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Laitinen MK. CORR Insights®: How Does Customized Cutting Guide Design Affect Accuracy and Ergonomics in Pelvic Tumor Resection? A Study in Cadavers. Clin Orthop Relat Res 2024; 482:1003-1005. [PMID: 38502816 PMCID: PMC11124704 DOI: 10.1097/corr.0000000000003048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Minna K Laitinen
- Head of the Orthopaedic and Traumatology Department, Helsinki University Central Hospital, Helsinki, Finland
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2
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Constantinescu DS, Costello JP, Yakkanti RR, Vanden Berge DJ, Carvajal Alba JA, Hernandez VH, D'Apuzzo MR. Lower Perioperative Complication Rates and Shorter Lengths of Hospital Stay Associated With Technology-Assisted Total Knee Arthroplasty Versus Conventional Instrumentation in Primary Total Knee Arthroplasty. J Arthroplasty 2024; 39:1512-1517. [PMID: 38103801 DOI: 10.1016/j.arth.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The use of technology allows increased precision in component positioning in total knee arthroplasty (TKA). The objectives of this study were to compare (1) perioperative complications and (2) resource utilization between robotic-assisted (RA) and computer-navigated (CN) versus conventional (CI) TKA. METHODS A retrospective cohort study was performed using a national database to identify patients undergoing unilateral, primary elective TKA from January 2016 to December 2019. A total of 2,174,685 patients were identified and included RA (69,445), CN (112,225), or CI (1,993,015) TKA. Demographics, complications, lengths of stay, dispositions, and costs were compared between the cohorts. Binary logistic regression analysis was performed. RESULTS The RA TKA cohort had lower rates of intraoperative fracture (0.05 versus 0.08%, P < .05), respiratory complications (0.6 versus 1.1%, P < .05), renal failure (1.3 versus 1.7%, P < .05), delirium (0.1 versus 0.2%, P < .05), gastrointestinal complications (0.04 versus 0.09%, P < .05), postoperative anemia (8.9 versus 13.9%, P < .05), blood transfusion (0.4 versus 0.9%, P < .05), pulmonary embolism, and deep vein thrombosis (0.1 versus 0.2%, P < .05), and mortality (0.01 versus 0.02%, P < .05) compared to conventional TKA, though the cohort did have higher rates of myocardial infarction (0.09 versus 0.07%, P < .05). The CN cohort had lower rates of myocardial infarction (0.02 versus 0.07%, P < .05), respiratory complications (0.8 versus 1.1%, P < .05), renal failure (1.5 versus 1.7%, P < .05), blood transfusion (0.8 versus 0.9%, P < .05), pulmonary embolism (0.08 versus 0.2%, P < .05), and deep vein thrombosis (0.2 versus 0.2%, P < .05) over CI TKA. Total cost was increased in RA (16,190 versus $15,133, P < .05) and CN (17,448 versus $15,133, P < .05). However, the length of hospital stay was decreased in both RA (1.8 versus 2.2 days, P < .05) and CN (2.1 versus 2.2 days, P < .05). CONCLUSIONS Technology-assisted TKA was associated with lower perioperative complication rates and faster recovery.
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Affiliation(s)
| | | | - Ramakanth R Yakkanti
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Jefferson Health, Philadelphia, Pennsylvania
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Marrero CE, Willard J. Case Report: Total Knee Arthroplasty in Ipsilateral Below-Knee Amputee. J Orthop Case Rep 2024; 14:7-12. [PMID: 38681930 PMCID: PMC11043974 DOI: 10.13107/jocr.2024.v14.i04.4340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/05/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Total knee arthroplasty (TKA) has the highest annual incidence among all joint replacement surgeries. Below-knee amputation (BKA) is another common procedure to treat lower-limb-threatening pathologies. These two procedures are commonly performed individually, but an ipsilateral TKA performed on a BKA patient is rare. While ipsilateral amputation is not a contraindication for TKA, it presents orthopaedic surgeons with a unique case and necessitates thoughtful pre-operative planning regarding proper positioning, alignment determination, surgical technique, and rehabilitation for the best outcome. Objectives We present a case of a patient with a BKA who underwent ipsilateral TKA. Case Report This patient has a history of osteoarthritis (OA) of the right knee and diabetic neuropathy and underwent a right BKA after sustaining second-degree thermal burns to the bilateral forefeet. The patient was scheduled to undergo elective TKA prior to these injuries but was forced to postpone due to their severity. Following the BKA, the patient regained his ability to ambulate independently with prosthesis but continued to suffer from OA symptoms. The patient was then scheduled for surgery, and a TKA was performed. Conclusion The patient underwent a TKA and tolerated the surgery well without complications. Appropriate positioning was achieved using a popliteal post. Alignment and tibial cut were checked using fluoroscopy. All components were cemented into position, and the patella was resurfaced. The patient did well postoperatively and was using his prosthesis and ambulating independently at the final follow-up.
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Affiliation(s)
| | - Jonathan Willard
- Department of Orthopaedic Surgery, LSUHSC, New Orleans, Louisiana
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Maniar RN, Mody B, Wakankar HM, Sardar I, Adkar N, Natesan R, Paravath SA, Pai S, Mahajan US. Expert Consensus on Best Practices for Optimal Wound Closure in Total Knee Arthroplasty: A STRIDE Initiative for Orthopedic Surgeons of India. Indian J Orthop 2023; 57:2066-2072. [PMID: 38009180 PMCID: PMC10673754 DOI: 10.1007/s43465-023-00922-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/02/2023] [Indexed: 11/28/2023]
Abstract
Background Wound closure in joint replacement surgeries is crucial for postoperative rehabilitation. Despite substantial advances in total knee arthroplasty (TKA), no guidelines/recommendation or consensus practice statement available internationally or nationally around the optimal method of wound closure. The study aimed to develop evidence-based consensus on current practices, and proposed adoption of advanced wound closure initiatives. Methods From Nov 2020 to Jan 2021, a group of 12 leading orthopedic surgeons from India met virtually under the Success in Total joint replacement through Recommendation In wounD closure (STRIDE) initiative. Expert committee used Delphi method to evaluate definitional statements that were identified through a comprehensive review of the published literature. Over three rounds of iterative voting, revision, and exclusion, the expert panel provided recommendations based on their clinical expertise and scientific evidence. Statements that reached ≥ 80% agreement was considered as "consensus". A survey poll was conducted following each round to add or suggest changes to the statements. Results General recommendations include marking the arthrotomy before incision, placing the knee in flexion (less than 90°) for re-approximation during arthrotomy closure. The barbed suture can be a good alternative to traditional sutures for providing water-tight capsule closure and topical skin adhesives (TSAs) to staples for minimizing hospital visits and improving patient satisfaction. Conclusion This consensus provides interim guidance and practical references to orthopedic surgeons of India enabling easy access to evidence-based healthcare solutions for TKA wound closure. These recommendations need to be periodically reviewed in light of emerging evidence.
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Affiliation(s)
- Rajesh N. Maniar
- Department of Orthopedics, Lilavati Hospital, Bandra West, Mumbai, Maharashtra 400050 India
| | | | - Hemant M. Wakankar
- Department of Joint Replacement & Reconstruction, Deenanath Mangeshkar Hospital, Pune, Maharashtra India
| | - Indrajit Sardar
- Department of Orthopedics, Nightingale Hospital, Kolkata, West Bengal India
| | - Neeraj Adkar
- Department of Orthopedics, SaiShree Hospital for Special Surgery, Pune, Maharashtra India
| | - Rajkumar Natesan
- Department of Orthopedics, Ganga Hospital, Coimbatore, Tamil Nadu India
| | | | - Sanjay Pai
- Department of Orthopedics, Apollo Specialty Hospital, Bangalore, Karnataka India
| | - Unmesh S. Mahajan
- Department of Orthopedics, Mahajan Ortho and Surgical Hospital, Nagpur, Maharashtra India
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Le Stum M, Bertin T, Le Goff-Pronost M, Apremont C, Dardenne G, Rolland-Lozachmeur G, Stindel E. Three-Dimensional Printed Knee Implants: Insights into Surgeons' Points of View. J Pers Med 2023; 13:jpm13050811. [PMID: 37240981 DOI: 10.3390/jpm13050811] [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: 03/24/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Three-dimensional printing is a technology that has been developed and applied in several medical specialties, especially orthopedic surgery. Knee arthroplasty is the most commonly performed procedure. To fit the morphology of each knee, surgeons can choose between different standardized off-the-shelf implant sizes or opt for customized 3D-printed implants. However, routine adoption of the latter has been slow and faces several barriers. Existing studies focus on technical improvements or case studies and do not directly address the surgeon's perspective. Our study invited surgeons to express themselves freely and answer the question "What do you think about the manufacture of a prosthesis by 3D printing?". The questionnaire was completed by 90 surgeons. On average, they had more than 10 years of experience (52, 57.8% ± 10.2%), worked in public hospitals (54, 60% ± 10.1%), and performed between 0 and 100 prostheses per year (60, 66.7% ± 9.7%). They also reported not using planning software (47, 52.2% ± 9.7%), navigation systems, or robots (62, 68.9% ± 9.6%). Regarding the use of technological innovation, they agreed on the extra surgical time needed (67, 74.4% ± 9.0%). The answers obtained were classified according to two criteria: (i) opinions, and (ii) motivations. Among the respondents, 51 (70% ± 9.5%) had positive and 22 (30% ± 9.5%) had negative opinions about 3D printing. The motivations were distributed among seven categories (surgery, materials, costs, logistics, time, customization, and regulatory) and mainly related to "pre-surgery" and "post-surgery" concerns. Finally, the results showed that the use of navigation systems or robots may be associated with a more positive view of 3DP. The purpose of our study was to examine knee surgeons' perceptions of 3DP at a time of significant expansion of this technology. Our study showed that there was no opposition to its implementation, although some surgeons indicated that they were waiting for validated results. They also questioned the entire supply chain, including hospitals, insurance companies, and manufacturers. Although there was no opposition to its implementation, 3D printing is at a crucial point in its development and its full adoption will require advances in all areas of joint replacement.
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Affiliation(s)
- Mathieu Le Stum
- Laboratoire de Traitement de l'Information Médicale (LATIM), UMR 1101, Faculté de Médecine de Brest, Université de Brest, Université de Bretagne Occidentale, 29200 Brest, France
- Laboratoire de Traitement de l'Information Médicale (LATIM), UMR 1101, Institut National de la Santé et de la Recherche Médicale, INSERM, 29200 Brest, France
| | - Thomas Bertin
- Laboratoire de Traitement de l'Information Médicale (LATIM), UMR 1101, Faculté de Médecine de Brest, Université de Brest, Université de Bretagne Occidentale, 29200 Brest, France
| | - Myriam Le Goff-Pronost
- Laboratoire de Traitement de l'Information Médicale (LATIM), UMR 1101, M@rsouin, Institut Mines-Telecom, IMT Atlantique, 29200 Brest, France
| | - Claire Apremont
- Laboratoire de Traitement de l'Information Médicale (LATIM), UMR 1101, Faculté de Médecine de Brest, Université de Brest, Université de Bretagne Occidentale, 29200 Brest, France
| | - Guillaume Dardenne
- Laboratoire de Traitement de l'Information Médicale (LATIM), UMR 1101, Centre Hospitalo-Universitaire de Brest, CHU Brest, 29200 Brest, France
| | - Ghislaine Rolland-Lozachmeur
- Laboratoire de Traitement de l'Information Médicale (LATIM), UMR 1101, Faculté de Médecine de Brest, Université de Brest, Université de Bretagne Occidentale, 29200 Brest, France
| | - Eric Stindel
- Laboratoire de Traitement de l'Information Médicale (LATIM), UMR 1101, Faculté de Médecine de Brest, Université de Brest, Université de Bretagne Occidentale, 29200 Brest, France
- Laboratoire de Traitement de l'Information Médicale (LATIM), UMR 1101, Centre Hospitalo-Universitaire de Brest, CHU Brest, 29200 Brest, France
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Trieu J, Schilling CG, Spelman T, Dowsey MM, Choong PF. No Difference in Quality-Of-Life Outcomes in the First 7 Years Following Primary Total Knee Arthroplasty Performed Using Computer Navigation Versus Conventional Referencing: A Propensity Score-Matched Analysis. J Arthroplasty 2022; 37:1783-1792. [PMID: 35447276 DOI: 10.1016/j.arth.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/03/2022] [Accepted: 04/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Computer navigation techniques can potentially improve both the accuracy and precision of prosthesis implantation in total knee arthroplasty (TKA) but its impact on quality-of-life outcomes following surgery remains unestablished. METHODS An institutional arthroplasty registry was queried to identify patients with TKA performed between January 1, 2007 and December 31, 2019. Propensity score matching based on demographical, medical, and surgical variables was used to match computer-navigated to conventionally referenced cases. The primary outcomes were Veterans RAND 12 Item Health Survey scores (VR-12 PCS and MCS), Short Form 6 Dimension utility values (SF-6D), and quality-adjusted life years (QALYs) in the first 7 years following surgery. RESULTS A total of 629 computer-navigated TKAs were successfully matched to 1,351 conventional TKAs. The VR-12 PCS improved by a mean of 12.75 and 11.94 points in computer-navigated and conventional cases at 12-month follow-up (P = .25) and the VR-12 MCS by 6.91 and 5.93 points (P = .25), respectively. The mean VR-12 PCS improvement at 7-year follow-up (34.4% of the original matched cohort) for navigated and conventional cases was 13.00 and 12.92 points (P = .96) and for the VR-12 MCS was 4.83 and 6.30 points (P = .47), respectively. The mean improvement in the SF-6D utility score was 0.164 and 0.149 points at 12 months (P = .11) and at 7 years was 0.115 and 0.123 points (P = .69), respectively. Computer-navigated cases accumulated 0.809 QALYs in the first 7 years, compared to 0.875 QALYs in conventionally referenced cases (P = .65). There were no differences in these outcomes among a subgroup analysis of obese patients (body mass index ≥ 30 kg/m2). CONCLUSION The use of computer navigation did not provide an incremental benefit to quality-of-life outcomes at a mean of 2.9 years following primary TKA performed for osteoarthritis when compared to conventional referencing techniques.
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Affiliation(s)
- Jason Trieu
- Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia
| | - Chris G Schilling
- Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia
| | - Tim Spelman
- Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
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Navigated and Robot-Assisted Technology in Total Knee Arthroplasty: Do Outcome Differences Achieve Minimal Clinically Important Difference? J Arthroplasty 2022; 37:1562-1569. [PMID: 35367335 DOI: 10.1016/j.arth.2022.03.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 03/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In total knee arthroplasty (TKA), computer-assisted navigation (N-TKA) and robotic-assisted methods (RA-TKA) are intended to increase precision of mechanical and component alignment. However, the clinical significance of published patient-reported outcome measure (PROM) differences in comparison to conventional TKA (C-TKA) is unknown. METHODS A systematic review was performed to identify all studies reporting perioperative PROMs for either primary N-TKA or RA-TKA with a C-TKA comparison cohort with a minimum 1-year follow-up. Relative improvements in PROMs for the two cohorts were compared to published minimal clinically important difference (MCID) values. RESULTS After systematic review, 21 studies (N = 3,214) reporting on N-TKA and eight studies (N = 1,529) reporting on RA-TKA met inclusion criteria. Eighteen of 20 studies (90%) reported improved radiographic outcomes with N-TKA relative to C-TKA; five of five studies reported improved radiographic outcomes with RA-TKA relative to C-TKA. Five of 21 studies (24%) reported statistically significant greater improvements in clinical PROMs for N-TKA relative to C-TKA, whereas only two (10%) achieved clinical significance relative to MCID on a secondary analysis. One of 8 studies (13%) reported statistically significant greater improvements in PROMs for RA-TKA relative to C-TKA, whereas none achieved clinical significance relative to MCID on a secondary analysis. No studies reported a significant difference in revision rates. CONCLUSION While most studies comparing RA-TKA and N-TKA with C-TKA demonstrate improved radiographic alignment outcomes, a minority of studies reported PROM differences that achieve clinical significance. Future studies should report data and be interpreted in the context of clinical significance to establish patient and surgeon expectations for emerging technologies.
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A Randomized Trial Investigating the Cost-Utility of Patient-Specific Instrumentation in Total Knee Arthroplasty in an Obese Population. J Arthroplasty 2021; 36:3078-3088. [PMID: 34053752 DOI: 10.1016/j.arth.2021.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patient-specific instrumentation (PSI) has been introduced in total knee arthroplasty (TKA) with the goal of increased accuracy of component positioning by custom fitting cutting guides to the patient's bony anatomy. A criticism of this technology is the associated cost. The purpose of this randomized controlled trial was to determine the cost-utility of PSI compared with standard of care (SOC) instrumentation for TKA in an obese population. METHODS Patients with body mass index greater than 30 with osteoarthritis and undergoing primary TKA were randomized to SOC or PSI. Patients completed a health care resource use diary and the EuroQol-5D at three, six, nine, and 12 months and the Western Ontario and McMaster Universities Osteoarthritis Index at three and 12 months postsurgery. We performed cost-utility and cost-effectiveness analyses from public health care payer and societal perspectives. RESULTS One hundred seventy-three patients were included in the analysis with 86 patients randomized to PSI and 87 to SOC. PSI was dominated (more costly and less effective) by SOC from a health care payer perspective. From a societal perspective, an incremental cost-utility ratio was calculated at $11,230.00 per quality-adjusted life year gained, which is cost-effective at a willingness to pay threshold of $50,000. Net benefit analyses found PSI was not significantly cost-effective at any willingness to pay value from either perspective. CONCLUSION Our results suggest that widespread adoption of PSI may not be economically attractive or clinically indicated. Future considerations are to compare long-term clinical outcomes and radiographic alignment between the groups.
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Austin MS, Ashley BS, Bedard NA, Bezwada HP, Hannon CP, Fillingham YA, Kolwadkar YV, Rees HW, Grosso MJ, Zeegen EN. What is the Level of Evidence Substantiating Commercial Payers' Coverage Policies for Total Joint Arthroplasty? J Arthroplasty 2021; 36:2665-2673.e8. [PMID: 33867209 DOI: 10.1016/j.arth.2021.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States. METHODS The references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease. RESULTS 282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA. CONCLUSION Most of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.
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Affiliation(s)
- Matthew S Austin
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Blair S Ashley
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Nicholas A Bedard
- Department of Orthopaedic Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
| | | | - Charles P Hannon
- Department of Orthopaedic Surgery, The Mayo Clinic, Ochester, MN
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Yogesh V Kolwadkar
- Department of Orthopaedic Surgery, VA Central California Health Care System, Fresno, CA
| | - Harold W Rees
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Connecticut Joint Replacement Institute, Hartford, CT
| | - Erik N Zeegen
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA
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Moorthy V, Chen JY, Liow MHL, Chin PL, Chia SL, Lo NN, Yeo SJ. Mid-term functional outcomes of patient-specific versus conventional instrumentation total knee arthroplasty: a prospective study. Arch Orthop Trauma Surg 2021; 141:669-674. [PMID: 33386974 DOI: 10.1007/s00402-020-03729-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/06/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Patient-specific instrumentation (PSI) utilizes three-dimensional imaging to produce total knee arthroplasty cutting jigs which matches patient's native anatomy. However, there are limited mid- to long-term studies examining its clinical efficacy. The aim of this study was to compare functional outcomes of PSI surgery versus conventional TKA surgery at 5-year follow-up. MATERIALS AND METHODS Sixty patients were prospectively recruited into either the MRI-based PSI or conventional TKA group. Functional outcomes were assessed using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS) and Oxford Knee Score (OKS), while quality of life was evaluated with the Physical Component Score (PCS) and Mental Component Score (MCS) of Short-Form 36 and compared between the two groups at 5-year follow-up. RESULTS Although the PCS was 7 ± 3 points better in the PSI group preoperatively (p = 0.017), it became 5 ± 2 points worse than the conventional group at 5-year follow-up (p = 0.025). As compared to the PSI group, the conventional group showed a significantly greater improvement in PCS at 5 years as compared to before surgery (p = 0.003). There were no significant differences in KSFS, KSKS, OKS or MCS between the two groups. CONCLUSIONS PSI TKA did not result in improved functional outcomes or better quality of life when compared to conventional TKA. The additional costs and waiting time associated with PSI are not justifiable and therefore not recommended as an alternative to conventional TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Vikaesh Moorthy
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
| | - Pak Lin Chin
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
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Sekimura TK, Upfill-Brown A, Hsiue PP, Khoshbin A, Zeegen EN, Stavrakis AI. Trends in Operative Time and Short-Term Outcomes After Conventional and Navigated Total Knee Arthroplasty. Arthroplast Today 2021; 8:188-193. [PMID: 33889700 PMCID: PMC8050795 DOI: 10.1016/j.artd.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Adoption of navigated total knee arthroplasty (Nav-TKA) is increasing. However, it has been suggested that a perceived decrease in surgical efficiency and a lack of proven superior functional outcomes associated with Nav-TKA have hindered its widespread adoption. METHODS The American College of Surgeons National Surgical Quality Improvement Program was queried to identify patients who had undergone TKA with or without navigation between 2012 and 2018. Patients were further subclassified based on the type of navigation used, image-guided or imageless. Multivariate logistic regression was used to compare operative time and 30-day complication rates between conventional TKA (Conv-TKA) and Nav-TKA with and without image guidance. RESULTS A total of 316,210 Conv-TKAs and 8554 Nav-TKAs (8270 imageless, 284 image-guided) were identified. Across the study period, the use of Nav-TKA was associated with a 1.5-minute increase in operative time. However, the overall time burden decreased over the study period, and by 2018, the mean operative time for Nav-TKA was 2.4 minutes less than that of Conv-TKA. Compared with Conv-TKA, Nav-TKA was associated with decreased rates of postoperative transfusion and surgical site complications but a similar incidence of systemic thromboembolism. CONCLUSIONS This is the first large-scale database study to examine the differences in operative time between Conv-TKA and Nav-TKA. The time burden associated with Nav-TKA decreased over the study period and even reversed by 2018. Nav-TKA was associated with lower rates of postoperative transfusion and surgical site complications. Further studies are needed to evaluate the long-term and functional outcomes between conventional and navigated knee arthroplasty techniques.
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Affiliation(s)
- Troy K. Sekimura
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alexander Upfill-Brown
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter P. Hsiue
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amir Khoshbin
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Erik N. Zeegen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alexandra I. Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Abstract
Because value in healthcare has shifted to a measurement of quality relative to the cost, a greater emphasis exists on improving clinical and functional outcomes and patient satisfaction. Despite advances in implant design, surgical technique, and postoperative rehabilitation, multiple studies demonstrate that nearly 20% of patients remain dissatisfied with their overall outcomes after primary total knee arthroplasty (TKA). Because implant positioning, alignment, and equal soft-tissue balance are critical for a successful TKA, malalignment in the coronal, sagittal, and rotational planes continue to increase failure rates and cause poor clinical outcomes. Robotic-assisted TKA has gained momentum within the past 10 years to better control surgical variables by mitigating technical errors caused by insecure cutting guides and imprecise bone cuts. Contemporary robotic platforms have evolved along with our ability to collect high-quality patient-reported outcome measures data, and this combination is proving the clinical effectiveness. This comprehensive review investigates the advent of robotic-assisted TKA including advantages, disadvantages, historical, and commercially available newer generation systems, clinical outcomes, and cost analysis to better understand the potential added value of this technology.
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Abdeen A. CORR Insights®: Widespread Pain Is Associated with Increased Risk of No Clinical Improvement After TKA in Women. Clin Orthop Relat Res 2020; 478:1466-1468. [PMID: 31794477 PMCID: PMC7310407 DOI: 10.1097/corr.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/07/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Ayesha Abdeen
- A. Abdeen, Assistant Professor, Harvard Medical School, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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14
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Conventional instruments are more accurate for measuring the depth of the tibial cut than computer-assisted surgery in total knee arthroplasty: a prospective study. Arch Orthop Trauma Surg 2020; 140:801-806. [PMID: 32146591 DOI: 10.1007/s00402-020-03403-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The most commonly used tool for implant positioning are conventional instruments (CI) followed by computer-assisted surgery (CAS). A number of studies have investigated the cutting error of the tibial component when CAS is used, but most of them were focused on the cutting angles. The accuracy of CAS to determine the depth of the cut has not received much attention, even though implications are similar or worse, than with an angle mismatch. MATERIALS AND METHODS This was an ethics board approved, prospective study of 23 consecutive varus TKAs by a single surgeon. Implant positioning was performed using CAS; however, the depth of the tibial cut was determined with both CAS and CI. Targeted alignment was the mechanical axis and 3° of posterior slope. The planned and the achieved cut, as determined by CAS needed to match. The achieved cut was then measured using a caliper and compared to the depth of the cut as per CAS. Medial and lateral cuts were analyzed separately. Analysis of variance and Bland-Altman plots were used for the comparison. RESULTS Mean medial navigated cut was 6.3 (± 2.2) mm, mean measured medial cut was 6.6 (± 2.3) mm. Mean lateral navigated cut was 8.9 (± 1.8) mm, mean measured lateral cut was 8.8 (± 1.5) mm. There was a statistical significance for both the medial (p < 0.001) and the lateral (p = 0.004) navigated and measured cuts. CONCLUSIONS The results of this study suggest that the tibial cut depth, measured by the navigation, does not match the actual bony cuts performed, even if a perfect cut was achieved in both sagittal and coronal plane. Surgeons should be aware of the measurement error in the navigation system and potentially add an additional step for verifying the achieved depth of the cut.
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15
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Hazratwala K, Brereton SG, Grant A, Dlaska CE. Computer-Assisted Technologies in Arthroplasty: Navigating Your Way Today. JBJS Rev 2020; 8:e0157. [PMID: 32224641 DOI: 10.2106/jbjs.rvw.19.00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Computer-assisted technologies that are used in arthroplasty include navigation, image-derived instrumentation (IDI), and robotics. Computer-assisted navigation improves accuracy and allows for real-time assessment of component positioning and soft-tissue tension. It is not clear whether the implementation of these technologies improves the clinical outcome of surgery. High cost and time demands have prevented the global implementation of computer-assisted technologies.
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Affiliation(s)
- Kaushik Hazratwala
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mater Health Services North Queensland, Townsville, Queensland, Australia.,Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Sarah G Brereton
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mater Health Services North Queensland, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
| | - Constantin E Dlaska
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mackay Hospital and Health Services, Mackay, Queensland, Australia
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16
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Hu HZ, Feng XB, Shao ZW, Xie M, Xu S, Wu XH, Ye ZW. Application and Prospect of Mixed Reality Technology in Medical Field. Curr Med Sci 2019; 39:1-6. [PMID: 30868484 DOI: 10.1007/s11596-019-1992-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/14/2018] [Indexed: 01/04/2023]
Abstract
Mixed reality (MR) technology is a new digital holographic image technology, which appears in the field of graphics after virtual reality (VR) and augmented reality (AR) technology, a new interdisciplinary frontier. As a new generation of technology, MR has attracted great attention of clinicians in recent years. The emergence of MR will bring about revolutionary changes in medical education training, medical research, medical communication, and clinical treatment. At present, MR technology has become the popular frontline information technology for medical applications. With the popularization of digital technology in the medical field, the development prospects of MR are inestimable. The purpose of this review article is to introduce the application of MR technology in the medical field and prospect its trend in the future.
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Affiliation(s)
- Hong-Zhi Hu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiao-Bo Feng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zeng-Wu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Mao Xie
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Song Xu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xing-Huo Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhe-Wei Ye
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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17
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Abstract
The method by which surgeons conduct outpatient total knee procedures has yet to be fully elucidated. Literature demonstrates different experiences from various care protocols in place across the nation. This article reviews current recommendations for implementing successful total knee arthroplasty (TKA) and unicompartmental knee arthroplasty outpatient protocols. Specifically, information regarding anesthesia and analgesia modalities, perioperative care, operative technique, and postoperative care within outpatient TKA pathways is discussed.
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18
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Abstract
PURPOSE OF REVIEW Total joint arthroplasty is regarded as a highly successful procedure. Patient outcomes and implant longevity, however, are related to proper alignment and position of the prostehses. In an attempt to reduce outliers and improve accuracy and precision of component position, navigation and robotics have been introduced. These technologies, however, come at a price. The goals of this review are to evaluate these technologies in total joint arthroplasty and determine if they add value. RECENT FINDINGS Recent studies have demonstrated that navigation and robotics in total joint arthroplasty can decrease outliers while improving accuracy in component positioning. While some studies have demonstrated improved patient reported outcomes, not all studies have shown this to be true. Most studies cite increased cost of equipment and longer operating room times as the major downsides of the technologies at present. Long-term studies are just becoming available and are promising, as some studies have shown decreased revision rates when navigation is used. Finally, there are relatively few studies evaluating the direct cost and value of these technologies. Navigation and robotics have been shown to improve component position in total joint arthroplasty, which can improve patient outcomes and implant longevity. These technologies offer a promising future for total joint arthroplasty.
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Affiliation(s)
- Bradford S Waddell
- Department of Orthopaedic Surgery, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA.
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA.
| | - Kaitlin Carroll
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Seth Jerabek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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19
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Beal MD, Delagrammaticas D, Fitz D. Erratum to: Improving outcomes in total knee arthroplasty-do navigation or customized implants have a role? J Orthop Surg Res 2016; 11:114. [PMID: 27741953 PMCID: PMC5065700 DOI: 10.1186/s13018-016-0453-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Matthew D Beal
- Northwestern University Feinberg School of Medicine, Chicago, USA.
| | | | - David Fitz
- Northwestern University Feinberg School of Medicine, Chicago, USA
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