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Dong M, Fan H, Yang D, Sun X, Yan C, Feng Y. Comparison of spatiotemporal, kinematic, and kinetic gait characteristics in total and unicompartmental knee arthroplasty during level walking: A systematic review and meta-analysis. Gait Posture 2023; 104:58-69. [PMID: 37321113 DOI: 10.1016/j.gaitpost.2023.06.005] [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: 09/29/2022] [Revised: 03/26/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE This meta-analysis was performed to compare the spatiotemporal, kinematic, and kinetic gait characteristics during level walking between total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). METHODS An electronic database literature search was performed to screen clinical trials which were included the studies evaluating not only spatiotemporal, kinematic, and kinetic gait parameters, but also knee range of motion and knee score (Knee Society Score and Oxford Knee Score, i.e., KSS and OKS). The data analysis was performed using statistical software Stata 14.0 and Review Manager 5.4. RESULTS Thirteen studies (369 knees) that met the criteria were eventually included in this meta-analysis. The results revealed significant differences between UKA and TKA with regard to walking speed (P = 0.04), stride length (P = 0.02), maximum knee flexion at loading (P = 0.001), the 1st peak of vert-GRF (P = 0.006), the 1st valley of vert-GRF (P = 0.007), knee internal rotational moment (P = 0.04), knee extension (P < 0.00001), and KSS Function score (P = 0.05). In contrast, there were no statistical differences in the remaining spatiotemporal, kinematic, and kinetic gait parameters. CONCLUSION Medial UKA design is superior to TKA design with regard to walking speed, stride length, maximum knee flexion at loading, the 1st peak and the 1st valley of vert-GRF, knee internal rotational moment, knee extension, and KSS Function score. And it could provide a stronger basis for physicians to make clinical decisions.
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Affiliation(s)
- Mingjie Dong
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Hao Fan
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Dinglong Yang
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Xiaoyu Sun
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Chaochao Yan
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Yi Feng
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, 030000 Taiyuan, China.
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Plancher KD, Briggs KK, Chinnakkannu K, Dotterweich KA, Commaroto SA, Wang KH, Petterson SC. Isolated Lateral Tibiofemoral Compartment Osteoarthritis: Survivorship and Patient Acceptable Symptom State After Lateral Fixed-Bearing Unicompartmental Knee Arthroplasty at Mean 10-Year Follow-up. J Bone Joint Surg Am 2022; 104:1621-1628. [PMID: 35766399 DOI: 10.2106/jbjs.21.01523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral unicompartmental knee arthroplasty (UKA) is an excellent option to alleviate disability and restore function in patients with lateral compartment knee osteoarthritis (OA). The purpose of the present study was to determine the survivorship and long-term outcomes in both younger/middle-aged and older patients with lateral compartment OA following non-robotically-assisted, fixed-bearing lateral UKA and to determine if an acceptable symptom state can be achieved. METHODS All patients were managed with fixed-bearing lateral UKA by a single surgeon utilizing a lateral parapatellar approach without robotic assistance. The primary outcome variables were the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living (ADL) and Sport subscale scores. In addition, the other KOOS subscores, the Lysholm score, the achievement of the Patient Acceptable Symptom State (PASS), and the Veterans RAND (VR-12) Physical Component Summary score (PCS) and Mental Component Summary score (MCS) were collected. Failure was defined as conversion to total knee arthroplasty (TKA). Patients were divided into 2 cohorts: younger/middle-aged patients (<60 years of age) and older patients (≥60 years of age). RESULTS A cohort of 256 patients underwent medial (n = 193) or lateral (n = 63) UKA. Sixty-one patients met the inclusion criteria. At mean of 10 years (range, 4 to 17 years) of follow-up, there were no significant differences between the groups in terms of any patient-reported outcome measures (p > 0.05). The percentage of patients in whom PASS was achieved on the KOOS ADL and Sport subscores was 82% and 88%, respectively, in the younger cohort and 80% and 80%, respectively, in the older cohort. The mean survival estimate of the prothesis was 15.3 years (95% confidence interval [CI], 14.5 to 16.2 years) for the entire cohort. The estimated rate of implant survival in the younger cohort was 100% at 5 and 10 years, and the estimated rate of implant survival in the older cohort was 98% at 5 years and 96% at 10 years. CONCLUSIONS Lateral fixed-bearing, non-robotic UKA for the treatment of isolated lateral compartment OA resulted in >80% of patients reaching an acceptable symptom state in terms of both activities of daily living and sporting activities. UKA provides an excellent option that provides longevity with high PASS rates and return to activities with a low risk of complications and failure. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.,Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY.,Plancher Orthopaedics & Sports Medicine, New York, NY.,Orthopaedic Foundation, Stamford, Connecticut
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Shen G, Shen D, Fang Y, Li X, Cui L, Wei B, Wu L. Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis. Orthop Surg 2022; 14:1549-1557. [PMID: 35611758 PMCID: PMC9363736 DOI: 10.1111/os.13311] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 12/01/2022] Open
Abstract
As more high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are performed, orthopaedic surgeons realize that more HTO and UKA failures will require revision to total knee arthroplasty (TKA) in the future. To systematically evaluate the clinical outcomes of TKA after HTO and TKA after UKA, the Embase, PubMed, Ovid, Web of Science, and Cochrane Library databases were searched for studies investigating revision TKA after HTO and UKA published up to June 2021. RevMan version 5.3 was used to perform the meta‐analysis. The revision TKA after HTO and revision TKA after UKA groups were compared in terms of operative time, range of motion (ROM), knee score, postoperative complications, postoperative infection, revision, and revision implants used. Nine studies were ultimately included in the meta‐analysis. Results revealed that the knee score for the revision TKA after HTO group was better than that of the revision TKA after UKA group (MD 4.50 [95% CI 0.80–8.20]; p = 0.02). The revision TKA after HTO group had a lower revision rate (OR 0.65 [95% CI 0.55–0.78]; p < 0.00001) and fewer revision implants used (OR 0.11 [95% CI 0.05–0.23]; p < 0.00001). There were no statistical differences in operation time (MD ‐2.00 [95% CI −11.22 to 7.21]; p = 0.67), ROM (MD ‐0.04 [95% CI ‐3.69–3.61]; p = 0.98), postoperative complications (OR 1.41 [95% CI 0.77–2.60]; p = 0.27), or postoperative infections (OR 0.89 [95% CI 0.61–1.29]; p = 0.53). To conclude, the revision rate of revision TKA after UKA was greater, and more revision implants were required. It is important for orthopaedic surgeons to preserve bone during primary UKA.
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Affiliation(s)
- Gaobo Shen
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Danhong Shen
- Nanjing University of Science and Technology, Nanjing, China
| | - Yuan Fang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuefei Li
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Longkang Cui
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bing Wei
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lianguo Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Xuequan Z, Bin Z, Shuzhang Y, Kanduo C, Chongxi R. Measurement for gap balancing technique in patients undergoing total knee arthroplasty: a large retrospective observational study. J Orthop Surg Res 2022; 17:209. [PMID: 35392951 PMCID: PMC8991780 DOI: 10.1186/s13018-022-03104-6] [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: 12/06/2021] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Many traditional methods are available to prevent unbalance of extension and flexion gap during total knee arthroplasty (TKA), but there are no reports on the use of measurement and positioning method before tibial osteotomy with self-made tools. We designed a self-made tool measuring the location before tibial osteotomy and determined the clinical effect. Methods The retrospective study included patients who received TKA at our hospital, between January 1, 2012 and December 31, 2015. A new method, named as the measurement and localization before osteotomy with self-made tools, was developed to measure the osteotomy position of the posterior femoral condyle during TKA. They were divided into two groups, one that received the new method (Group I), and the other that received the traditional method as a control (Group I I). HSS score, Oxford score, VAS score and knee joint activity were evaluated in two groups. Results One hundred and eighty-seven of 210 eligible patients were included. The function of knee joint in all patients was improved and the pain was obviously relieved. Significant differences were found in the HSS score, Oxford score, VAS score, knee joint activity between two groups at 5-year follow-up (p < 0.05). Conclusions The biomet knee prosthesis was selected for all intraoperative implants. All operations were completed by the same senior surgeon. The use of self-made tools may contribute to improve the balance between flexion and extension gaps as well as the balance between internal and external gaps during TKA, and overcome knee flexion instability.
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Affiliation(s)
- Zhao Xuequan
- Department of Orthopaedics, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Qian Tong North Street No. 17, Cangzhou City, 061000, Hebei Province, China.
| | - Zhao Bin
- Department of Orthopaedics, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Qian Tong North Street No. 17, Cangzhou City, 061000, Hebei Province, China
| | - Yao Shuzhang
- Department of Orthopaedics, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Qian Tong North Street No. 17, Cangzhou City, 061000, Hebei Province, China
| | - Cao Kanduo
- Department of Orthopaedics, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Qian Tong North Street No. 17, Cangzhou City, 061000, Hebei Province, China
| | - Ren Chongxi
- Department of Oncology Surgery, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, 061000, China
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Liu B, Feng C, Tu C. Kinematic alignment versus mechanical alignment in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials. J Orthop Surg Res 2022; 17:201. [PMID: 35379289 PMCID: PMC8981671 DOI: 10.1186/s13018-022-03097-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/23/2022] [Indexed: 01/02/2023] Open
Abstract
Background The purpose of this study was to perform an updated meta-analysis to compare the outcomes of kinematic alignment (KA) and mechanical alignment (MA) in patients undergoing total knee arthroplasty. Methods PubMed, EMBASE, Web of Science, Google Scholar, and the Cochrane Library were systematically searched. Eligible randomized controlled trials regarding the clinical outcomes of patients undergoing total knee arthroplasty with KA and MA were included for the analysis. Results A total of 1112 participants were included in this study, including 559 participants with KA and 553 patients with MA. This study revealed that the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society Score (knee and combined), and knee flexion range were better in the patients with kinematic alignment than in the mechanical alignment. In terms of radiological results, the femoral knee angle, mechanical medial proximal tibial angle, and joint line orientation angle were significantly different between the two techniques. Perioperatively, the walk distance before discharge was longer in the KA group than in the MA group. In contrast, other functional outcomes, radiological results, perioperative outcomes, and postoperative complication rates were similar in both the kinematic and mechanical alignment groups. Conclusions The KA technique achieved better functional outcomes than the mechanical technique in terms of KSS (knee and combined), WOMAC scores, and knee flexion range. PROSPERO trial registration number CRD42021264519. Date registration: July 28, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03097-2.
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Affiliation(s)
- Binfeng Liu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan, Zhengzhou, 450003, China.,Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Chengyao Feng
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Chao Tu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Zhao C, Wang Y, Wu X, Zhu G, Shi S. Design and evaluation of an intelligent reduction robot system for the minimally invasive reduction in pelvic fractures. J Orthop Surg Res 2022; 17:205. [PMID: 35379278 PMCID: PMC8981738 DOI: 10.1186/s13018-022-03089-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Pelvic fracture is a severe high-energy injury with the highest disability and mortality of all fractures. Traditional open surgery is associated with extensive soft tissue damages and many complications. Minimally invasive surgery potentially mitigates the risks of open surgical procedures and is becoming a new standard for pelvic fracture treatment. The accurate reduction has been recognized as the cornerstone of minimally invasive surgery for pelvic fracture. At present, the closed reduction in pelvic fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces of soft tissue involved in the fragment manipulation, which might result in fracture malreduction. To overcome these shortcomings and facilitate pelvic fracture reduction, we developed an intelligent robot-assisted fracture reduction (RAFR) system for pelvic fracture. Methods The presented method is divided into three parts. The first part is the preparation of 20 pelvic fracture models. In the second part, we offer an automatic reduction algorithm of our robotic reduction system, including Intraoperative real-time 3D navigation, reduction path planning, control and fixation, and robotic-assisted fracture reduction. In the third part, image registration accuracy and fracture reduction accuracy were calculated and analyzed. Results All 20 pelvic fracture bone models were reduced by the RAFR system; the mean registration error E1 of the 20 models was 1.29 ± 0.57 mm. The mean reduction error E2 of the 20 models was 2.72 ± 0.82 mm. The global error analysis of registration and reduction results showed that higher errors are mainly located at the edge of the pelvis, such as the iliac wing. Conclusion The accuracy of image registration error and fracture reduction error in our study was excellent, which could reach the requirements of the clinical environment. Our study demonstrated the precision and effectiveness of our RAFR system and its applicability and usability in clinical practice, thus paving the way toward robot minimally invasive pelvic fracture surgeries.
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Affiliation(s)
- Chunpeng Zhao
- Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Xinbao Wu
- Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Gang Zhu
- Rossum Robot Co., Ltd., Beijing, 100083, China
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Ma P, Muheremu A, Zhang S, Zheng Q, Wang W, Jiang K. Biomechanical effects of fixed-bearing femoral prostheses with different coronal positions in medial unicompartmental knee arthroplasty. J Orthop Surg Res 2022; 17:150. [PMID: 35264185 PMCID: PMC8905781 DOI: 10.1186/s13018-022-03037-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background To study the biomechanical effects of femoral prostheses at different coronal positions using finite element analysis and provide a clinical reference for unicompartmental knee arthroplasty (UKA). Methods A normal knee joint model was established and verified, establishing 13 working conditions for the femoral prosthesis: the standard position, varus and valgus angles of 3°, 6° and 9° and medial and lateral translations of 1 mm, 3 mm and 5 mm. The stress changes at different positions were analysed, including the polyethylene (PE) insert upper surface, the surface of lateral compartment cartilage and the surface of cancellous bone under tibial prosthesis. Results The stresses on the PE insert upper surface and the cancellous bone surface increased with increasing femoral prosthesis valgus/varus, and the stress increased gradually during medial to lateral translation. The stress change is more significant during valgus and lateral translation. However, the stress on the cartilage surface decreases in the process of varus to valgus and medial translation to lateral translation. Conclusion The fixed-bearing femoral prosthesis of the medial UKA should avoid translation or varus/valgus tilt on the coronal plane as much as possible. The obvious misalignment of the femoral prosthesis will significantly affect the stress on the internal structure of the knee joint, especially the PE insert and cartilage surface. A femoral prosthesis coronal tilt of more than 6° may significantly increase the stress on the PE surface, and varus of more than 6° may significantly increase the stress on the cartilage surface. For the femoral prosthesis position at the distal end of the femoral condyle, it is recommended to be placed in the centre.
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Affiliation(s)
- Pengcheng Ma
- Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, 39 Wuxing Nan Rd, Tianshan District, Ürümqi, 830001, Xinjiang, People's Republic of China
| | - Aikeremujiang Muheremu
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830001, Xinjiang, People's Republic of China
| | - Siping Zhang
- Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, 39 Wuxing Nan Rd, Tianshan District, Ürümqi, 830001, Xinjiang, People's Republic of China
| | - Qian Zheng
- Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, 39 Wuxing Nan Rd, Tianshan District, Ürümqi, 830001, Xinjiang, People's Republic of China
| | - Wei Wang
- Urumqi DW Innovation InfoTech Co., Ltd., Ürümqi, 830001, Xinjiang, People's Republic of China
| | - Kan Jiang
- Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, 39 Wuxing Nan Rd, Tianshan District, Ürümqi, 830001, Xinjiang, People's Republic of China.
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Lin B, Jin D, Socorro Borges MA. 3D surface reconstruction of the femur and tibia from parallel 2D contours. J Orthop Surg Res 2022; 17:145. [PMID: 35248091 PMCID: PMC8898446 DOI: 10.1186/s13018-022-02994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Segmented structures, such as bones, are typically stored as 2D contours contained on evenly spaced images (slices). Contour interpolation algorithms to turn 2D contours into a 3D surface may differ in their results, causing discrepancies in analysis. This study aimed to create an accurate and consistent algorithm for the interpolation of femur and tibial contours that can be used in computer-assisted surgical navigation systems.
Methods The implemented algorithm performs contour interpolation in a step-by-step manner, determining an optimal surface between each pair of consecutive contours. Determining such a surface is reduced to the problem of finding certain minimum-cost cycles in a directed toroidal graph. The algorithm assumes that the contours are ordered. The first step in the algorithm is the determination of branching patterns, followed by the removal of keyholes from contours, optimization of a target function based on the surface area, and mesh triangulation based on the optimization results and mesh seal. Results The algorithm was tested on contours segmented on computed tomography images from femoral and tibial specimens; it was able to generate qualitatively good 3D meshes from the set of 2D contours for all the tested examples. Conclusion The contour interpolation algorithm proved to be quite effective using optimization based on minimizing the area of the triangles that form the 3D surface. The algorithm can be used for the 3D reconstruction of other types of 2D cuts, but special attention must be paid with the branches, since the proposed algorithm is not designed for complex branching structures.
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Sanz-Ruiz P, León-Román VE, Matas-Diez JA, Villanueva-Martínez M, Vaquero J. Long-term outcomes of one single-design varus valgus constrained versus one single-design rotating hinge in revision knee arthroplasty after over 10-year follow-up. J Orthop Surg Res 2022; 17:135. [PMID: 35246182 PMCID: PMC8896104 DOI: 10.1186/s13018-022-03026-3] [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: 01/10/2022] [Accepted: 02/18/2022] [Indexed: 08/30/2023] Open
Abstract
Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessitating the use of the lowest possible constraint. This study aimed to compare the long-term clinical and survival results of revision with rotation hinge knee (RHK) VS constrained condylar constrained knee (CCK) implants. Methods Overall, 117 revision case were prospectively reviewed and dividing into two groups based on the degree of constraint used, using only one prosthetic model in each group (61 CCK vs 56 RHK). All implants were evaluated for a minimum of 10 years. Survival of both implants at the end of follow-up, free from revision for any cause, aseptic loosening, and septic cause was compared. Results Better results were seen with use of the RHK in joint ranges of (p = 0.023), KSCS (p = 0.015), KSFS (p = 0.043), and KOOS (p = 0.031). About 22.2% of the cases required repeat surgery (11.7% RHK vs 29.6% CCK, p = 0.023). Constrained condylar implants had a significantly lower survival rates than rotating hinge implants (p = 0.005), due to a higher aseptic loosening rate (p = 0.031). Conclusion Using a specific RHK design with less rotational constraint has better clinical and survival outcomes than implants with greater rotational constraint, such as one specific CCK.
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Affiliation(s)
- Pablo Sanz-Ruiz
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo nº 46, 28007, Madrid, Spain. .,Faculty of Medicine, Complutense University of Madrid, Pza. Ramón y Cajal, Square, University City, 28040, Madrid, Spain.
| | - Víctor Estuardo León-Román
- Department of Traumatology and Orthopaedic Surgery, Villalba Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Collado Villalba, Spain
| | - José Antonio Matas-Diez
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo nº 46, 28007, Madrid, Spain
| | | | - Javier Vaquero
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo nº 46, 28007, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Pza. Ramón y Cajal, Square, University City, 28040, Madrid, Spain
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Comparison of computer-assisted navigated technology and conventional technology in unicompartmental knee arthroplasty: a meta-analysis. J Orthop Surg Res 2022; 17:123. [PMID: 35209906 PMCID: PMC8867766 DOI: 10.1186/s13018-022-03013-8] [Citation(s) in RCA: 1] [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: 10/26/2021] [Accepted: 02/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Though unicompartmental knee arthroplasty (UKA) is a useful procedure to treat knee osteoarthritis, it remains a great controversial point as to if navigated systems are able to achieve better accuracy of limb alignment and greater clinic results. Current meta-analysis was conducted to explore if better clinical outcomes and radiographic outcomes could be acquired in the navigated system when compared with conventional procedures. Methods We identified studies in the online databases, including Medline, Embase, the Cochrane Library and Web of Science before May 2021. The PRISMA guidelines in this report were strictly followed. Our research was completed via Review Manager 5.4 software. Results Fourteen articles were included, involving 852 knees. The present meta-analysis displayed that the navigated system had remarkably improved outcomes in inliers of mechanical axis (MA) (P < 0.01), MA in the Kennedy's central zone (Zone C) (P = 0.04), inliers of the coronal femoral component (P < 0.01), inliers of the coronal tibial component (P = 0.005), inliers of the sagittal femoral component (P = 0.03), inliers of the sagittal tibial component (P = 0.002) and Range Of Motion (ROM) (P = 0.04). No significant differences were observed in Oxford Knee Score (OKS) (P = 0.15), American Knee Society Knee Score (KSS score) (P = 0.61) and postoperative complications (P = 0.73) between these 2 groups. Regarding operating time, the navigated group was 10.63 min longer in contrast to the traditional group. Conclusion Based on our research, the navigated system provided better radiographic outcomes and no significant difference in the risk of complications with longer surgical time than the conventional techniques. But no significant differences were found in functional outcomes. Because the included studies were small samples and short-term follow-up, high-quality RCTs with large patients and sufficient follow-up are required to identify the long-term effect of the navigated system.
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