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Gong J, Zhang W, Zhao R, Zhang W, Wang B, Ma D. The role of intraoperative navigation in surgical treatment of unilateral zygomatic complex fractures: A systematic review and meta-analysis. J Oral Maxillofac Surg 2023:S0278-2391(23)00325-7. [PMID: 37084764 DOI: 10.1016/j.joms.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/02/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE The application of a computer-aided navigation system (CANS) in zygomatic complex (ZMC) fractures has been extensively reported, but individual results are heterogeneous. The purpose of this systematic review was to evaluate the role of CANS in the surgical treatment of unilateral ZMC fractures. METHODS Electronic retrieval of MEDLINE, Embase, and Cochrane Library (CENTRAL) and manual searching until November 1, 2022 were used to identify cohort studies and randomized controlled trials employing CANS in the surgical treatment of ZMC fractures. The identified reports contained at least 1 of the following outcome variables: accuracy of reduction, total treatment time, amount of bleeding, postoperative complications, satisfaction, and cost. Weighted or mean differences (MD), risk ratios, and corresponding 95% confidence intervals (CI) were calculated, where P<.05 and I2>50% random-effect model was adopted, and a vice versa fixed-effect model was adopted. Descriptive analysis was applied to qualitative statistics. The protocol was conducted in accordance with PRISMA guidelines and prospectively registered with PROSPERO (CRD42022373135). RESULTS A total of 562 studies were identified, of which 2 cohort studies and 3 randomized controlled trials with 189 participants were included. Meta-analysis indicated that employing CANS significantly decreased the reduction error (MD = -0.86, 95% CI -1.58 to -0.14; P = .02, random-effect model) compared with conventional surgery without using CANS. The differences in total treatment time (preoperative planning time: MD = 1.44, 95% CI -3.55 to 6.43; P = .57 and operative time: MD = 3.02, 95% CI -9.21 to 15.26; P = .63, fixed-effect model) and amount of bleeding (MD = 14.86, 95% CI -8.86 to 38.58; P = .22, fixed-effect model) were not statistically significant between the two groups. Descriptive analysis suggested that postoperative complications, postoperative satisfaction, and cost were also similar with or without CANS. CONCLUSION Within the limitations of the present review, the reduction accuracy of unilateral ZMC fractures using CANS is superior to that of conventional surgery. CANS presents limited influence on operation time, amount of bleeding, postoperative complications, postoperative satisfaction, and cost.
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Affiliation(s)
- Jiaming Gong
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Resident, Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, Quzhou City, PR China
| | - Wenlong Zhang
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Resident, Professor, Director, School of Stomatology, Lanzhou University, Lanzhou City, PR China
| | - Ruimin Zhao
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Resident, Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, Quzhou City, PR China
| | - Wenkai Zhang
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China
| | - Bingwu Wang
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China
| | - Dongyang Ma
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Resident, Professor, Director, School of Stomatology, Lanzhou University, Lanzhou City, PR China.
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Image-Less THA Cup Navigation in Clinical Routine Setup: Individual Adjustments, Accuracy, Precision, and Robustness. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060832. [PMID: 35744095 PMCID: PMC9227241 DOI: 10.3390/medicina58060832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 12/13/2022]
Abstract
Background and Objectives: Even after the ‘death’ of Lewinnek’s safe zone, the orientation of the prosthetic cup in total hip arthroplasty is crucial for success. Accurate cup placement can be achieved with surgical navigation systems. The literature lacks study cohorts with large numbers of hips because postoperative computer tomography is required for the reproducible evaluation of the acetabular component position. To overcome this limitation, we used a validated software program, HipMatch, to accurately assess the cup orientation based on an anterior-posterior pelvic X-ray. The aim of this study were to (1) determine the intraoperative ‘individual adjustment’ of the cup positioning compared to the widely suggested target values of 40° of inclination and 15° of anteversion, and evaluate the (2) ‘accuracy’, (3) ‘precision’, and (4) robustness, regarding systematic errors, of an image-free navigation system in routine clinical use. Material and Methods: We performed a retrospective, accuracy study in a single surgeon case series of 367 navigated primary total hip arthroplasties (PiGalileoTM, Smith+Nephew) through an anterolateral approach performed between January 2011 and August 2018. The individual adjustments were defined as the differences between the target cup orientation (40° of inclination, 15° of anteversion) and the intraoperative registration with the navigation software. The accuracy was the difference between the intraoperative captured cup orientation and the actual postoperative cup orientation determined by HipMatch. The precision was analyzed by the standard deviation of the difference between the intraoperative registered and the actual cup orientation. The outliers were detected using the Tukey method. Results: Compared to the target value (40° inclination, 15° anteversion), the individual adjustments showed that the cups are impacted in higher inclination (mean 3.2° ± 1.6°, range, (−2)−18°) and higher anteversion (mean 5.0° ± 7.0°, range, (−15)−23°) (p < 0.001). The accuracy of the navigated cup placement was −1.7° ± 3.0°, ((−15)−11°) for inclination, and −4.9° ± 6.2° ((−28)−18°) for anteversion (p < 0.001). Precision of the system was higher for inclination (standard deviation SD 3.0°) compared to anteversion (SD 6.2°) (p < 0.001). We found no difference in the prevalence of outliers for inclination (1.9% (7 out of 367)) compared to anteversion (1.63% (6 out of 367), p = 0.78). The Bland-Altman analysis showed that the differences between the intraoperatively captured final position and the postoperatively determined actual position were spread evenly and randomly for inclination and anteversion. Conclusion: The evaluation of an image-less navigation system in this large study cohort provides accurate and reliable intraoperative feedback. The accuracy and the precision were inferior compared to CT-based navigation systems particularly regarding the anteversion. However the assessed values are certainly within a clinically acceptable range. This use of image-less navigation offers an additional tool to address challenging hip prothesis in the context of the hip−spine relationship to achieve adequate placement of the acetabular components with a minimum of outliers.
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Nakahara I, Kyo T, Kuroda Y, Miki H. Does difference in stem design affect accuracy of stem alignment in total hip arthroplasty with a CT-based navigation system? J Artif Organs 2020; 24:74-81. [PMID: 32710390 DOI: 10.1007/s10047-020-01196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
The efficacy of a computed tomography (CT)-based navigation system to accurately position the stem for intended alignment is unclear. In addition, the influence of stem design on the accuracy of insertion is unknown. We therefore retrospectively compared the accuracy and precision for the intended alignment of two different designs of femoral stem which were implanted with or without the navigation system. Forty-nine total hip arthroplasties (THAs) using a tapered wedge stem and 91 THAs using an anatomic stem were evaluated for the navigation group. Thirty-three THAs using the tapered wedge stem and 15 THAs using the anatomic stem were controls for the non-navigation group. Differences between postoperative measurement and preoperative planning were compared among the groups. In the navigation groups, accuracy (mean absolute difference) and precision (95% limits of agreement) of stem anteversion were 4.3° and ± 10.1° in the tapered wedge stem and 3.1° and ± 6.9° in the anatomic stem. In the non-navigation groups, these were 6.0° and ± 15.2° and 4.8° and ± 12.4°, respectively. The accuracy and precision in the navigation groups were significantly superior to those in the non-navigation group, and those in the anatomic stem group were significantly superior to those in the tapered wedge group. Using the CT-based navigation system, the accuracy and precision for intended stem anteversion were improved. When compared under guidance of navigation system, the accuracy and precision for intended stem anteversion in the anatomic stem were superior to those in the tapered wedge stem.
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Affiliation(s)
- Ichiro Nakahara
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 5400006, Japan.
| | - Takayuki Kyo
- Department of Orthopaedic Surgery, Bellland General Hospital, 500-3 Higashiyama, Naka-ku, Sakai-city, Osaka, 5998247, Japan
| | - Yasuo Kuroda
- Department of Orthopaedic Surgery, Suita Municipal Hospital, 5-7 Kishibeshinmachi, Suita-city, Osaka, 5648567, Japan
| | - Hidenobu Miki
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 5400006, Japan
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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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Mitsutake R, Tanino H, Nishida Y, Higa M, Ito H. A simple angle-measuring instrument for measuring cemented stem anteversion during total hip arthroplasty. BMC Musculoskelet Disord 2020; 21:113. [PMID: 32075628 PMCID: PMC7031998 DOI: 10.1186/s12891-020-3142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background During total hip arthroplasty (THA), the accurate placement of the femoral components is an important determinant of the success of the procedure. This study assessed the accuracy of cemented stem placement using a new angle-measuring instrument. The primary objective was to investigate the accuracy of the intraoperative measurements of cemented stem anteversion obtained using the angle-measuring instrument. Our secondary objective was to evaluate the accuracy of stem positioning performed using the angle-measuring instrument. Methods We compared the intraoperative stem anteversion measurements obtained using the angle-measuring instrument with postoperative stem anteversion measurements obtained using computed tomography in 149 hips (measurement accuracy). We also compared the target angle and postoperative stem anteversion in 105 hips (implantation accuracy). Results The mean amount of intraoperative stem anteversion was 37.9° ± 10.1°, and the mean amount of postoperative stem anteversion was 37.0° ± 10.4°. The mean measurement accuracy was 0.9° ± 6.1°, and the absolute measurement accuracy was 4.9° ± 3.7°. The correlation coefficient for the relationship between the intraoperative and postoperative stem anteversion measurements was 0.824 (p = 0.000). The mean amount of target angle was 37.4° ± 7.6°, and the mean amount of postoperative stem anteversion was 35.9° ± 9.1°. The mean implantation accuracy was 1.4° ± 5.6°, and the mean absolute implantation accuracy was 4.3° ± 3.6°. The correlation coefficient for the relationship between the target angle and postoperative stem anteversion was 0.795 (p = 0.000). Conclusions The angle-measuring instrument measured intraoperative stem anteversion accurately, and cemented stem was implanted accurately during THA with the angle-measuring instrument.
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Affiliation(s)
- Ryo Mitsutake
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan.
| | - Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Yasuhiro Nishida
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Masaru Higa
- Department of Mechanical Engineering, University of Hyogo, 2167 Shosha, Himeji, 671-2280, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
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Nakahara I, Kyo T, Kuroda Y, Miki H. Effect of improved navigation performance on the accuracy of implant placement in total hip arthroplasty with a CT-based navigation system. J Artif Organs 2018; 21:340-347. [PMID: 29611147 DOI: 10.1007/s10047-018-1041-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 03/27/2018] [Indexed: 12/28/2022]
Abstract
A computed tomography (CT)-based navigation system is one of the support tools to place implant with appropriate alignment and position in total hip arthroplasty (THA). To determine whether the higher performance of the navigation would further improve the accuracy of implant placement in the clinical setting, we retrospectively compared the navigation accuracy of two different versions of a navigation system. The newer version of the navigation system had an upgraded optical sensor with superior positional accuracy. Navigation accuracy, defined as differences between postoperative measurements on CT images and intraoperative records on the navigation system, of 49 THAs performed with the newer version of the navigation system was compared with that of 49 THAs performed with the older version. With the newer version, the mean absolute accuracy (95% limits of agreement) of implant alignment was 1.2° (± 3.3°) for cup inclination, 1.0° (± 2.4°) for cup anteversion, 2.0° (± 4.9°) for stem anteversion, and 1.1° (± 2.4°) for stem valgus angle. The accuracy of the implant position was 1.5 mm (± 3.1 mm), 1.3 mm (± 3.0 mm), and 1.5 mm (± 3.1 mm) for cup x-, y-, and z-axes, respectively, 1.6 mm (± 3.2 mm), 1.4 mm (± 2.9 mm), and 1.5 mm (± 2.7 mm) for stem x-, y-, and z-axes, respectively, and 2.4 mm (± 4.5 mm) for leg length discrepancy. The values for the newer version were significantly more accurate with less variation compared to those of the older version. With upgraded navigation performance, more accurate implant placement was demonstrated in the clinical setting.
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Affiliation(s)
- Ichiro Nakahara
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan.
| | - Takayuki Kyo
- Department of Orthopaedic Surgery, Bellland General Hospital, 500-3 Higashiyama, Naka-ku, Sakai-city, Osaka, Japan
| | - Yasuo Kuroda
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan
| | - Hidenobu Miki
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan
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Kyo T, Nakahara I, Kuroda Y, Miki H. Effects of coordinate-system construction methods on postoperative computed tomography evaluation of implant orientation after total hip arthroplasty. ACTA ACUST UNITED AC 2015; 20:52-60. [PMID: 26290170 DOI: 10.3109/10929088.2015.1076047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In total hip arthroplasty, it is important to assess postoperative implant orientation. The computed tomography-based (CT-based) three-dimensional (3D) templating method using 3D preoperative planning software is generally recommended. In this method, postoperative implant orientation within a bony coordinate system can be measured by overlaying a 3D computerized model of the implant on a real postoperative CT image of the implant. The bony coordinate system consists of several reference points (RPs) marked on a CT image of the bone surface. Therefore, preoperative and postoperative coordinate systems do not always match. We investigated how the difference between coordinate systems constructed from RPs chosen by manual methods (M1 and M2) and those constructed by the computer matching method influences the results of measurement validation. METHODS In M1, postoperative RPs were chosen without a specific tool in a single planning module. In M2, postoperative RPs were chosen with as little deviation as possible from preoperative RPs, verifying preoperative RPs on another monitor. RESULTS M1 and M2 produced mean errors in acetabular cup inclination of 0.7° ± 0.5° and 0.5° ± 0.3°, respectively, and mean errors in cup anteversion of 1.3° ± 1.2° and 0.5° ± 0.4°, respectively, which were statistically significant differences. M1 and M2 produced mean errors in femoral stem anteversion of 2.4° ± 2.0° and 2.7° ± 2.1°, respectively, not a significant difference, but these errors were larger than errors in cup orientation. DISCUSSION We recommend referring to preoperative RPs when choosing postoperative RPs. Surgeons must be aware that for evaluation of postoperative stem anteversion, manual methods may produce considerable error.
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Affiliation(s)
- Takayuki Kyo
- a Department of Orthopedic Surgery , Osaka National Hospital , Osaka , Japan
| | - Ichiro Nakahara
- a Department of Orthopedic Surgery , Osaka National Hospital , Osaka , Japan
| | - Yasuo Kuroda
- a Department of Orthopedic Surgery , Osaka National Hospital , Osaka , Japan
| | - Hidenobu Miki
- a Department of Orthopedic Surgery , Osaka National Hospital , Osaka , Japan
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