Miskovic
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
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14
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Comparison of custom cutting guides based on three-dimensional computerized CT-scan planning and a conventional ancillary system based on two-dimensional planning in total knee arthroplasty: a randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2019; 43:2529-2538. [PMID: 31227853 DOI: 10.1007/s00264-019-04357-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Incorrect positioning of components during total knee arthroplasty (TKA) increases the risk of pain, instability, and early revision. The purpose of this study was to compare 3D planning-assisted and a conventional system for TKA positioning. We hypothesized that the use of three-dimensional CT-scan planning and custom cutting guides would increase the accuracy of component positioning. METHODS A randomized, controlled, prospective study of two groups was performed. In one group, patient-specific custom cutting guides (PSCG) were used for component positioning based on 3D CT-scan planning. In the control group, TKA was performed with a conventional ancillary system. The components' positioning angles were measured on 3D reconstructions. The main evaluation criterion was the percentage of outliers outside of a target zone of ± 3° for the coronal positioning of the femoral component. RESULTS Eighty patients were included. The percentage of outliers for the femoral component was significantly lower in the 3D-guided group (1 patient) compared to the control group (7 patients p = 0.02). The coronal femoral angle was restored with greater accuracy in the 3D-assisted group (- 0.1° ± 1.4°) compared to the control group (1.6° ± 2.5°). Surgery was significantly shorter in the 3D group. The clinical outcomes were better in the 3D group at the two year follow-up with fewer failures and a lower standard deviation in IKS scores. CONCLUSION The use of a 3D planning and custom guides can improve TKA component positioning by increasing the accuracy of implants alignment and reducing the percentage of outliers. The same benefit was not demonstrated for the global knee alignment and the clinical scores with no indisputable clinical advantage for the PSCG.
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15
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Shamir SK, Wolynski JG, Duncan CG, Puttlitz C, Duerr FM. Ex vivo evaluation of a novel surgical guide on the accuracy of closing wedge osteotomies. Vet Surg 2019; 48:1429-1436. [PMID: 31120595 DOI: 10.1111/vsu.13237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/06/2019] [Accepted: 04/28/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the influence of a novel surgical guide on the accuracy and technical difficulty of closing wedge osteotomies (CWO). STUDY DESIGN Ex vivo experimental study. SAMPLE POPULATION Canine tibia models (n = 40). METHODS A 20° cranial CWO (CCWO) was created without (standard procedure; STCCWO) or with the aid of a novel wedge osteotomy guide (WOCCWO). Procedures were performed by diplomate (n = 4) and resident (n = 6) surgeons, with each performing 2 STCCWO followed by 2 WOCCWO. To prevent bias, surgeons were unaware of the study purpose until after completing the STCCWO. The wedges were evaluated by comparing the deviation from the 20° target angle, divergence of the 2 osteotomies (osteotomy divergence angle [ODA]), and measurements of the wedge height at the caudomedial cortex (CMC) and caudolateral cortex (CLC). Technique difficulty was explored through a surgeon questionnaire. RESULTS The WOCCWO resulted in smaller mean ODA (WOCCWO = 0.86°, SD ± 0.38°, P < .001), and smaller mean difference between CMC and CLC (WOCCWO = 0.29 mm, SD ± 0.19, P < .001) than for the STCCWO (4.22°, SD ± 2.16° and 1.39 mm, SD ± 0.65 respectively). Deviation from the target 20° wedge angle was greater after STCCWO (1.46°, SD ± 1.27°) than after WOCCWO (0.53°, SD ± 0.33°, P = .004). No difference was reported regarding the difficulty of the procedures, but resident surgeons stated that they were more likely to use the guide in a clinical setting compared with diplomates. CONCLUSION The wedge osteotomy guide improved the accuracy of CCWO compared with standard technique. CLINICAL SIGNIFICANCE The clinical significance of the differences detected in this study is unclear and warrants in vivo investigation.
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Affiliation(s)
- Shelly K Shamir
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Jakob G Wolynski
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Colleen G Duncan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Christian Puttlitz
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Felix M Duerr
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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16
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Patellar bone strain after total knee arthroplasty is correlated with bone mineral density and body mass index. Med Eng Phys 2019; 68:17-24. [PMID: 30979584 DOI: 10.1016/j.medengphy.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 11/20/2022]
Abstract
Patella-related complications after total knee arthroplasty (TKA) remain a major clinical concern. Previous studies have suggested that increased postoperative patellar bone strain could be related to such complications, but there is limited knowledge on patellar strain after TKA. The objective of this study was to predict patellar bone strain after TKA and evaluate correlations with various preoperative data. Fourteen TKA patients with a minimum follow-up of one year were included in this study. Using preoperative CT datasets, preoperative planning, and postoperative X-rays, a method is presented to generate patient-specific finite element models after virtual TKA. Patellar kinematics and forces were predicted during a squat movement, and patellar bone strain was evaluated at 60° of knee flexion. Strain varied greatly among patients, but was strongly negatively correlated (r = -0.85, p < 0.001) with bone mineral density (BMD) and moderately positively (r = 0.54, p = 0.05) with body mass index (BMI). The BMI/BMD ratio explained 87% of strain, and should be further investigated as a potential risk factor for clinical complications. This study represents a preliminary step towards the identification of patients at risk of patellar complications after TKA.
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17
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Boudissa M, Oliveri H, Chabanas M, Tonetti J. Computer-assisted surgery in acetabular fractures: Virtual reduction of acetabular fracture using the first patient-specific biomechanical model simulator. Orthop Traumatol Surg Res 2018; 104:359-362. [PMID: 29458201 DOI: 10.1016/j.otsr.2018.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/28/2017] [Accepted: 01/04/2018] [Indexed: 02/02/2023]
Abstract
UNLABELLED Preoperative planning for the management of acetabular fracture is founded on geometric models allowing virtual repositioning of the bone fragments, but not taking account of soft tissue and the realities of the surgical procedure. The present technical note reports results using the first simulator to be based on a patient-specific biomechanical model, simulating the action of forces on the fragments and also the interactions between soft issue and bone: muscles, capsules, ligaments, and bone contacts. In all 14 cases, biomechanical simulation faithfully reproduced the intraoperative behavior of the various bone fragments and reduction quality. On Matta's criteria, anatomic reduction was achieved in 12 of the 14 patients (86%; 0.25mm±0.45 [range: 0-1]) and in the 12 corresponding simulations (86%; 0.42mm±0.51 [range: 0-1]). Mean semi-automatic segmentation time was 156min±37.9 [range: 120-180]. Mean simulation time was 23min±9 [range: 16-38]. The model needs larger-scale prospective validation, but offers a new tool suitable for teaching purposes and for assessment of surgical results in acetabular fracture. LEVEL OF EVIDENCE IV: retrospective study.
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Affiliation(s)
- M Boudissa
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Laboratoire TIMC-IMAG, université Grenoble Alpes, CNRS UMR 5525, pavillon Taillefer, 38700 La Tronche, France.
| | - H Oliveri
- Laboratoire TIMC-IMAG, université Grenoble Alpes, CNRS UMR 5525, pavillon Taillefer, 38700 La Tronche, France
| | - M Chabanas
- Laboratoire TIMC-IMAG, université Grenoble Alpes, CNRS UMR 5525, pavillon Taillefer, 38700 La Tronche, France
| | - J Tonetti
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
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18
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Miura M, Hagiwara S, Nakamura J, Wako Y, Kawarai Y, Ohtori S. Interobserver and Intraobserver Reliability of Computed Tomography-Based Three-Dimensional Preoperative Planning for Primary Total Knee Arthroplasty. J Arthroplasty 2018; 33:1572-1578. [PMID: 29352686 DOI: 10.1016/j.arth.2017.12.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Preoperative planning is an important factor for total knee arthroplasty (TKA). The aim of this study is to document the interobserver and intraobserver reliability of computed tomography (CT)-based 3-dimensional (3D) preoperative planning for primary TKA. METHODS Twenty knees (10 with osteoarthritis and 10 with rheumatoid arthritis) were studied independently by 6 orthopedic surgeons using a CT-based 3D planning system. The measurements were made twice at more than 3-week intervals without any knowledge of their own previous measurements or those of the others. We assessed the femoral and tibial component sizes and the alignment of the femoral component. RESULTS The interobserver and intraobserver agreements for femoral component size were 44.3% and 62.5% with exact size, and increased to 90.7% and 99.2% within one size difference; the intraclass correlation coefficients (ICCs) were 0.919 and 0.936, respectively. The interobserver and intraobserver agreements for tibial component size were 57.0% and 66.7% with exact size, and increased to 87.3% and 90.0% within one size difference; the ICCs were 0.909 and 0.924, respectively. The ICCs for femoral and tibial size were better in rheumatoid arthritis than in osteoarthritis. Interobserver ICC for femoral valgus angle was 0.807, and 0.893 for intraobserver reliability. Interobserver ICC of the femoral external rotation angle was 0.463, and 0.622 for intraobserver reliability. CONCLUSION CT-based 3D preoperative planning for primary TKA has clinical implications for predicting appropriate size and alignment of the component in patients with osteoarthritis and rheumatoid arthritis.
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Affiliation(s)
- Michiaki Miura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeo Hagiwara
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasushi Wako
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuya Kawarai
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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19
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Smoljkić M, Verbrugghe P, Larsson M, Widman E, Fehervary H, D'hooge J, Vander Sloten J, Famaey N. Comparison of in vivo vs. ex situ obtained material properties of sheep common carotid artery. Med Eng Phys 2018; 55:16-24. [PMID: 29580793 DOI: 10.1016/j.medengphy.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
Patient-specific biomechanical modelling can improve preoperative surgical planning. This requires patient-specific geometry as well as patient-specific material properties as input. The latter are, however, still quite challenging to estimate in vivo. This study focuses on the estimation of the mechanical properties of the arterial wall. Firstly, in vivo pressure, diameter and thickness of the arterial wall were acquired for sheep common carotid arteries. Next, the animals were sacrificed and the tissue was stored for mechanical testing. Planar biaxial tests were performed to obtain experimental stress-stretch curves. Finally, parameters for the hyperelastic Mooney-Rivlin and Gasser-Ogden-Holzapfel (GOH) material model were estimated based on the in vivo obtained pressure-diameter data as well as on the ex situ experimental stress-stretch curves. Both material models were able to capture the in vivo behaviour of the tissue. However, in the ex situ case only the GOH model provided satisfactory results. When comparing different fitting approaches, in vivo vs. ex situ, each of them showed its own advantages and disadvantages. The in vivo approach estimates the properties of the tissue in its physiological state while the ex situ approach allows to apply different loadings to properly capture the anisotropy of the tissue. Both of them could be further enhanced by improving the estimation of the stress-free state, i.e. by adding residual circumferential stresses in vivo and by accounting for the flattening effect of the tested samples ex vivo. • Competing interests: none declared • Word count: 4716.
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Affiliation(s)
- Marija Smoljkić
- Biomechanics Section, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
| | - Peter Verbrugghe
- Clinical Cardiac Surgery, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Matilda Larsson
- School of Technology and Health, Department of Medical Engineering, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Erik Widman
- School of Technology and Health, Department of Medical Engineering, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Heleen Fehervary
- Biomechanics Section, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
| | - Jan D'hooge
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Section, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
| | - Nele Famaey
- Clinical Cardiac Surgery, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
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20
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Yiasemidou M, Galli R, Glassman D, Tang M, Aziz R, Jayne D, Miskovic D. Patient-specific mental rehearsal with interactive visual aids: a path worth exploring? Surg Endosc 2017; 32:1165-1173. [PMID: 28840324 PMCID: PMC5807505 DOI: 10.1007/s00464-017-5788-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/28/2017] [Indexed: 11/06/2022]
Abstract
Background Surgeons of today are faced with unprecedented challenges; necessitating a novel approach to pre-operative preparation which takes into account the specific tests each case poses. In this study, we examine patient-specific mental rehearsal for pre-surgical practice and assess whether this method has an additional effect when compared to generic mental rehearsal. Methods Sixteen medical students were trained how to perform a simulated laparoscopic cholecystectomy (SLC). After baseline assessments, they were randomised to two equal groups and asked to complete three SLCs involving different anatomical variants. Prior to each procedure, Group A practiced mental rehearsal with the use of a pre-prepared checklist and Group B mental rehearsal with the checklist combined with virtual models matching the anatomical variations of the SLCs. The performance of the two groups was compared using simulator provided metrics and competency assessment tool (CAT) scoring by two blinded assessors. Results The participants performed equally well when presented with a “straight-forward” anatomy [Group A vs. Group B—time sec: 445.5 vs. 496 p = 0.64—NOM: 437 vs. 413 p = 0.88—PL cm: 1317 vs. 1059 p = 0.32—per: 0.5 vs. 0 p = 0.22—NCB: 0 vs. 0 p = 0.71—DVS: 0 vs. 0 p = 0.2]; however, Group B performed significantly better [Group A vs. B Total CAT score—Short Cystic Duct (SCD): 20.5 vs. 26.31 p = 0.02 η2 = 0.32—Double cystic Artery (DA): 24.75 vs. 30.5 p = 0.03 η2 = 0.28] and committed less errors (Damage to Vital Structures—DVS, SCD: 4 vs. 0 p = 0.03 η2=0.34, DA: 0 vs. 1 p = 0.02 η2 = 0.22). in the cases with more challenging anatomies. Conclusion These results suggest that patient-specific preparation with the combination of anatomical models and mental rehearsal may increase operative quality of complex procedures.
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Affiliation(s)
- Marina Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
| | - Raffaele Galli
- John Goligher Surgery Unit, St. James University Hospital, Leeds, UK
| | | | | | - Rahoz Aziz
- Medical School, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Danilo Miskovic
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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21
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Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online 2016; 15:115. [PMID: 27769304 PMCID: PMC5073919 DOI: 10.1186/s12938-016-0236-4] [Citation(s) in RCA: 547] [Impact Index Per Article: 68.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/09/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. METHODS Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. RESULTS 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. CONCLUSION 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis.
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Affiliation(s)
- Philip Tack
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Jan Victor
- Ghent University Hospital, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Paul Gemmel
- Departement of Economics & Business Administration, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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22
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Sorin G, Pasquier G, Drumez E, Arnould A, Migaud H, Putman S. Reproducibility of digital measurements of lower-limb deformity on plain radiographs and agreement with CT measurements. Orthop Traumatol Surg Res 2016; 102:423-8. [PMID: 27052940 DOI: 10.1016/j.otsr.2016.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Five angles (HKA, HKS, alpha, beta, tibial slope) are used for goniometry in total knee arthroplasty. The reproducibility of the measurement of these angles has been assessed on plain and digitized x-rays, but to our knowledge, this has not been confirmed on x-rays taken on the PACS system and they have not been compared to computed tomography (CT) measurements, the reference for angle measurement. This prospective study aimed to: (1) evaluate the inter- and intrarater reliability of the measurement of these angles on digital x-rays taken on a PACS; (2) determine the agreement of these measurements with those obtained using a CT protocol. HYPOTHESIS The measurements of these five angles on digitized radiographs are reproducible and in agreement with CT values. MATERIAL AND METHODS Forty-two patients suffering from knee osteoarthritis and scheduled for total knee arthroplasty were included in the study. Each patient had a PACS digitized x-ray and a CT intended to produce patient-specific instrumentation (Symbios, Yverdon, Switzerland) including measurements of the angles evaluated. Four senior orthopaedic surgeon-raters measured all the angles twice. Inter- and intrarater reliability was then calculated as well as the agreement between the second measurement of each rater and the CT measurement using interclass correlation and kappa coefficients (data provided as means and 95% confidence intervals). RESULTS The inter- and intrarater reliability values were excellent for the HKA, alpha, and beta angles (with, respectively, a coefficient of 0.99 [0.97-0.99], 0.84 [0.76-0.9], and 0.94 [0.86-0.96] interrater reliability and 0.98 [0.96-0.99], 0.86 [0.75-0.92], and 0.65 [0.44-0.8] intrarater reliability). Interrater reliability was low for HKS and tibial slope angles (coefficients all<0.4 for interrater reliability and <0.7 for intrarater reliability). The x-ray/CT agreement was very good for the HKA, alpha, and beta angles (0.81 [0.67-0.99], 0.74 [0.56-0.91], and 0.74 [0.45-0.92], respectively) and low for the HKS and tibial slope angles (all<0.45). DISCUSSION/CONCLUSION The HKA, alpha, and beta angles were reproducible for digital radiographs and showed good agreement with CT measurements. HKS and tibial slope angles should be used with greater caution, and other navigation methods or patient-specific instrumentation should be explored. LEVEL OF EVIDENCE Level III, prospective, comparative diagnostic case-control study.
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Affiliation(s)
- G Sorin
- Département d'orthopédie, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France.
| | - G Pasquier
- Département de chirurgie orthoépdique et de traumatologie, CHRU de Lille, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - E Drumez
- Département de chirurgie orthoépdique et de traumatologie, CHRU de Lille, université de Lille, 59000 Lille, France; Unité de biostatistiques et d'é́pidémiologie, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - A Arnould
- Département de chirurgie orthoépdique et de traumatologie, CHRU de Lille, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - H Migaud
- Département de chirurgie orthoépdique et de traumatologie, CHRU de Lille, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - S Putman
- Département de chirurgie orthoépdique et de traumatologie, CHRU de Lille, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
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23
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Latypova A, Arami A, Becce F, Jolles-Haeberli B, Aminian K, Pioletti DP, Terrier A. A patient-specific model of total knee arthroplasty to estimate patellar strain: A case study. Clin Biomech (Bristol, Avon) 2016; 32:212-9. [PMID: 26651475 DOI: 10.1016/j.clinbiomech.2015.11.008] [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: 05/21/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inappropriate patellar cut during total knee arthroplasty can lead to patellar complications due to increased bone strain. In this study, we evaluated patellar bone strain of a patient who had a deeper patellar cut than the recommended. METHODS A patient-specific model based on patient preoperative data was created. The model was decoupled into two levels: knee and patella. The knee model predicted kinematics and forces on the patella during squat movement. The patella model used these values to predict bone strain after total knee arthroplasty. Mechanical properties of the patellar bone were identified with micro-finite element modeling testing of cadaveric samples. The model was validated with a robotic knee simulator and postoperative X-rays. For this patient, we compared the deeper patellar cut depth to the recommended one, and evaluated patellar bone volume with octahedral shear strain above 1%. FINDINGS Model predictions were consistent with experimental measurements of the robotic knee simulator and postoperative X-rays. Compared to the recommended cut, the deeper cut increased the critical strain bone volume, but by less than 3% of total patellar volume. INTERPRETATION We thus conclude that the predicted increase in patellar strain should be within an acceptable range, since this patient had no complaints 8 months after surgery. This validated patient-specific model will later be used to address other questions on groups of patients, to eventually improve surgical planning and outcome of total knee arthroplasty.
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Affiliation(s)
- Adeliya Latypova
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland
| | - Arash Arami
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Movement Analysis and Measurement, Lausanne, Switzerland
| | - Fabio Becce
- Lausanne University Hospital (CHUV), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland
| | | | - Kamiar Aminian
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Movement Analysis and Measurement, Lausanne, Switzerland
| | - Dominique P Pioletti
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland
| | - Alexandre Terrier
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland.
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Schlatterer B, Linares JM, Cazal J, Merloz P, Plaweski S. Posterior tibial slope accuracy with patient-specific cutting guides during total knee arthroplasty: A preliminary study of 50 cases. Orthop Traumatol Surg Res 2015; 101:S233-40. [PMID: 26249539 DOI: 10.1016/j.otsr.2015.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/25/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patient-specific cutting guides were recently introduced to facilitate total knee arthroplasty (TKA). Their accuracy in achieving optimal implant alignment remains controversial. The objective of this study was to evaluate postoperative radiographic outcomes of 50 TKA procedures with special attention to posterior tibial slope (PTS), which is difficult to control intraoperatively. We hypothesized that patient-specific cutting guides failed to consistently produce the planned PTS. MATERIAL AND METHODS The Signature™ patient-specific cutting guides (Biomet) developed from magnetic resonance imaging data were used in a prospective case-series of 50 TKAs. The target PTS was 2°. Standardised digitised radiographs were obtained postoperatively and evaluated by an independent reader. Reproducibility of the radiographic measurements was assessed on 20 cases. The posterior cortical line of the proximal tibia was chosen as the reference for PTS measurement. Inaccuracy was defined as an at least 2° difference in either direction compared to the target. RESULTS The implant PTS was within 2° of the target in 72% of knees. In the remaining 28%, PTS was either excessive (n=10; maximum, 9°) or reversed (n=4; maximum, -6°). The postoperative hip-knee-ankle angle was 0° ± 3° in 88% of knees, and the greatest deviation was 9° of varus. CONCLUSION These findings support our hypothesis that patient-specific instrumentation decreases PTS accuracy. They are consistent with recently published data. In contrast, patient-specific instrumentation provided accurate alignment in the coronal plane.
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Affiliation(s)
- B Schlatterer
- Institut monégasque de médecine et chirurgie du sport, 98000 Monaco.
| | - J-M Linares
- Aix-Marseille université, CNRS, ISM UMR 7287, 13288 Marseille, France
| | - J Cazal
- Institut monégasque de médecine et chirurgie du sport, 98000 Monaco
| | - P Merloz
- Service de chirurgie orthopédique et traumatologie, hôpital A.-Michallon, CHU de Grenoble, 38043 Grenoble, France
| | - S Plaweski
- Service de chirurgie orthopédique et traumatologie du sport, hôpital sud, CHU de Grenoble, avenue de Kimberley, 38034 Échirolles, France
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