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Jenny JY, Baldairon F. The coronal plane alignment of the knee classification does not correlate with the functional knee phenotype classification. Knee Surg Sports Traumatol Arthrosc 2023; 31:3906-3911. [PMID: 36947230 DOI: 10.1007/s00167-023-07394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE It is now well established that the coronal anatomy of the lower limb is highly variable both in non-arthritic subjects and subjects undergoing total knee arthroplasty (TKA). Two new classifications were recently described independently, but never compared: functional knee phenotypes classification and coronal plane alignment of the knee (CPAK) classification. The hypothesis of this study was that there was a significant difference between the values of the hip-knee-ankle angle (HKA) and the arithmetic hip-knee-ankle angle (aHKA) measures in the same patient at the time of TKA. METHODS Five hundred and twenty cases were randomly selected among patients operated on for a TKA with navigation assistance. Anatomical parameters were collected during surgery by a navigation system, and the corresponding data of the CPAK classification were calculated. The numerical values of measured HKA and aHKA in the same patient were compared. RESULTS The measured HKA had a mean of 3.0° varus (standard deviation of 6.0°). The calculated aHKA had a mean of 1.8° varus (standard deviation 4.8°). There was a significant difference between the values of the two measurements in the same subject (p = 0.005) and a weak negative correlation between the values of the two measurements in the same subject. In addition, there was no relationship between HKA values and joint line obliquity values or CPAK class. CONCLUSION A significant difference and a weak correlation between the values of the HKA and aHKA measures in the same subject were observed. The two analysis techniques used provide different information, and their correlation is only partial. These two techniques therefore appear to be complementary rather than exclusive. The clinical relevance of using these techniques during TKA remains unknown. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jean-Yves Jenny
- Locomax Unit, University Hospital, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Florent Baldairon
- Locomax Unit, University Hospital, 1 Avenue Molière, 67200, Strasbourg, France
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Mizu-Uchi H, Kido H, Chikama T, Kamo K, Kido S, Nakashima Y. The Adjustment of the Rotational Alignment of the Distal End of the Extramedullary Guide to the Anteroposterior Axis of the Proximal Tibia in Total Knee Arthroplasty. J Knee Surg 2022; 35:1273-1279. [PMID: 33511586 DOI: 10.1055/s-0040-1722660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The optimal placement within 3 degrees in coronal alignment was reportedly achieved in only 60 to 80% of patients when using an extramedullary alignment guide for the tibial side in total knee arthroplasty (TKA). This probably occurs because the extramedullary alignment guide is easily affected by the position of the ankle joint which is difficult to define by tibial torsion. Rotational direction of distal end of the extramedullary guide should be aligned to the anteroposterior (AP) axis of the proximal tibia to acquire optimal coronal alignment in the computer simulation studies; however, its efficacy has not been proven in a clinical setting. The distal end of the guide can be overly displaced from the ideal position when using a conventional guide system despite the alignment of the AP axis to the proximal tibia. This study investigated the effect of displacement of the distal end of extramedullary guide relative to the tibial coronal alignment while adjusting the rotational alignment of the distal end to the AP axis of the proximal tibia in TKA. A total of 50 TKAs performed in 50 varus osteoarthritic knees using an image-free navigation system were included in this study. The rotational alignment of the proximal side of the guide was adjusted to the AP axis of the proximal tibia. The position of the distal end of the guide was aligned to the center of the ankle joint as viewed from the proximal AP axis (ideal position) and as determined by the navigation system. The tibial intraoperative coronal alignments were recorded as the distal end was moved from the ideal position at 3-mm intervals. The intraoperative alignments were 0.5, 0.9, and 1.4 degrees in valgus alignment with 3-, 6-, and 9-mm medial displacements, respectively. The intraoperative alignments were 0.7, 1.2, and 1.7 degrees in varus alignment with 3-, 6-, and 9-mm lateral displacements, respectively. In conclusion, the acceptable tibial coronal alignment (within 2 degrees from the optimal alignment) can be achieved, although some displacement of the distal end from the ideal position can occur after the rotational alignment of the distal end of the guide is adjusted to the AP axis of the proximal tibia.
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Affiliation(s)
- Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Hidehiko Kido
- Department of Orthopaedic Surgery, Yamaguchi Red Cross Hospital, Yamaguchi City, Yamaguchi, Japan
| | - Tomonao Chikama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Kenta Kamo
- Department of Orthopaedic Surgery, Yamaguchi Red Cross Hospital, Yamaguchi City, Yamaguchi, Japan
| | - Satoshi Kido
- Department of Orthopaedic Surgery, Yamaguchi Red Cross Hospital, Yamaguchi City, Yamaguchi, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
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Iacono V, Farinelli L, Natali S, Piovan G, Screpis D, Gigante A, Zorzi C. The use of augmented reality for limb and component alignment in total knee arthroplasty: systematic review of the literature and clinical pilot study. J Exp Orthop 2021; 8:52. [PMID: 34287721 PMCID: PMC8295423 DOI: 10.1186/s40634-021-00374-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/16/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE A systematic review of the literature has been carried out to assess the actual evidence of the use of augmented reality in total knee arthroplasty (TKA). We then conducted a pilot clinical study to examine the accuracy of the Knee + augmented reality navigation in performing TKA. The present augmented reality (AR) system allows the surgeon to view the tibial and femur axis superimposed on the surgical field through the smart glasses. It provides real-time information during surgery and intraoperative feedback. METHODS A systematic review of the PubMed, MEDLINE, and Embase databases up to May 2021 using the keywords "augmented reality", "knee arthroplasty", "computer assisted surgery", "navigation knee arthroplasty" was performed by two independent reviewers. We performed five TKAs using the Knee + system. Patients were 4 females, with mean age of 76.4 years old (range 73-79) and mean Body Max Index (BMI) of 31.9 kg/m2 (range 27-35). The axial alignment of the limb and the orientation of the components were evaluated on standardized pre and postoperative full leg length weight-bearing radiographs, anteroposterior radiographs, and lateral radiographs of the knee. The time of tourniquet was recorded. The perception of motion sickness was assessed by Virtual Reality Sickness Questionnaire (VRSQ) subjected to surgeon immediately after surgery. RESULTS After duplicate removal, a total of 31 abstracts were found. However, only two studies concerned knee arthroplasty. Unfortunately, both were preclinical studies. Knee + system is able to perform a cutting error of less than 1° of difference about coronal alignment of femur and tibia and less than 2° about flexion/extension of femur and posterior tibial slope. The absolute differences between the values obtained during surgery and the measurement of varus femur, varus tibia, posterior slope, and femur flexion angle on post-operative radiographs were 0.6° ± 1.34°, 0.8° ± 0.84°, 0.8° ± 1.79°, and 0.4 mm ± 0.55 mm, respectively. CONCLUSIONS On light of our preliminary results, the Knee + system is accurate and effective to perform TKA. The translation from pilot study to high-level prospective studies is warranted to assess accuracy and cost-effective analysis compared to conventional techniques. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- V Iacono
- Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - L Farinelli
- Clinical Ortopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - S Natali
- Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy.
| | - G Piovan
- Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - D Screpis
- Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - A Gigante
- Clinical Ortopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - C Zorzi
- Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
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Novoa-Parra CD, Sanjuan-Cerveró R, de la Iglesia NH, Franco-Ferrando N, Larrainzar-Garijo R, Lizaur-Utrilla A. Importance of the gender and preoperative knee sagittal alignment to avoid unnecessary tibial resection in TKR. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:333-340. [PMID: 32886248 DOI: 10.1007/s00590-020-02773-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Standard resections according to the TKR manufacturers can lead to unnecessary bone resections in some patients. The objective of this study was to determine in which patients is recommended to perform a minimal tibial resection (MTR) that could restore the joint line height (JLH). METHODS Navigation records of 108 consecutive posterior cruciate-substituting TKR performed by one surgeon were analyzed. Optimal tibial resection depth to restore the JLH (0 mm) was calculated by an algorithm. Postoperatively, the knees were distributed in two groups: those in which a MTR (depth ≤ 8 mm) would have been enough to restore the JLH and those in which a standard resection depth would have been necessary. ROC curves and Youden index were used to determine the cutoff point of the coronal and sagittal mechanical axis that predicted a MTR restoring the JLH. Multivariate analysis was used to identify independent factors associated with requiring an MTR. RESULTS A MTR could be required in 20 (18.5%) knees. In the ROC curve analyses, the cutoff points that best discriminated between minimal and standard tibial resection was ≤ 3° of varus and < 2° of flexion preoperative deformity. Multivariate analysis showed that female gender and preoperative flexion < 2° were significant predictors of requiring a MTR to restore JLH. CONCLUSION A MTR with the JLH restoration could be possible in female patients with a preoperative sagittal deformity less than 2° of flexion. Preoperative coronal alignment had no influence to discriminate when a MTR is required.
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Affiliation(s)
- Carlos Daniel Novoa-Parra
- Orthopaedic and Traumatology Department, Denia Hospital, Partida Beniadla S/N, 03700, Alicante, Spain.
| | - R Sanjuan-Cerveró
- Orthopaedic and Traumatology Department, Denia Hospital, Partida Beniadla S/N, 03700, Alicante, Spain
| | - N H de la Iglesia
- Orthopaedic and Traumatology Department, Denia Hospital, Partida Beniadla S/N, 03700, Alicante, Spain
| | - N Franco-Ferrando
- Orthopaedic and Traumatology Department, Denia Hospital, Partida Beniadla S/N, 03700, Alicante, Spain
| | - R Larrainzar-Garijo
- Orthopaedic and Traumatology Department, Infanta Leonor University Hospital, Madrid, Spain
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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Tsukada S, Ogawa H, Nishino M, Kurosaka K, Hirasawa N. Augmented reality-based navigation system applied to tibial bone resection in total knee arthroplasty. J Exp Orthop 2019; 6:44. [PMID: 31712907 PMCID: PMC6848533 DOI: 10.1186/s40634-019-0212-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/28/2019] [Indexed: 01/03/2023] Open
Abstract
Background This pilot study was performed to examine the accuracy of the AR-KNEE system, an imageless navigation system using augmented reality (AR) technology for total knee arthroplasty. The AR-KNEE system enables the surgeon to view information from the navigation superimposed on the surgical field on a smartphone screen in real time. Methods Using the AR-KNEE system, one surgeon resected 10 tibial sawbones with viewing the tibial axis and aiming varus/valgus, posterior slope, internal/external rotation angles, and resection level superimposed on the surgical field. We performed computed tomography of the resected sawbones and measured the varus/valgus, posterior slope, and internal/external rotation angles using a designated computer software. The thickness of the resected bone was measured using digital calipers. Results The absolute differences between the values displayed on the smartphone screen and the measurement values for varus/valgus, posterior slope, internal/external rotation angles, and thickness of the resected bone were 0.5° ± 0.2°, 0.8° ± 0.9°, 1.8° ± 1.5°, and 0.6 mm ± 0.7 mm, respectively. Conclusions This pilot study using sawbones suggested that the AR-KNEE system may provide reliable accuracy for coronal, sagittal, and rotational alignment in tibial bone resection during total knee arthroplasty.
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Affiliation(s)
- Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan
| | - Hiroyuki Ogawa
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan.
| | - Masahiro Nishino
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan
| | - Kenji Kurosaka
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan
| | - Naoyuki Hirasawa
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan
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Viceconti M, Ascani D, Mazzà C. Pre-operative prediction of soft tissue balancing in knee arthoplasty part 1: Effect of surgical parameters during level walking. J Orthop Res 2019; 37:1537-1545. [PMID: 30908694 PMCID: PMC6617758 DOI: 10.1002/jor.24289] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/08/2019] [Indexed: 02/04/2023]
Abstract
An important reason for poor functional outcome of Total Knee Arthroplasty is inadequate soft tissue balancing. Custom-made cutting guides or computer-aided surgical navigation make possible to accurately achieve what is planned; the challenge is to perform a pre-operative planning that properly accounts for soft-tissue balancing. The first step in the development of a patient-specific computer model that can predict during pre-operative planning the post-operative soft-tissue balancing is a better understanding of the role that cutting heights and angles have on the balancing of the soft tissues after TKA as the patient perform the more common daily tasks. In the present study, we conducted a sensitivity analysis of the ligament elongations during level walking due to TKA as a function of position and orientation of the cutting guides, by means of a validated patient-specific dynamic model of the post-TKA knee biomechanics. The results suggest a considerable sensitivity of the collateral ligaments elongation to the surgical variables, and in particular to the varus-valgus angles of both tibia and femur. This complete elongation map can be used as a baseline for the development of reduced-order models to be integrated in pre-operative planning environments. © 2019 The Authors Journal of Orthopaedic Research. Published by Wiley Periodicals, Inc. J Orthop Res 37:1537-1545, 2019.
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Affiliation(s)
- Marco Viceconti
- Department of Industrial EngineeringUniversity of BolognaViale Risorgimento 2Bologna 40136Italy,Laboratorio di Tecnologia MedicaIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Daniele Ascani
- Department of Mechanical Engineering and INSIGNEO Institute for in silico MedicineUniversity of SheffieldSheffieldUnited Kingdom
| | - Claudia Mazzà
- Department of Mechanical Engineering and INSIGNEO Institute for in silico MedicineUniversity of SheffieldSheffieldUnited Kingdom
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