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Liu Z, Cai M, Hong S, Shi J, Xie S, Liu C, Du H, Morin JD, Li G, Wang L, Wang H, Tang K, Fang NX, Guo CF. Data-driven inverse design of flexible pressure sensors. Proc Natl Acad Sci U S A 2024; 121:e2320222121. [PMID: 38954542 DOI: 10.1073/pnas.2320222121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/04/2024] [Indexed: 07/04/2024] Open
Abstract
Artificial skins or flexible pressure sensors that mimic human cutaneous mechanoreceptors transduce tactile stimuli to quantitative electrical signals. Conventional trial-and-error designs for such devices follow a forward structure-to-property routine, which is usually time-consuming and determines one possible solution in one run. Data-driven inverse design can precisely target desired functions while showing far higher productivity, however, it is still absent for flexible pressure sensors because of the difficulties in acquiring a large amount of data. Here, we report a property-to-structure inverse design of flexible pressure sensors, exhibiting a significantly greater efficiency than the conventional routine. We use a reduced-order model that analytically constrains the design scope and an iterative "jumping-selection" method together with a surrogate model that enhances data screening. As an exemplary scenario, hundreds of solutions that overcome the intrinsic signal saturation have been predicted by the inverse method, validating for a variety of material systems. The success in property design on multiple indicators demonstrates that the proposed inverse design is an efficient and powerful tool to target multifarious applications of flexible pressure sensors, which can potentially advance the fields of intelligent robots, advanced healthcare, and human-machine interfaces.
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Affiliation(s)
- Zhiguang Liu
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230027, China
| | - Minkun Cai
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Shenda Hong
- National Institute of Health Data Science, Peking University, Beijing 100191, China
| | - Junli Shi
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Sai Xie
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Chang Liu
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Huifeng Du
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - James D Morin
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Gang Li
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Liu Wang
- Department of Modern Mechanics, University of Science and Technology of China, 230027 Hefei, China
| | - Hong Wang
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Ke Tang
- Guangdong Provincial Key Laboratory of Brain-Inspired Intelligent Computation, Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Nicholas X Fang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong 999077, China
| | - Chuan Fei Guo
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
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Lee DW, Jang HJ, Kim MS, Choi KY, Hong SA, In Y. Can a Total Knee System Providing 1 mm Increment of Polyethylene Insert Thickness Offer a Clinical Benefit? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:322. [PMID: 38399609 PMCID: PMC10890109 DOI: 10.3390/medicina60020322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The purpose of this study was to compare clinical outcomes and polyethylene (PE) insert thickness between total knee arthroplasty (TKA) systems providing 1 mm and 2 mm increments. Materials and Methods: In this randomized controlled trial, 50 patients (100 knees) undergoing same-day or staggered bilateral TKA were randomized to receive a TKA system providing 1 mm increments in one knee (1 mm group) and a TKA system providing 2 mm increments in the other knee (2 mm group). At 2 years postoperatively, Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Forgotten Joint Score (FJS), range of motion (ROM), and insert thicknesses were compared between the groups. Results: A total of 47 patients (94 knees) participated in follow-up analysis. In each group, patient-reported outcomes improved significantly after TKA (all, p < 0.05). There were no significant differences in patient-reported outcomes. The mean ROM was not significantly different between groups at preoperative and 2-year points. The rate of postoperative flexion contracture ≥ 5° was 2.1% and 4.3%, and the rate of postoperative recurvatum ≥ 5° was 4.3% and 2.1% in the 1 mm group and 2 mm, respectively (all, p = 1.000). Mean insert thickness was significantly thinner in the 1 mm group than the 2 mm group (p = 0.001). The usage rate of a thick insert (≥14 mm) was 12.7% and 38.3% in the 1 mm group and 2 mm group (p = 0.005). Conclusions: The use of a TKA system providing 1 mm PE insert thickness increments offered no clinical benefit in terms of patient reported outcomes over systems with 2 mm increments at 2 years of follow-up. However, the TKA system with 1 mm increments showed significantly thinner PE insert usage. As a theoretical advantage of 1 mm increments has yet to be proven, the mid- to long-term effects of thinner PE insert usage must be determined.
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Affiliation(s)
- Dhong-Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
| | - Hyuk-Jin Jang
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea; (H.-J.J.); (M.-S.K.); (K.-Y.C.); (S.-A.H.)
| | - Man-Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea; (H.-J.J.); (M.-S.K.); (K.-Y.C.); (S.-A.H.)
| | - Keun-Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea; (H.-J.J.); (M.-S.K.); (K.-Y.C.); (S.-A.H.)
| | - Sung-An Hong
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea; (H.-J.J.); (M.-S.K.); (K.-Y.C.); (S.-A.H.)
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea; (H.-J.J.); (M.-S.K.); (K.-Y.C.); (S.-A.H.)
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Wang J, Chu J, Song J, Li Z. The application of impantable sensors in the musculoskeletal system: a review. Front Bioeng Biotechnol 2024; 12:1270237. [PMID: 38328442 PMCID: PMC10847584 DOI: 10.3389/fbioe.2024.1270237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
As the population ages and the incidence of traumatic events rises, there is a growing trend toward the implantation of devices to replace damaged or degenerated tissues in the body. In orthopedic applications, some implants are equipped with sensors to measure internal data and monitor the status of the implant. In recent years, several multi-functional implants have been developed that the clinician can externally control using a smart device. Experts anticipate that these versatile implants could pave the way for the next-generation of technological advancements. This paper provides an introduction to implantable sensors and is structured into three parts. The first section categorizes existing implantable sensors based on their working principles and provides detailed illustrations with examples. The second section introduces the most common materials used in implantable sensors, divided into rigid and flexible materials according to their properties. The third section is the focal point of this article, with implantable orthopedic sensors being classified as joint, spine, or fracture, based on different practical scenarios. The aim of this review is to introduce various implantable orthopedic sensors, compare their different characteristics, and outline the future direction of their development and application.
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Affiliation(s)
- Jinzuo Wang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning, China
| | - Jian Chu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Jinhui Song
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning, China
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Manara JR, Goonatillake M, Marley M, Pretty W, Collopy D, Clark G. Virtual assessment of coronal balance prior to bone resection with the MAKO robotic-assisted system accurately predicts final balance in TKA. J Robot Surg 2023; 17:2849-2854. [PMID: 37776492 DOI: 10.1007/s11701-023-01705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/19/2023] [Indexed: 10/02/2023]
Abstract
Total knee arthroplasty (TKA) has traditionally relied on the surgeon's judgement and manual instruments to determine balance. The MAKO robotic system (Stryker Ltd, Kalamazoo, MI, USA) allows assessment of virtual compartmental gaps from CT-derived bone models intra-operatively as a predictor of soft tissue balance that will be achieved, prior to any bony resection. This study aims to assess the accuracy of this pre-resection balancing technique in determining the resultant final soft tissue balance of the TKA. A consecutive prospective cohort of 2027 Robotic-Assisted TKAs (RATKA) were performed between January'17 and March'22. Osteophytes were removed; initial virtual gaps on the virtual bone model were measured at 10° and 90° of flexion prior to bone resections. Optimization of the virtual component positions was then made and final pre-resection gaps were measured. The gaps were then re-assessed post-implantation and compared to the final pre-resection values. Virtual balancing in extension within 1 mm was achieved in 95% of cases. Of those, 98% maintained coronal balance within 1 mm after implantation, with 1.5% requiring a coronal plane soft tissue release. Inability to virtually balance a TKA within 2 mm prior to bone resection resulted in a soft tissue release in 44.4% of cases. The absolute values of the final gaps achieved were a mean of 1.3 mm greater than virtual gaps. The ability to balance a knee on the virtual bone model prior to bone resection, in conjunction with robotic-assisted execution of TKA, consistently achieves a balanced knee after component implantation.
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Affiliation(s)
- J R Manara
- SJOG Healthcare, Perth, WA, Australia
- Aneurin Bevan University Health Board, Caerleon, Wales
| | | | - M Marley
- SJOG Healthcare, Perth, WA, Australia
| | - W Pretty
- Perth Hip & Knee Clinic, 1/1Wexford St, Subiaco, Perth, WA, 6008, Australia
| | - D Collopy
- SJOG Healthcare, Perth, WA, Australia
- Perth Hip & Knee Clinic, 1/1Wexford St, Subiaco, Perth, WA, 6008, Australia
| | - G Clark
- SJOG Healthcare, Perth, WA, Australia.
- Perth Hip & Knee Clinic, 1/1Wexford St, Subiaco, Perth, WA, 6008, Australia.
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Kuriyama S, Nishitani K, Nakamura S, Matsuda S. An electronic force sensor accurately detects increased but not decreased soft tissue tension in total knee arthroplasty. Knee 2023; 42:210-219. [PMID: 37084481 DOI: 10.1016/j.knee.2023.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Postoperative knee instability is a leading cause of revision total knee arthroplasty (TKA). This study used a commercially available insert-shaped electronic force sensor to measure joint loads and facilitate ligament balance adjustment, and assessed the ability of this sensor to detect increased or decreased soft tissue tension during primary TKA. METHODS Changes in medial and lateral tibiofemoral joint loads during knee flexion were evaluated with sensor thicknesses ranging from 10 to 16 mm using six varus osteoarthritis cadaver knees with intact medial collateral ligaments (MCLs), and the measurements were repeated after MCL resection. Correlations between joint loads and maximum knee extension angle were also evaluated. To validate the efficacy of the sensor, the values were compared with those obtained using a conventional tension device. RESULTS For MCL-intact knees in extension, the medial joint load increased with sensor thickness. The maximum knee extension angle decreased with sensor thickness (ρ = -0.4), resulting in extension restriction up to -20°. Knee flexion contracture was below 5° when the total tibiofemoral joint load was below a cut-off of 42 lb. After the MCL was resected, medial joint loads remained unchanged at low values, even with increased sensor thickness. In contrast, the tension device clearly detected an increased gap as the degree of tension decreased. CONCLUSIONS The electronic sensor identified increased joint loads associated with increased ligament tension, and could predict knee flexion contracture during TKA. However, unlike the tension device, it did not accurately detect excessively decreased ligament tension.
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Affiliation(s)
- Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Song SJ, Kim KI, Park CH. Sensor Use in Cruciate-Retaining Total Knee Arthroplasty Compared with Posterior-Stabilized Total Knee Arthroplasty: Load Balancing and Posterior Femoral Rollback. J Knee Surg 2022; 35:1349-1356. [PMID: 33545730 DOI: 10.1055/s-0041-1723012] [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 purpose was to investigate the proportion of severe load imbalance after appropriate conventional gap balancing and analyze the intraoperative kinematics after load balancing in cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasties (TKAs). In total, 45 sensor-assisted CR and 45 PS TKAs using NexGen prosthesis were prospectively evaluated. After appropriate conventional gap balancing, the loads at 10, 45, and 90 degrees of knee flexion were evaluated with a wireless load sensor placed in trial implants. The proportion of severe load imbalance (medial load-lateral load >75 lbs) was investigated. After load balancing, location of the femorotibial contact point was investigated at each flexion angle to analyze femorotibial kinematics. The proportion of the severe load imbalance was significantly higher in CR TKAs at the 10 degrees knee flexion (37.8 vs. 15.6%, p = 0.031). This proportion was higher in CR TKAs than in PS TKAs at the 45 and 90 degrees knee flexion angles, but without statistical significance (31.1 vs. 15.6%, p = 0.134 and 33.3 vs. 15.6%, p = 0.085, respectively). After load balancing, consistent posterior femoral rollback occurred in medial and lateral compartments during 90 degrees flexion in CR TKAs (p < 0.001), but not in PS TKAs. Medial pivot kinematics was not observed in both TKA designs. The sensor was more beneficial in CR TKAs for achieving appropriate load balancing and consistent posterior femoral rollback compared with PS TKAs. Further studies are required to identify target load distribution to restore ideal knee kinematics after TKA. This study shows level of evidence II.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kang Il Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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Giuntoli M, Scaglione M, Bonicoli E, Piolanti N, Puccioni G, Zepeda K, Giannini E, Marchetti S, Indelli PF. Intraoperative Load Sensing in Total Knee Arthroplasty Leads to a Functional but Not Clinical Difference: A Comparative, Gait Analysis Evaluation. J Funct Morphol Kinesiol 2022; 7:jfmk7010023. [PMID: 35225909 PMCID: PMC8883885 DOI: 10.3390/jfmk7010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Although Total Knee Arthroplasty (TKA) is a successful procedure, a significant number of patients are still unsatisfied, reporting instability at the mid-flexion range (Mid-Flexion Instability-MFI). To avoid this complication, many innovations, including load sensors (LS), have been introduced. The intraoperative use of LS may facilitate the balance of the knee during the entire range of motion to avoid MFI postoperatively. The objective of this study was to perform a Gait Analysis (GA) evaluation of a series of patients who underwent primary TKA using a single LS technology. METHODS The authors matched and compared two groups of patients treated with the same posterior stabilized TKA design. In Group A, 10 knees were intraoperatively balanced with LS technology, while 10 knees (Group B) underwent standard TKA. The correct TKA alignment was preoperatively determined aiming for a mechanical alignment. Clinical evaluation was performed according to the WOMAC, Knee Society Score (KSS) and Forgotten Joint Score, while functional evaluation was performed using a state-of-the-art GA platform. RESULTS We reported excellent clinical results in both groups without any statistical difference in patient reported outcome measurements (PROMs); from a functional standpoint, several GA space-time parameters were closer to normal in the sensor group when compared to the standard group, but a statistically significant difference was not reached. CONCLUSIONS Gait Analysis represents a valid method to evaluate TKA kinematics. This study, with its limitations, showed that pressure sensitive technology represents a valid aid for surgeons aiming to improve the postoperative stability of TKA; however, other factors (i.e., level of intra-articular constraint and alignment) may play a major role in reproducing the normal knee biomechanics.
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Affiliation(s)
- Michele Giuntoli
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
- Correspondence:
| | - Michelangelo Scaglione
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Enrico Bonicoli
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Nicola Piolanti
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Gianmarco Puccioni
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Karlos Zepeda
- Harlem Campus, Touro College of Osteopathic Medicine, Harlem, New York, NY 10027, USA;
| | | | - Stefano Marchetti
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA;
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Ernstbrunner L, Andronic O, Grubhofer F, Jundt-Ecker M, Fucentese SF. The Effect of Patellar Positioning on Femoral Component Rotation when Performing Flexion Gap Balancing Using a Tensioning Device for Total Knee Arthroplasty. J Knee Surg 2022; 35:185-189. [PMID: 32663883 DOI: 10.1055/s-0040-1713896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is an increasing interest in new devices such as tensiometers for flexion gap balancing during total knee arthroplasty (TKA). The purpose of this study was to determine the influence of patella positioning during flexion gap balancing on femoral component rotation. We prospectively evaluated 32 consecutive knees in 31 patients who underwent primary TKA for degenerative osteoarthritis and where soft tissue balancing was performed using the same tensiometer. Preoperative measurements included valgus/varus deformation, mechanical axis, epicondylar axis, and tibial slope. Intraoperatively, measurement of femoral component rotation in 90 degrees of knee flexion was conducted in three different positions of the patella: (1) patella reduced, (2) patella dislocated but not everted, and (3) patella dislocated and everted. The femoral component had significantly higher rotation when the patella was reduced compared with a dislocated patella (4.9 ± 2.1 degrees vs. 4.2 ± 2.2 degrees; p = 0.006) and compared with a dislocated and everted patella (4.9 ± 2.1 degrees vs. 4.1 ± 2.3 degrees; p = 0.006). Varus knees (n = 22) demonstrated significantly increased femoral component rotation if the patella was reduced (5.3 ± 2.2 degrees) compared with dislocated patella without eversion (4.7 ± 2.3 degrees; p = 0.037) and with eversion (4.4 ± 2.5 degrees; p = 0.019). As such, the measurement of the mediolateral flexion gap stability with a laterally dislocated patella leads to a statistically significant overestimation of the lateral ligament stability and an underestimation of the external rotation positioning of the femoral component of approximately 1 degree, which is aggravated in varus knees. This is a Level II, prospective consecutive series study.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Switzerland
| | - Octavian Andronic
- Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Switzerland
| | - Florian Grubhofer
- Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Switzerland
| | - Michèle Jundt-Ecker
- Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Switzerland
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Yapp LZ, Robinson PG, Clement ND, Scott CEH. Total Knee Arthroplasty and Intra-Articular Pressure Sensors: Can They Assist Surgeons with Intra-Operative Decisions? Curr Rev Musculoskelet Med 2021; 14:361-368. [PMID: 34962638 PMCID: PMC8733123 DOI: 10.1007/s12178-021-09724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Soft tissue imbalance, presenting as instability or stiffness, is an important cause of revision total knee arthroplasty (TKA). Traditional methods of determining soft tissue balance of the knee lack precision and are not reliable between operators. Use of intra-operative pressure sensors offers the potential to identify and avoid soft tissue imbalance following TKA. This review aims to summarise the literature supporting the clinical indication for the use of intra-articular pressure sensors during TKA. RECENT FINDINGS Analytical validation studies suggest that intra-operative pressure sensors demonstrate 'moderate' to 'good' intra-observer reliability and 'good' to 'excellent' interobserver reliability throughout the flexion arc. However, there are important errors associated with measurements when devices are used out-with the stated guidelines and clinicians should be aware of the limitations of these devices in isolation. Current evidence regarding patient benefit is conflicting. Despite positive early results, several prospective studies have subsequently failed to demonstrate significant differences in overall survival, satisfaction, and patient-reported outcome measures within 1 year of surgery. Surgeon-defined soft tissue stability appears to be significantly different from the absolute pressures measured by the intra-operative sensor. Whilst it could be argued that this confirms the need for intra-articular sensor guidance in TKA; the optimal 'target' balance remains unclear and the relationship with outcome in patients is not determined. Future research should (1) identify a suitable reference standard for comparison; (2) improve the accuracy of the sensor outputs; and (3) demonstrate that sensor-assisted TKA leads to patient benefit in patient-reported outcome measures and/or enhanced implant survival.
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Affiliation(s)
- Liam Z. Yapp
- Department of Orthopaedics, Deanery of Clinical Sciences, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SY UK
| | - Patrick G. Robinson
- Department of Orthopaedics, Deanery of Clinical Sciences, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SY UK
| | - Nicholas D. Clement
- Department of Orthopaedics, Deanery of Clinical Sciences, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SY UK
| | - Chloe E. H. Scott
- Department of Orthopaedics, Deanery of Clinical Sciences, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SY UK
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Current role of intraoperative sensing technology in total knee arthroplasty. Arch Orthop Trauma Surg 2021; 141:2255-2265. [PMID: 34427757 DOI: 10.1007/s00402-021-04130-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Sensors have been introduced within the last 10 years to quantify soft tissue balancing during total knee arthroplasty (TKA) and to give the surgeon objective data. These devices are fairly new and their impact on patient outcome remains uncertain. The aim of this systematic review was to summarize all the relevant surgical and clinical results of sensors for TKA. METHODS A PRISMA systematic review was conducted using five databases (PubMed, EMBASE, MEDLINE, GOOGLE SCHOLAR, and the COCHRANE LIBRARY) to identify all available literature that described the surgical and clinical results of sensors for TKA between 2000 and 2021. The main investigated outcome criteria were intraoperative data, postoperative functional and clinical outcome, knee range of motion, complications and revision rates. RESULTS Twenty-seven articles were finally included. The maximum reported follow-up was 26 months. A balanced knee with sensor corresponded to a mediolateral difference inferior to 15 lb and a stable posterior drawer test. The standard assessment of knee balance was a poor predictor of the true soft tissue balance when compared to sensor data. At least 60% of TKA needed an additional rebalancing procedure with the sensor, after conventional gap balancing. Achieving a quantitatively balanced knee resulted in a significantly higher patient satisfaction score. But the prospective comparative studies found no demonstrable improvement in clinical outcome, range of motion or complication rate at one year postoperatively for patients undergoing TKA using sensor-guided balancing compared with routine techniques. CONCLUSION Even though the use of the intraoperative sensing technology was not related to an improvement in clinical outcome, the current studies showed that using sensors facilitates the reproduction of natural joint stability, and improves the rate of achieving a balanced knee. Sensor use in complex cases could be particularly valuable, but their use in standard practice remains to be defined.
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Allom RJ, Wood JA, Chen DB, MacDessi SJ. Tibiofemoral dynamic stressed gap laxities correlate with compartment load measurements in robotic arm-assisted total knee arthroplasty. Bone Jt Open 2021; 2:974-980. [PMID: 34818899 PMCID: PMC8636298 DOI: 10.1302/2633-1462.211.bjo-2021-0066.r1] [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] [Indexed: 11/05/2022] Open
Abstract
Aims It is unknown whether gap laxities measured in robotic arm-assisted total knee arthroplasty (TKA) correlate to load sensor measurements. The aim of this study was to determine whether symmetry of the maximum medial and lateral gaps in extension and flexion was predictive of knee balance in extension and flexion respectively using different maximum thresholds of intercompartmental load difference (ICLD) to define balance. Methods A prospective cohort study of 165 patients undergoing functionally-aligned TKA was performed (176 TKAs). With trial components in situ, medial and lateral extension and flexion gaps were measured using robotic navigation while applying valgus and varus forces. The ICLD between medial and lateral compartments was measured in extension and flexion with the load sensor. The null hypothesis was that stressed gap symmetry would not correlate directly with sensor-defined soft tissue balance. Results In TKAs with a stressed medial-lateral gap difference of ≤1 mm, 147 (89%) had an ICLD of ≤15 lb in extension, and 112 (84%) had an ICLD of ≤ 15 lb in flexion; 157 (95%) had an ICLD ≤ 30 lb in extension, and 126 (94%) had an ICLD ≤ 30 lb in flexion; and 165 (100%) had an ICLD ≤ 60 lb in extension, and 133 (99%) had an ICLD ≤ 60 lb in flexion. With a 0 mm difference between the medial and lateral stressed gaps, 103 (91%) of TKA had an ICLD ≤ 15 lb in extension, decreasing to 155 (88%) when the difference between the medial and lateral stressed extension gaps increased to ± 3 mm. In flexion, 47 (77%) had an ICLD ≤ 15 lb with a medial-lateral gap difference of 0 mm, increasing to 147 (84%) at ± 3 mm. Conclusion This study found a strong relationship between intercompartmental loads and gap symmetry in extension and flexion measured with prostheses in situ. The results suggest that ICLD and medial-lateral gap difference provide similar assessment of soft-tissue balance in robotic arm-assisted TKA. Cite this article: Bone Jt Open 2021;2(11):974–980.
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Affiliation(s)
| | - Jil A Wood
- Sydney Knee Specialists, Kogarah, New South Wales, Australia
| | - Darren B Chen
- Sydney Knee Specialists, Kogarah, New South Wales, Australia
| | - Samuel J MacDessi
- Sydney Knee Specialists, Kogarah, New South Wales, Australia.,University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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Wang Q, Zhang X. [Optimal lower limb alignment and soft tissue balancing strategy for robot-assisted total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1221-1226. [PMID: 34651472 DOI: 10.7507/1002-1892.202107069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Lower limb alignment and soft tissue balance are important factors affecting patient satisfaction, clinical functional outcome, and prosthetic long-term survival rate after total knee arthroplasty (TKA). Robot-assisted TKA (rTKA) has the advantages of achieving precise osteotomy and soft tissue balance. However, rTKA under the guidance of classic mechanical alignment principles does not significantly improve the functional outcome after operation. The new TKA alignment principles, such as kinematic alignment (KA) and functional alignment (FA), can better consider the patient's own knee joint morphology and kinematic characteristics, which may help improve the clinical results of TKA. With the help of more objective and accurate soft tissue balance assessment tool such as pressure sensors, KA and FA have been proven to better achieve soft tissue balance. rTKA can achieve non-neutral alignment goals such as KA or FA more accurately and reproducibly. The use of these lower limb alignment and soft tissue balancing strategies will be expected to further increase the patients' satisfaction rate after rTKA.
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Affiliation(s)
- Qiaojie Wang
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Xianlong Zhang
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
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Sherman WF, Freiberger C. Use of Fulcrum Positioning as a Balancing Tool During Total Knee Arthroplasty on a Robotic Platform. Arthroplast Today 2021; 8:176-180. [PMID: 33869700 PMCID: PMC8042414 DOI: 10.1016/j.artd.2021.03.002] [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: 11/07/2020] [Revised: 12/23/2020] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Abstract
Total knee arthroplasty is a common procedure performed to improve pain and dysfunction attributed to arthritis, yet postoperative patient dissatisfaction rates remain relatively high. Patient satisfaction and outcomes have been linked to successful joint gap balancing in the coronal and sagittal planes intraoperatively. In previously described balancing techniques, the fulcrum used for alignment changes is customarily centered on the intramedullary axis generating symmetric changes in medial and lateral gaps. We propose a novel technique in the literature that, with the use of robotic-arm assisted technology or similar systems, allows manipulation of the fulcrum center of rotation during pre-resection planning and intraoperative gap establishment before bony cuts to asymmetrically influence medial and lateral, flexion and extension gaps to aid in balancing during total knee arthroplasty.
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Affiliation(s)
- William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Christina Freiberger
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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14
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Park CH, Song SJ. Sensor-Assisted Total Knee Arthroplasty: A Narrative Review. Clin Orthop Surg 2021; 13:1-9. [PMID: 33747371 PMCID: PMC7948048 DOI: 10.4055/cios20034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/17/2020] [Indexed: 01/20/2023] Open
Abstract
Wireless intraoperative load sensors have been used to improve the quality of soft-tissue balancing during total knee arthroplasty(TKA). Recent studies using the sensors have demonstrated reductions in gap imbalance, as well as early improvement of patient-reported clinical outcomes and low rates of arthrofibrosis. However, well-designed prospective studies are needed to determine whether the application of the sensor technology for TKA will have clinical benefits and improve the survival of prosthesis. Knowledge of the load-sensing technology (advantages and disadvantages, potential pitfalls, and future prediction) is crucial to apply this new TKA technique successfully. Herein, we conduct a narrative review of previous studies on this technique.
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Affiliation(s)
- Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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15
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Batailler C, Swan J, Sappey Marinier E, Servien E, Lustig S. New Technologies in Knee Arthroplasty: Current Concepts. J Clin Med 2020; 10:jcm10010047. [PMID: 33375702 PMCID: PMC7795103 DOI: 10.3390/jcm10010047] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
Total knee arthroplasty (TKA) is an effective treatment for severe osteoarthritis. Despite good survival rates, up to 20% of TKA patients remain dissatisfied. Recently, promising new technologies have been developed in knee arthroplasty, and could improve the functional outcomes. The aim of this paper was to present some new technologies in TKA, their current concepts, their advantages, and limitations. The patient-specific instrumentations can allow an improvement of implant positioning and limb alignment, but no difference is found for functional outcomes. The customized implants are conceived to reproduce the native knee anatomy and to reproduce its biomechanics. The sensors have to aim to give objective data on ligaments balancing during TKA. Few studies are published on the results at mid-term of these two devices currently. The accelerometers are smart tools developed to improve the TKA alignment. Their benefits remain yet controversial. The robotic-assisted systems allow an accurate and reproducible bone preparation due to a robotic interface, with a 3D surgical planning, based on preoperative 3D imaging or not. This promising system, nevertheless, has some limits. The new technologies in TKA are very attractive and have constantly evolved. Nevertheless, some limitations persist and could be improved by artificial intelligence and predictive modeling.
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Affiliation(s)
- Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, 69004 Lyon, France; (J.S.); (E.S.M.); (E.S.); (S.L.)
- Service de Chirurgie Orthopédique, Université de Lyon, Université Claude Bernard Lyon 1, LBMC UMR_T9406, 69003 Lyon, France
- Cécile BATAILLER, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
- Correspondence:
| | - John Swan
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, 69004 Lyon, France; (J.S.); (E.S.M.); (E.S.); (S.L.)
| | - Elliot Sappey Marinier
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, 69004 Lyon, France; (J.S.); (E.S.M.); (E.S.); (S.L.)
- Service de Chirurgie Orthopédique, Université de Lyon, Université Claude Bernard Lyon 1, LBMC UMR_T9406, 69003 Lyon, France
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, 69004 Lyon, France; (J.S.); (E.S.M.); (E.S.); (S.L.)
- EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, 69100 Villeurbanne, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, 69004 Lyon, France; (J.S.); (E.S.M.); (E.S.); (S.L.)
- Service de Chirurgie Orthopédique, Université de Lyon, Université Claude Bernard Lyon 1, LBMC UMR_T9406, 69003 Lyon, France
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Song SJ, Kim KI, Park CH. Comparison of the contact stress between the sensor and real polyethylene insert in total knee arthroplasty: a finite element analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1424. [PMID: 33313169 PMCID: PMC7723577 DOI: 10.21037/atm-20-3011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background In implants, sensors are made of an acrylic-like plastic, while polyethylene (PE) inserts are made of ultra-high-molecular-weight PE (UHMPE). Thus, the stress distribution on the sensor may be different from that on the PE insert due to variations in material properties. The present study sought to analyze and compare the stress distribution profile between the sensor and PE insert after total knee arthroplasty (TKA). Methods Finite element analysis was performed to estimate contact stress between the sensor and PE insert after TKA. The materials of the femoral component, sensor, and PE insert were determined as cobalt-chrome-molybdenum, acryl plastic, and UHMWPE, respectively. The stiffness levels of medial and lateral soft tissue were set at 28.8 N/mm and 18.8 N/mm at knee flexion and 24.7 N/mm and 17.2 N/mm at knee extension, respectively. The average and peak contact stress levels on the sensor and PE were analyzed in knee flexion and extension. Results The average amount of contact stress in the medial compartment was 43.4 MPa on the sensor and 31.9 MPa on the PE insert at knee extension. Meanwhile, the medial compartmental peak contact stress levels were 55.2 MPa on the sensor and 48.8 MPa on the PE insert at knee extension. The other values of average and peak contact stress among the two materials were less than 5 MPa. Conclusions There was a difference in the contact stress distribution between the sensor and PE insert due to material properties, especially in the medial compartment at knee extension. The development of a sensor composed of a material with properties similar to a PE insert would be useful in the prediction of femorotibial contact stress in real implants.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kang Il Kim
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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