1
|
Cochrane NH, Kim BI, Leal J, Hallows RK, Seyler TM. Comparing a robotic imageless second-generation system to traditional instrumentation in total knee arthroplasty: A matched cohort analysis. J Orthop 2024; 57:1-7. [PMID: 38881681 PMCID: PMC11179564 DOI: 10.1016/j.jor.2024.05.022] [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: 04/18/2024] [Revised: 05/09/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Robotic-assisted total knee arthroplasty (rTKA) has gained interest from patients and surgeons alike. Robotic systems assist with gap balancing and bone cut accuracy, which can theoretically minimize post-operative pain by decreasing soft tissue damage. This study compared perioperative results, 30- and 90-day complications, patient-reported outcomes (PROs), and survivorship to all-cause revisions between patients undergoing traditional versus rTKA. Methods A total of 430 TKAs (215 rTKA, 215 traditional) by two fellowship trained arthroplasty surgeons were retrospectively reviewed from 2017 to 2022. All rTKAs were performed using the CORI Surgical System (Smith & Nephew, Memphis, Tennessee). Cohorts were propensity score matched by age, sex, body mass index, and American Society of Anesthesiologist classification. Blood loss, surgical times, length of stays, 30- and 90-day complications, pain scores and PROs were compared with univariable analyses. Cox regression analyses evaluated survival to all-cause revisions. Results Patients undergoing rTKA had a higher incidence of discharge home (86.5 %-60.0 %) (p < 0.01). There was no difference in blood loss or surgical time. rTKA pain scores were lower in-hospital mean 2 (range, 0 to 9) vs 3 (range, 0 to 9) (p = 0.02) as well as at one-year post-operatively, mean 1 (range, 0 to 7) vs 2 (range, 0 to 10) (p = 0.02). Cox hazard ratio demonstrated no difference in survival to all-cause revisions (HR 1.3; CI 0.5 to 3.7) (p = 0.64). Conclusion This matched cohort analysis demonstrated potential short-term benefits associated with imageless second generation rTKA including improved early post-operative pain, without compromising survivorship to all-cause revisions.
Collapse
Affiliation(s)
- Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Billy I Kim
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Justin Leal
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Rhett K Hallows
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
2
|
Tian R, Duan X, Xing F, Zhao Y, Liu C, Li H, Kong N, Cao R, Guan H, Li Y, Li X, Zhang J, Wang K, Yang P, Wang C. Computed tomography radiomics in predicting patient satisfaction after robotic-assisted total knee arthroplasty. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03192-1. [PMID: 38836956 DOI: 10.1007/s11548-024-03192-1] [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: 03/12/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE After robotic-assisted total knee arthroplasty (RA-TKA) surgery, some patients still experience joint discomfort. We aimed to establish an effective machine learning model that integrates radiomic features extracted from computed tomography (CT) scans and relevant clinical information to predict patient satisfaction three months postoperatively following RA-TKA. MATERIALS AND METHODS After careful selection, data from 142 patients were randomly divided into a training set (n = 99) and a test set (n = 43), approximately in a 7:3 ratio. A total of 1329 radiomic features were extracted from the regions of interest delineated in CT scans. The features were standardized using normalization algorithms, and the least absolute shrinkage and selection operator regression model was employed to select radiomic features with ICC > 0.75 and P < 0.05, generating the Rad-score as feature markers. Univariate and multivariate logistic regression was then used to screen clinical information (age, body mass index, operation time, gender, surgical side, comorbidities, preoperative KSS score, preoperative range of motion (ROM), preoperative and postoperative HKA angle, preoperative and postoperative VAS score) as potential predictive factors. The satisfaction scale ≥ 20 indicates patient satisfaction. Finally, three prediction models were established, focusing on radiomic features, clinical features, and their fusion. Model performance was evaluated using Receiver Operating Characteristic curves and decision curve analysis. RESULTS In the training set, the area under the curve (AUC) of the clinical model was 0.793 (95% CI 0.681-0.906), the radiomic model was 0.854 (95% CI 0.743-0.964), and the combined radiomic-clinical model was 0.899 (95% CI 0.804-0.995). In the test set, the AUC of the clinical model was 0.908 (95% CI 0.814-1.000), the radiomic model was 0.709 (95% CI 0.541-0.878), and the combined radiomic-clinical model was 0.928 (95% CI 0.842-1.000). The AUC of the radiomic-clinical model was significantly higher than the other two models. The decision curve analysis indicated its clinical application value. CONCLUSION We developed a radiomic-based nomogram model using CT imaging to predict the satisfaction of RA-TKA patients at 3 months postoperatively. This model integrated clinical and radiomic features and demonstrated good predictive performance and excellent clinical application potential.
Collapse
Affiliation(s)
- Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xudong Duan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fangze Xing
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yiwei Zhao
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - ChengYan Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Heng Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ning Kong
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruomu Cao
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huanshuai Guan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yiyang Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinghua Li
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiewen Zhang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Chunsheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| |
Collapse
|
3
|
Cochrane NH, Kim BI, Stauffer TP, Hallows RK, Urish KL, Carvajal Alba JA, Seyler TM. Revision Total Knee Arthroplasty With an Imageless, Second-Generation Robotic System. J Arthroplasty 2024:S0883-5403(24)00118-9. [PMID: 38355066 DOI: 10.1016/j.arth.2024.02.018] [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: 09/29/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty is increasingly used in revision total knee arthroplasty (rTKA), with imageless systems recently receiving Food and Drug Administration (FDA) approval. However, there remains a paucity of literature on the use of robotic assistance in revision total knee arthroplasty (TKA). This paper describes the imageless surgical technique for robotic revision TKA using a second-generation robotic system and details both intraoperative and 90-day outcomes. METHODS This was a retrospective review of 115 robotic revision TKAs from March 2021 to May 2023 at 3 tertiary academic centers. Patient demographics, perioperative surgical data, and 90-day outcomes were collected. Pain and Patient-Reported Outcomes Measurement Information System scores preoperatively and postoperatively were recorded. All-cause reoperations at the final follow-up were detailed. The mean patient age was 65 years (range, 43 to 88), and 58% were women. The mean follow-up time was 13 months (range, 3 to 51). RESULTS The most common indications for rTKA were instability (n = 37, 32%) and aseptic loosening (n = 42, 37%). There were 83 rTKAs to a posterior-stabilized liner, 22 to a varus-valgus constrained liner, and 5 to a hinged construct. The median polyethylene size was 11 (interquartile range, 10 to 13), and 93% of patients had their joint line restored within 5 millimeters of the native contralateral knee. Within the 90-day postoperative window, there were 8 emergency department visits and 2 readmissions. At the final follow-up, there were 5 reoperations and 2 manipulations under anesthesia. There were 4 patients who required irrigation and debridement after superficial wound dehiscence, and one had an arthrotomy disruption after a fall. CONCLUSIONS This review demonstrates favorable intraoperative and 90-day outcomes and suggests that imageless robotic surgery is a promising modality in rTKA. Further studies comparing the longitudinal outcomes after robotic and conventional rTKA are warranted.
Collapse
Affiliation(s)
- Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Billy I Kim
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Taylor P Stauffer
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Rhett K Hallows
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kenneth L Urish
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jaime A Carvajal Alba
- Department of Orthopaedic Surgery, University of Miami Health System, Miami, Florida
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
4
|
Duan X, Zhao Y, Zhang J, Kong N, Cao R, Guan H, Li Y, Wang K, Yang P, Tian R. Learning curve and short-term clinical outcomes of a new seven-axis robot-assisted total knee arthroplasty system: a propensity score-matched retrospective cohort study. J Orthop Surg Res 2023; 18:425. [PMID: 37308901 DOI: 10.1186/s13018-023-03899-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE The purpose of the present study was to determine the learning curve for a novel seven-axis robot-assisted (RA) total knee arthroplasty (TKA) system and to explore whether it could provide superior short-term clinical and radiological outcomes compared with conventional surgery. METHODS In the present retrospective study, 90 patients who underwent RA-TKA were included in robot-assisted system (RAS) group and 90 patients who underwent conventional TKA were included in the conventional group. The duration of surgery and robot-related complications were recorded to evaluate the learning curve through cumulative sum and risk-adjusted cumulative sum methods. The demographic data, preoperative clinical data, preoperative imaging data, duration of surgery, alignment of the prosthesis, lower limb force line alignment, Knee Society score, 10-cm visual analog scale pain score and range of motion were compared between the RAS and conventional groups. In addition, the proficiency group was compared with the conventional group using propensity score matching. RESULTS RA-TKA was associated with a learning curve of 20 cases for the duration of surgery. There was no significant difference in indicators representing the accuracy of the prosthetic installation between the learning and proficiency phases in RA-TKA group patients. A total of 49 patients in the proficiency group were matched with 49 patients from the conventional group. The number of postoperative hip-knee-ankle (HKA) angle, component femoral coronal angle (CFCA), component tibial coronal angle (CTCA), and sagittal tibial component angle (STCA) outliers in the proficiency phase was lower than that in the conventional group, while deviations of the HKA angle, CFCA, CTCA, and STCA in the proficiency phase were significantly lower than those in the conventional group (P < 0.05). CONCLUSION In summary, from the learning curve data, 20 cases are required for a surgeon using a novel seven-axis RA-TKA system to enter the proficiency phase. In the proficiency group, compared with the conventional group using propensity score matching, the RAS was found to be superior to the conventional group in prosthesis and lower limb alignment.
Collapse
Affiliation(s)
- Xudong Duan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yiwei Zhao
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Jiewen Zhang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Ning Kong
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Ruomu Cao
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Huanshuai Guan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yiyang Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
| |
Collapse
|
5
|
Batra S, Malhotra R. Medial Ball and Socket Total Knee Arthroplasty in Indian Population: 5-Year Clinical Results. Clin Orthop Surg 2022; 14:90-95. [PMID: 35251545 PMCID: PMC8858900 DOI: 10.4055/cios20268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Medial pivot total knee arthroplasty aims to restore native knee kinematics through highly conforming medial tibiofemoral articulation with survival comparable to contemporary knee designs. The aim of this study was to report preliminary clinical results of medial pivot total knee arthroplasty in an Indian population. Methods A retrospective analysis of 45 patients (average age, 62 years; 40 women and 5 men) with end-stage arthritis (Kellgren-Lawrence grade 4) operated with a medial pivot prosthesis was done. All patients were assessed using Knee Society Score (satisfaction, expectation, and functional scores) and Oxford Knee Score, and range of motion was recorded at the end of 5-year postoperative follow-up. In addition, all patients underwent standardized radiological assessment. Results At the final follow-up, patients reported significant improvement in mean Knee Society Score (satisfaction, expectation, and functional scores) and Oxford Knee Score (p < 0.05). The mean range of motion achieved at the end of 5 years ranged from 0° (extension) to 118.4° (further flexion). There was no evidence of loosening or osteolysis at a minimum follow-up of 5 years. Conclusions These results demonstrated satisfactory clinical and radiological outcomes at 5 years after total knee arthroplasty with a medial pivot design, which may be related to better replication of natural knee kinematics with the medial pivot knee and inherent advantages of this design.
Collapse
Affiliation(s)
- Sahil Batra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Broberg JS, Naudie DDR, Howard JL, Vasarhelyi EM, McCalden RW, Teeter MG. Contact kinematics of patient-specific instrumentation versus conventional instrumentation for total knee arthroplasty. Knee 2020; 27:1501-1509. [PMID: 33010767 DOI: 10.1016/j.knee.2020.07.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/24/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The goal was to evaluate the joint contact kinematics of total knee arthroplasties implanted using patient-specific instrumentation (PSI) compared to conventional instrumentation (CI). We hypothesized that use of PSI would not significantly alter contact kinematics. METHODS The study was a prospective randomized controlled trial, with equal allocation of fifty patients to PSI and CI groups. At two years post-operation, patients underwent weight-bearing stereo X-ray examinations at 0°, 20°, 40°, 60°, 80°, and 100° of flexion. The shortest tibiofemoral distance on each condyle determined the contact location. Magnitude of the shortest distance was measured and condylar separation was analyzed using thresholds of 0.5 and 0.75 mm. Kinematic measurements derived from the shortest distance included anteroposterior (AP) translation, excursion, axial rotation, and paradoxical anterior motion. Pivot position and cam/post contact were also investigated. RESULTS There were no differences (p > 0.05) in medial and lateral AP contact locations, excursions, and magnitude of anterior motion, or in axial rotation, pivot patterns, frequency of cam/post engagement, frequency of medial anterior motion, and condylar separation at a 0.75 mm threshold. Significant differences were found in frequency of lateral anterior motion (p = 0.048) and condylar separation at a 0.5 mm threshold (p = 0.010). Both groups displayed typical kinematics for a fixed-bearing posterior-stabilized implant. CONCLUSIONS We found no major differences in knee kinematics between PSI and CI groups, which suggest that PSI does not provide a significant kinematic advantage over conventional instruments.
Collapse
Affiliation(s)
- Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Surgical Innovation Program, Lawson Health Research Institute, 750 Base Line Road East, Suite 300, London, ON N6C 2R5, Canada.
| | - Douglas D R Naudie
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Edward M Vasarhelyi
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Richard W McCalden
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Surgical Innovation Program, Lawson Health Research Institute, 750 Base Line Road East, Suite 300, London, ON N6C 2R5, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| |
Collapse
|
8
|
Siegel MA, Balach T, Sweeney KR, Nystrom LM, Colman MW. Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model. J Surg Oncol 2020; 122:1218-1225. [PMID: 32761627 DOI: 10.1002/jso.26124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The anatomical complexity of the pelvis creates challenges for orthopaedic oncologists to accurately and safely resect tumors involving the sacroiliac joint. Current technology may help overcome these obstacles. METHODS Four fellowship-trained orthopaedic oncologists performed 22 all-posterior sacroiliac cuts using freehand, computerized navigation, and patient-specific cutting guides on a Sawbones male pelvis model. Cut accuracies to preoperative planned margins were analyzed via a high-resolution optical scanner. Soft tissue damage was determined by visually inspecting the Sawbones foam placed on the far side of the cut. RESULTS Within 5 mm of the margins, the freehand technique resulted in 67.0% cut accuracy, the navigation technique had 71.1%, and the patient-specific cutting guide technique had 85.6% (P = .093). Within 2 mm, the techniques showed an accuracy of 25.8%, 32.5%, and 47.5%, respectively (P = .022). Regarding soft tissue damage, the freehand technique exhibited minimal penetration damage for 16.7% of the cuts, while navigation and patient-specific guide techniques exhibited 25.0% and 75.0%, respectively (P = .046). Years of surgical experience of the operator (1-7) did not influence the cut accuracy for any method. CONCLUSIONS Under ideal conditions, patient-specific guide technology possesses the same or better accuracy as other cutting techniques as well as the circumvention of soft tissue damage.
Collapse
Affiliation(s)
- Matthew A Siegel
- Department of Orthopaedic Surgery, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Tessa Balach
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Kyle R Sweeney
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas, Kansas
| | | | - Matthew W Colman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
9
|
Affiliation(s)
- B Kayani
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, The Princess Grace Hospital, London, UK
| | - F S Haddad
- University College London Hospitals NHS Foundation Trust, The Princess Grace Hospital, and the NIHR Biomedical Research Centre at UCLH, London, UK
| |
Collapse
|
10
|
Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS. Robotic technology in total knee arthroplasty: a systematic review. EFORT Open Rev 2019; 4:611-617. [PMID: 31754467 DOI: 10.1302/2058-5241.4.190022] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Robotic total knee arthroplasty (TKA) improves the accuracy of implant positioning and reduces outliers in achieving the planned limb alignment compared to conventional jig-based TKA.Robotic TKA does not have a learning curve effect for achieving the planned implant positioning. The learning curve for achieving operative times comparable to conventional jig-based TKA is 7-20 robotic TKA cases.Cadaveric studies have shown robotic TKA is associated with reduced iatrogenic injury to the periarticular soft tissue envelope compared to conventional jig-based TKA.Robotic TKA is associated with decreased postoperative pain, enhanced early functional rehabilitation, and decreased time to hospital discharge compared to conventional jig-based TKA. However, there are no differences in medium- to long-term functional outcomes between conventional jig-based TKA and robotic TKA.Limitations of robotic TKA include high installation costs, additional radiation exposure, learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs.Further higher quality studies are required to compare differences in conventional TKA versus robotic TKA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness. Cite this article: EFORT Open Rev 2019;4:611-617. DOI: 10.1302/2058-5241.4.190022.
Collapse
Affiliation(s)
- Babar Kayani
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Sujith Konan
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Atif Ayuob
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | | | | | - Fares S Haddad
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| |
Collapse
|
11
|
Harold RE, Macleod J, Butler BA, Sullivan R, Beal MD, Manning DW. Single-Use Custom Instrumentation in Total Knee Arthroplasty: Effect on In-Hospital Complications, Length of Stay, and Discharge Disposition. Orthopedics 2019; 42:299-303. [PMID: 30964541 DOI: 10.3928/01477447-20190403-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/29/2018] [Indexed: 02/03/2023]
Abstract
Total knee arthroplasty (TKA) is a quality surgical intervention with rapidly increasing use. This growth has brought with it a host of new technologies, including custom instrumentation (CI). With the current emphasis on value-based health care, the clinical benefit of CI TKA must be evaluated. The goal of this study was to compare CI and conventional TKA regarding multiple quality metrics, in-hospital complications, length of stay, and discharge destination. The authors propensity score matched 231 conventional TKAs to 231 consecutive CI TKAs for age, sex, and body mass index. Preoperative risk factors analyzed were age, sex, body mass index, and preoperative hemoglobin. Perioperative factors included transfusion rate, hemoglobin drop, hemovac output, operative time, length of stay, discharge disposition, deep venous thrombosis and pulmonary embolism rates, and in-hospital vital sign data. There were no differences in preoperative demographics between groups. Postoperatively, there was no difference between conventional and CI TKA in operative time, transfusion rate, discharge hemoglobin, length of stay, discharge disposition, or in-hospital venous thromboembolism rates. In the conventional and CI groups, length of stay was 2.6 and 2.5 days (P=.43) and discharge disposition was 82% home and 83% home (P=.90), respectively. Although CI TKA is commonly implemented, in this analysis, compared with conventional TKA, it was not associated with any difference in length of stay, discharge disposition, operative time, transfusion rate, or in-hospital complications. [Orthopedics. 2019; 42(5):299-303.].
Collapse
|
12
|
Teeter MG, Marsh JD, Howard JL, Yuan X, Vasarhelyi EM, McCalden RW, Naudie DDR. A randomized controlled trial investigating the value of patient-specific instrumentation for total knee arthroplasty in the Canadian healthcare system. Bone Joint J 2019; 101-B:565-572. [DOI: 10.1302/0301-620x.101b5.bjj-2018-1323.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The purpose of the present study was to compare patient-specific instrumentation (PSI) and conventional surgical instrumentation (CSI) for total knee arthroplasty (TKA) in terms of early implant migration, alignment, surgical resources, patient outcomes, and costs. Patients and Methods The study was a prospective, randomized controlled trial of 50 patients undergoing TKA. There were 25 patients in each of the PSI and CSI groups. There were 12 male patients in the PSI group and seven male patients in the CSI group. The patients had a mean age of 69.0 years (sd 8.4) in the PSI group and 69.4 years (sd 8.4) in the CSI group. All patients received the same TKA implant. Intraoperative surgical resources and any surgical waste generated were recorded. Patients underwent radiostereometric analysis (RSA) studies to measure femoral and tibial component migration over two years. Outcome measures were recorded pre- and postoperatively. Overall costs were calculated for each group. Results There were no differences (p > 0.05) in any measurement of migration at two years for either the tibial or femoral components. Movement between one and two years was < 0.2 mm, indicating stable fixation. There were no differences in coronal or sagittal alignment between the two groups. The PSI group took a mean 6.1 minutes longer (p = 0.04) and used a mean 3.4 less trays (p < 0.0001). Total waste generated was similar (10 kg) between the two groups. The PSI group cost a mean CAD$1787 more per case (p < 0.01). Conclusion RSA criteria suggest that both groups will have revision rates of approximately 3% at five years. The advantages of PSI were minimal or absent for surgical resources used and waste eliminated, and for meeting target alignment, yet had significantly greater costs. Therefore, we conclude that PSI may not offer any advantage over CSI for routine primary TKA cases. Cite this article: Bone Joint J 2019;101-B:565–572.
Collapse
Affiliation(s)
- M. G. Teeter
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Canada
- Department of Medical Biophysics, Schulich School of Medicine &Dentistry, Western University, London, Canada
- Surgical Innovation Program, Lawson Health Research Institute, London, Canada
- Imaging Research Laboratories, Robarts Research Institute, London, Canada
- Bone and Joint Institute, Western University, London, Canada
| | - J. D. Marsh
- Bone and Joint Institute, Western University, London, Canada
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - J. L. Howard
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Canada
| | - X. Yuan
- Imaging Research Laboratories, Robarts Research Institute, London, Canada
| | - E. M. Vasarhelyi
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Canada
| | - R. W. McCalden
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Canada
| | - D. D. R. Naudie
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Canada
| |
Collapse
|
13
|
Klasan A, Dworschak P, Heyse TJ, Lahner M, Malcherczyk D, Efe T, El-Zayat BF. Patient-specific instruments’ routine use over conventional total knee arthroplasty remains inconclusive: Analysis of 961 cases. Technol Health Care 2018; 26:523-528. [DOI: 10.3233/thc-171167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Antonio Klasan
- Center for Orthopaedics and Traumatology, University Clinic Marburg, Marburg, Germany
| | - Philipp Dworschak
- Center for Orthopaedics and Traumatology, University Clinic Marburg, Marburg, Germany
| | - Thomas J. Heyse
- Center for Orthopaedics and Traumatology, University Clinic Marburg, Marburg, Germany
| | - Matthias Lahner
- Joint Center Hilden, Ruhr-University Bochum, Bochum, Germany
| | - Dominik Malcherczyk
- Center for Orthopaedics and Traumatology, University Clinic Marburg, Marburg, Germany
| | - Turgay Efe
- Center for Orthopaedics and Traumatology, University Clinic Marburg, Marburg, Germany
| | - Bilal Farouk El-Zayat
- Center for Orthopaedics and Traumatology, University Clinic Marburg, Marburg, Germany
| |
Collapse
|
14
|
Jentzsch T, Vlachopoulos L, Fürnstahl P, Müller DA, Fuchs B. Tumor resection at the pelvis using three-dimensional planning and patient-specific instruments: a case series. World J Surg Oncol 2016; 14:249. [PMID: 27729037 PMCID: PMC5057447 DOI: 10.1186/s12957-016-1006-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/13/2016] [Indexed: 12/17/2022] Open
Abstract
Background Sarcomas are associated with a relatively high local recurrence rate of around 30 % in the pelvis. Inadequate surgical margins are the most important reason. However, obtaining adequate margins is particularly difficult in this anatomically demanding region. Recently, three-dimensional (3-D) planning, printed models, and patient-specific instruments (PSI) with cutting blocks have been introduced to improve the precision during surgical tumor resection. This case series illustrates these modern 3-D tools in pelvic tumor surgery. Methods The first consecutive patients with 3-D-planned tumor resection around the pelvis were included in this retrospective study at a University Hospital in 2015. Detailed information about the clinical presentation, imaging techniques, preoperative planning, intraoperative surgical procedures, and postoperative evaluation is provided for each case. The primary outcome was tumor-free resection margins as assessed by a postoperative computed tomography (CT) scan of the specimen. The secondary outcomes were precision of preoperative planning and complications. Results Four patients with pelvic sarcomas were included in this study. The mean follow-up was 7.8 (range, 6.0–9.0) months. The combined use of preoperative planning with 3-D techniques, 3-D-printed models, and PSI for osteotomies led to higher precision (maximal (max) error of 0.4 centimeters (cm)) than conventional 3-D planning and freehand osteotomies (max error of 2.8 cm). Tumor-free margins were obtained where measurable (n = 3; margins were not assessable in a patient with curettage). Two insufficiency fractures were noted postoperatively. Conclusions Three-dimensional planning as well as the intraoperative use of 3-D-printed models and PSI are valuable for complex sarcoma resection at the pelvis. Three-dimensionally printed models of the patient anatomy may help visualization and precision. PSI with cutting blocks help perform very precise osteotomies for adequate resection margins.
Collapse
Affiliation(s)
- Thorsten Jentzsch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Lazaros Vlachopoulos
- Computer Assisted Research and Development (CARD) Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development (CARD) Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Daniel A Müller
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Bruno Fuchs
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| |
Collapse
|
15
|
Verification of in vivo accuracy of Trumatch™ patient-specific instrumentation in total knee replacement using pin-less computer navigation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:125-132. [PMID: 27604905 DOI: 10.1007/s00590-016-1849-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Accurate component alignment in total knee replacement (TKR) is one of the important factors in determining long-term survivorship. This has been achieved by conventional jigs, computer-assisted technology (CAS) and more recently patient-specific instrumentation (PSI). The purpose of the current study was to investigate the in vivo accuracy of Trumatch™ PSI using validated pin-less computer navigation system. METHOD Twenty consecutive selected patients that fulfilled our inclusion/exclusion criteria underwent TKR using PSI. Coronal alignment, posterior slope, resection thickness and femoral sagittal alignment were recorded using pin-less navigation. The position of the actual cutting block was appropriately adjusted prior to proceeding to definitive resections. RESULTS The coronal alignment using PSI without the assistance of navigation would have resulted in 14 (70 %) within ±3°, 11 (55 %) within ±2° and 6 (30 %) outside acceptable alignment. Thirty-five percentage of proposed femur sagittal alignment and 55 % of posterior tibial slope were achieved within ±3°. Components size was accurately predicted in 95 % of femurs and 90 % of tibia. CONCLUSION The purported advantages in restoring alignments using Trumatch™ PSI alone over standard equipment are debatable. However, it predicts sizing well, and femoral coronal alignment is reasonable. Combining Trumatch™ PSI with CAS will allow in vivo verification and necessary corrections. LEVEL OF EVIDENCE IV.
Collapse
|