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Zheng K, Wang Y, Wang T, Zhu F, Zhang L, Li R, Zhou J, Geng D, Xu Y. Restoration of constitutional alignment optimizes outcomes of computer navigated total knee arthroplasty: a prospective randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2024; 48:971-981. [PMID: 38289379 DOI: 10.1007/s00264-024-06093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/14/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The value of computer navigation in total knee arthroplasty (TKA) for arthritic knees continues to be debated. The purpose of this study was to evaluate the value of navigated TKA associated with updated alignment philosophy. METHODS This prospective randomized controlled trial enrolled 38 consecutive patients (76 knees) and were randomly assigned to both groups. The demographic data and perioperative data were recorded. The coronal plane alignment of the knee (CPAK) classification was used to classify knee alignment phenotypes. Radiographic outcomes were measured and subgroup analysis was further performed. Clinical outcomes were evaluated using patient-reported outcome measures (PROMs). Surgery-related complications were recorded. RESULTS The distribution of CPAK phenotypes following constitutional aligned TKA was equivalent to the native cohort, whereas the mechanical aligned TKA dramatically altered the phenotype distribution from type I and type II to type V and type IV. Final implant positioning was different between groups, with constitutional aligned TKA having larger cTCA (P = .004), joint line obliquity (P = .006), joint line distance (P = .033) and smaller sFCA (P = .013). Subgroup analysis showed higher actual accuracy of component positioning was achieved in navigated TKA, especially in knees with deformity of > 10° (P < .05). Patients reported higher HSS score at three months postoperatively in constitutional aligned group (P = .002). One patient in navigated group suffered femoral pin site fracture caused by a minor trauma. CONCLUSION Computer navigated TKA allows for restoration of constitutional alignment and minimizes soft tissue release, which when compared to mechanical alignment may be associated with superior early outcomes.
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Affiliation(s)
- Kai Zheng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
| | - Yijun Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
| | - Tianhao Wang
- Department of Orthopedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Feng Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
| | - Lianfang Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
| | - Rongqun Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
| | - Jun Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
| | - Dechun Geng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
| | - Yaozeng Xu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China.
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Tang S, Pan X, Xu R, Shi X. Proximal fibular axis is a reliable landmark for tibial coronal alignment in patients with or without knee osteoarthritis: A radiological comparative study. J Orthop Surg (Hong Kong) 2023; 31:10225536231207564. [PMID: 37823821 DOI: 10.1177/10225536231207564] [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] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Proper coronal alignment of the limb is of vital importance in the progression of knee osteoarthritis even in the long-term survivorship of component after total knee arthroplasty (TKA). Nevertheless, to the best of our knowledge, the relationship between coronal fibular axis and tibial mechanical axis had not reached a consensus in the literatures available. The current study aimed to explore the anatomic relationship between tibia and fibula alignment. METHODS A total of 100 patients with knee osteoarthritis scheduled for total knee arthroplasty were enrolled in this study (Group A), and radiographic measurement was compared to a control group of 100 healthy volunteers without knee osteoarthritis (Group B). Full-length standing hip-to-ankle radiographs were used to assess limb alignment. The angle between coronal proximal fibular anatomic axis and tibia mechanical axis (PFTA) was used to represent the anatomic relationship between tibia and fibula alignment. A negative value indicates fibula varus relative to tibia mechanical axis, while a positive value indicates fibula valgus. RESULTS The mean PFTAs were -0.9° ± 0.9° and -1.0° ± 0.8° in Groups A and B. There was no significant difference between the two groups. No significant difference was detected in PFTA distribution in the group A and B. When the mean value of PFTA is used as baseline data, the percentage of subjects in which the PFTA deviation was within 0.5°, 1°, and 1.5° was 51%, 84%, and 94% in Group A and 53%, 87%, and 96% in Group B. There was also no significant difference in distribution deviation between the two groups. No patient-specific factors were correlated with the PFTA. CONCLUSIONS The proximal fibular anatomic axis is a reliable landmark for tibial mechanical axis in the coronal plane in patients with or without knee osteoarthritis.
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Affiliation(s)
- Shangkun Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital Sichuan University, Chengdu, China
| | - Xuelin Pan
- Department of Radiology, West China Hospital Sichuan University, Chengdu, China
| | - Renyuan Xu
- Department of Thyroid and Breast Surgery, Zigong First People's Hospital, Zigong, China
| | - Xiaojun Shi
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital Sichuan University, Chengdu, China
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Durán-Serrano M, Lizcano-Palomares M, Laclériga-Giménez AF, Roche-Albero A, Delfau-Lafuente D, Martín-Hernández C. Postoperative limb alignment in total knee replacement. Conventional versus navigated versus robotic techniques. Int J Med Robot 2023; 19:e2504. [PMID: 36738122 DOI: 10.1002/rcs.2504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Our objective was to compare the coronal mechanical axis after total knee replacement (TKR) obtained in three groups of patients subjected to conventional, navigated, and robotic surgery. METHODS Retrospective analysis. RESULTS 124 knees were included (36 conventional, 41 navigated, 47 robotic). No statistically significant differences were found between the postOp tibiofemoral angle of the conventional, navigated and robotic groups (p = 0.396). A repeated-measure analysis of preOp-to-postOp also found no significant differences (p = 0.387). There were no differences in the proportion of outliers (3-degree) found (p = 0.211). Nevertheless, a higher proportion of patients in the robotic group improved their mechanical alignment, as compared with conventional surgery (p = 0.023), although no differences were found when comparing with navigation (p = 0.121). CONCLUSIONS No statistically significant differences were found with respect to the postOp alignment achieved. However, statistically significant differences were detected between robotic and conventional surgery when considering the percentage of patients with improved limb alignment.
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Affiliation(s)
- María Durán-Serrano
- Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Miguel Lizcano-Palomares
- Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | | | - Adrián Roche-Albero
- Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Daniel Delfau-Lafuente
- Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, II Aragón, Zaragoza, Spain
| | - Carlos Martín-Hernández
- Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
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Charaya H, Gill HS, Bhan R. Functional Outcome Based on Mechanical Axis Alignment Following Total Knee Arthroplasty. Cureus 2022; 14:e22553. [PMID: 35371657 PMCID: PMC8958131 DOI: 10.7759/cureus.22553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Total knee arthroplasty (TKA) is the most commonly performed and highly successful surgical intervention for end-stage osteoarthritis of the knee, and it offers patients pain relief, functional recovery, and improved quality of life. The success of knee arthroplasty depends on various factors such as precise surgical technique, alignment of the limb and components, patient selection, and compliance with rehabilitation. Mechanical alignment of the lower limb has been considered an important factor in planning and assessing the success of TKA. Optimal alignment remains a matter of controversy; hence, it is paramount to assess the alignment and functional outcomes. Aim and objective This study aimed to evaluate the reliability of conventional instrumentation in imparting the intended femoral and tibial coronal alignment, as well as study the functional outcome among the neutrally aligned outliers with respect to the mechanical axis of the lower limb using standing long-leg radiographs. Methodology This is a prospective, hospital-based, observational study that was conducted on 60 knees in 42 patients with primary osteoarthritis of the knee joint in the department of orthopedics, Satguru Partap Singh (SPS) Hospitals, Ludhiana. Patients undergoing total knee arthroplasty who fulfilled the inclusion criteria were included in our study and evaluated using Knee Society Score and knee flexion range at periodic follow-up till six months. Preoperative and postoperative standing long-leg radiographs were done for all the patients, and their functional outcome was compared among inliers and outliers. Results Out of these 60 total knee arthroplasties, 18 patients were operated on both knees, and 24 patients were operated on a single knee. There were 25 female patients and 17 male patients. The mean for pre-operative mechanical axis alignment angle was 11.88° ± 5.63° with a range from -3° to 27°, which changed to 2.90° ± 1.59° with a range from 0° to 8° at six months follow-up. It was observed that 42 of the knees were in the inliers, and the remaining 18 knees were in the outliers group. On comparison among inliers and outliers, we found that the mean range of motion was 108.29° ± 4.82° for the inliers group and 106.11° ± 4.04° for the outliers group (p = 0.091), depicting non-significant statistical comparison. Mean Knee Society Score values in inliers and outliers group were 152.45 ± 5.33 and 151.61 ± 3.55, respectively (p = 0.740), showing no statistical significance. Conclusion At six months follow-up, there is no difference in the knee range of motion and Knee Society Scores between mechanical axis inliers and outliers. Thus, we conclude that although every knee arthroplasty is intended to have neutral mechanical alignment, there is no effect of mild mechanical axis malalignment on functional outcome following total knee arthroplasty in the short term.
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Xu Z, Zhang Y. What’s new in artificially intelligent joint surgery in China? The minutes of the 2021 IEEE ICRA and literature review. ARTHROPLASTY 2022; 4:10. [PMID: 35236509 PMCID: PMC8796390 DOI: 10.1186/s42836-021-00109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To outline the main results of the 2021 International Conference on Robotics and Automation (ICRA 2021) of the Institute of Electrical and Electronics Engineers (IEEE) and review the advances in artificially intelligent joint surgery in China. Methods The keynote speeches of the 2021 ICRA were summarized in detail, and publications indexed by five core electronic databases (PubMed, Cochrane, Medline, Embase and CNKI) were systematically surveyed (cutoff date: July 30, 2021) in terms of the main topics of the conference. Publications directly related to artificially intelligent joint surgery in China were identified by using the search strategies of (robotic AND arthroplasty OR replacement), (navigation AND arthroplasty OR replacement), (artificial intelligent AND arthroplasty OR replacement), and (mixed reality AND arthroplasty OR replacement) and systemically reviewed. Results While robot-assisted arthroplasty in China is mainly performed using robots made in other countries (e.g., Mako from Stryker, USA), China’s domestic R&D of robots and clinical studies of robotic joint surgery have made some achievements. Although reports on the safety, effectiveness and clinical efficacy of China’s domestic robot-assisted joint surgery were presented at conferences, they have rarely been published in journals. Existing data indicate that, after the learning curve is overcome, robot-assisted hip and knee replacement surgery can fully achieve the established goals of precision and individualization and can significantly improve the accuracy of prosthesis placement angle and the recovery of the mechanical axis as compared with conventional surgery. The downside is that the low level of intelligentization and individualization means that existing designs are not conducive to personalization during surgery, resulting in low cost-effectiveness. Conclusion The safety and efficacy of domestic robot-assisted arthroplasty in China are well documented, and its accuracy and short-term clinical efficacy have been reported. However, the long-term clinical efficacy and the cost-effectiveness of large-scale clinical application of this technique warrants further study. The inadequacies of robot-assisted surgery should be remedied through the deep integration of medicine, engineering and the network.
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Accuracy of different navigation systems for femoral and tibial implantation in total knee arthroplasty: a randomised comparative study. Arch Orthop Trauma Surg 2021; 141:2267-2276. [PMID: 34652514 DOI: 10.1007/s00402-021-04205-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE It remains to be established whether optical computed tomography (CT)-free and acceleration-based navigation systems differ in terms of implantation accuracy and clinical outcomes for total knee arthroplasty. This randomised prospective study compared the implantation accuracy of these two navigation systems in total knee arthroplasty. METHODS Optical CT-free navigation (ExactechGPS) or acceleration-based navigation (KneeAlign2) was randomly assigned to the left or right knee of 45 patients who underwent a single-stage bilateral total knee arthroplasty: the ExactechGPS (n = 45) and KneeAlign2 groups (n = 45) were compared. Component alignments were evaluated using three-dimensional computed tomography and radiography at pre- and post-surgery. Implantation accuracy of the component alignment, proportion of outliers, postoperative range of motion, and Japanese Orthopaedic Association (JOA) score were compared between the systems. RESULTS The implantation accuracies of the lower-extremity mechanical alignment, coronal femoral component angle, coronal tibial component angle, sagittal femoral component, axial femoral angle, and axial tibial angle had no significant difference between the groups. The implantation accuracy of the sagittal tibial component angle was superior in the ExactechGPS than the KneeAlign2 group (1.3° vs. 1.8°, P = 0.034). The proportions of outliers, range of motion, and JOA score had no significant difference between the groups. CONCLUSION In the tibial sagittal plane, there was a significant difference in the implantation accuracy, but its difference did not affect the clinical outcomes. Both navigation systems have clinically acceptable implantation accuracy.
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Sun H, Zheng K, Zhang W, Li N, Zhang L, Zhou J, Xu Y, Li R. [Early effectiveness of computer navigation-assisted total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1273-1280. [PMID: 34651480 DOI: 10.7507/1002-1892.202102070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To estimate the early effectivenss of computer navigation-assisted total knee arthroplasty (TKA) by comparing with traditional TKA. Methods The clinical data of 89 patients (100 knees) underwent primary TKA between October 2017 and July 2018 were analyzed retrospectively, including 44 patients (50 knees) who completed the TKA under the computer-assisted navigation system as the navigation group and 45 patients (50 knees) treated with traditional TKA as the control group. There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, diagnosis, side, disease duration, Kellgren-Lawrence classification of osteoarthritis, and preoperative American Hospital for Special Surgery (HSS) score, range of motion (ROM), hip-knee-ankle angle (HKA) deviation. The operation time, incision length, difference in hemoglobin before and after operation, postoperative hospital stay, and the complications were recorded and compared between the two groups. The HSS score, ROM, and joint forgetting score (FJS-12) were used to evaluate knee joint function in all patients. Unilateral patients also underwent postoperative time of up and go test and short physical performance battery (SPPB) test. At 1 day after operation, the HKA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), sagittal femoral component angle (sFCA), and sagittal tibial component angle (sTCA) were measured and calculated the difference between the above index and the target value (deviation); and the joint line convergence angle (JLCA) was also measured. Results The operations of the two groups were successfully completed, and the incisions healed by first intention. The operation time and incision length of the navigation group were longer than those of the control group ( P<0.05); the difference in difference of hemoglobin before and after the operation and the postoperative hospital stay between groups was not significant ( P>0.05). Patients in the two groups were followed up 27-40 months, with an average of 33.6 months. Posterior tibial vein thrombosis occurred in 1 case in each of the two groups, and 1 case in the control group experienced repeated knee joint swelling. The HSS scores of the two groups gradually increased after operation ( P<0.05); HSS scores in the navigation group at 1 and 2 years after operation, and knee ROM and FJS-12 scores at 2 years were significantly higher than those in the control group ( P<0.05). There was no significant difference in the postoperative time of up and go test and SPPB results between the two groups at 7 days after operation ( P>0.05); the postoperative time of up and go test of the navigation group was shorter than that of the control group at 2 years ( t=-2.226, P=0.029), but there was no significant difference in SPPB ( t=0.429, P=0.669). X-ray film measurement at 1 day after operation showed that the deviation of HKA after TKA in the navigation group was smaller than that of the control group ( t=-7.392, P=0.000); among them, the HKA deviations of 50 knees (100%) in the navigation group and 36 knees (72%) in the control group were less than 3°, showing significant difference between the two groups ( χ 2=16.279, P=0.000). The JLCA and the deviations of mLDFA, mMPTA, sFCA, and sTCA in the navigation group were smaller than those in the control group ( P<0.05). Conclusion Compared with traditional TKA, computer navigation-assisted TKA can obtain more accurate prosthesis implantation position and lower limb force line and better early effectiveness. But there is a certain learning curve, and the operation time and incision length would be extended in the early stage of technology application.
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Affiliation(s)
- Houyi Sun
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Kai Zheng
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Weicheng Zhang
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Ning Li
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Lianfang Zhang
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Jun Zhou
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Yaozeng Xu
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Rongqun Li
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
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Improved femoral component rotation in total knee arthroplasty: an anatomical study with optimized gap balancing. Arch Orthop Trauma Surg 2021; 141:1669-1675. [PMID: 32757034 DOI: 10.1007/s00402-020-03557-6] [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: 03/14/2020] [Accepted: 07/20/2020] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Surgically balanced total knee arthroplasties have shown improved functional and clinical outcomes. Two different alignment methods have been proposed, the measured resection technique which uses femoral landmarks on the one hand and the ligament balanced technique which uses spreaders on the other. As anatomical landmarks also vary widely, with regards to the tibial cut irrespective of the collateral ligaments, we hypothesized that anatomical landmarks are not suitable for ideal femoral component rotational alignment. MATERIALS AND METHODS Ten cadaveric bilateral knees underwent TKA using a navigational device and a double tensiometer. By means of the navigational device, flexion gaps were balanced by femoral component size, rotation and flexion until a symmetric flexion and extension gap was obtained. Acquired femoral component rotation was compared to femoral landmarks (Whiteside Line, posterior condylar line and trans-epicondylar line). RESULTS Using the Whiteside line, the posterior condylar line and the surgical trans-epicondylar line to identify femoral component rotation did not balance the flexion gap as well as navigation. Depending on the parameter, deviations in femoral rotation of up to 6° were observed compared to the gap balancing technique. Furthermore, large deviations between these landmarks were observed. CONCLUSION Based on this study flexion gap balancing can be better optimized using ligament balancing technique. As this technique is highly dependent on the proximal tibial cut, we do recommend the use of navigational devices, which additionally assure a neutral leg alignment.
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Siddiqi A, Piuzzi NS. Letter to the Editor: Does the Use of Intraoperative Technology Yield Superior Patient Outcomes Following Total Knee Arthroplasty? J Arthroplasty 2021; 36:e68-e69. [PMID: 34116773 DOI: 10.1016/j.arth.2020.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/23/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Ahmed Siddiqi
- Orthopaedic Institute of Central Jersey, A division of Ortho Alliance NJ, Manasquan, NJ; Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Hackensack, NJ; Department of Orthopedic Surgery, Jersey Shore University Medical Center, Neptune, NJ
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
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Buchlak QD, Clair J, Esmaili N, Barmare A, Chandrasekaran S. Clinical outcomes associated with robotic and computer-navigated total knee arthroplasty: a machine learning-augmented systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:915-931. [PMID: 34173066 DOI: 10.1007/s00590-021-03059-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Robotic (RTKA) and computer-navigated total knee arthroplasty (CNTKA) are increasingly replacing manual techniques in orthopaedic surgery. This systematic review compared clinical outcomes associated with RTKA and CNTKA and investigated the utility of natural language processing (NLP) for the literature synthesis. METHODS A comprehensive search strategy was implemented. Results of included studies were combined and analysed. A transfer learning approach was applied to train deep NLP classifiers (BERT, RoBERTa and XLNet), with cross-validation, to partially automate the systematic review process. RESULTS 52 studies were included, comprising 5,067 RTKA and 2,108 CNTKA. Complication rates were 0-22% and 0-16% and surgical time was 70-116 and 77-102 min for RTKA and CNTKA, respectively. Technical failures were more commonly associated with RTKA (8%) than CNTKA (2-4%). Patient satisfaction was equivalent (94%). RTKA was associated with a higher likelihood of achieving target alignment, less femoral notching, shorter operative time and shorter length of stay. NLP models demonstrated moderate performance (AUC = 0.65-0.68). CONCLUSIONS RTKA and CNTKA appear to be associated with similarly positive clinical outcomes. Further work is required to determine whether the two techniques differ significantly with regard to specific outcome measures. NLP shows promise for facilitating the systematic review process.
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Affiliation(s)
- Quinlan D Buchlak
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.
| | - Joe Clair
- Department of Orthopaedics, Werribee Mercy Hospital, Melbourne, VIC, Australia
| | - Nazanin Esmaili
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.,Faculty of Engineering and Information Technology, University of Technology Sydney, Ultimo, NSW, Australia
| | - Arshad Barmare
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.,Department of Orthopaedics, Werribee Mercy Hospital, Melbourne, VIC, Australia
| | - Siva Chandrasekaran
- Department of Orthopaedics, Werribee Mercy Hospital, Melbourne, VIC, Australia
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Siddiqi A, Horan T, Molloy RM, Bloomfield MR, Patel PD, Piuzzi NS. A clinical review of robotic navigation in total knee arthroplasty: historical systems to modern design. EFORT Open Rev 2021; 6:252-269. [PMID: 34040803 PMCID: PMC8142596 DOI: 10.1302/2058-5241.6.200071] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Robotic-assisted total knee arthroplasty (RA-TKA) has shown improved reproducibility and precision in mechanical alignment restoration, with improvement in early functional outcomes and 90-day episode of care cost savings compared to conventional TKA in some studies. However, its value is still to be determined.Current studies of RA-TKA systems are limited by short-term follow-up and significant heterogeneity of the available systems.In today's paradigm shift towards an increased emphasis on quality of care while curtailing costs, providing value-based care is the primary goal for healthcare systems and clinicians. As robotic technology continues to develop, longer-term studies evaluating implant survivorship and complications will determine whether the initial capital is offset by improved outcomes.Future studies will have to determine the value of RA-TKA based on longer-term survivorships, patient-reported outcome measures, functional outcomes, and patient satisfaction measures. Cite this article: EFORT Open Rev 2021;6:252-269. DOI: 10.1302/2058-5241.6.200071.
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Affiliation(s)
- Ahmed Siddiqi
- Cleveland Clinic Foundation, Department of Orthopedics Cleveland, Ohio, USA
| | - Timothy Horan
- Philadelphia College of Osteopathic Medicine, Department of Orthopedics, Philadelphia, Pennsylvania, USA
| | - Robert M. Molloy
- Cleveland Clinic Foundation, Department of Orthopedics Cleveland, Ohio, USA
| | | | - Preetesh D. Patel
- Cleveland Clinic Florida, Department of Orthopedics, Weston, Florida, USA
| | - Nicolas S. Piuzzi
- Cleveland Clinic Foundation, Department of Orthopedics Cleveland, Ohio, USA
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Kanna R, Brasanna A, Shetty GM, Ravichandran C. No influence of obesity on mid-term clinical, functional, and radiological results after computer-navigated total knee arthroplasty using a gap balancing technique. J Clin Orthop Trauma 2021; 16:136-142. [PMID: 33717948 PMCID: PMC7920157 DOI: 10.1016/j.jcot.2021.01.001] [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: 09/11/2020] [Revised: 01/01/2021] [Accepted: 01/02/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE In obese patients, thick subcutaneous tissue can introduce errors during registration and leg weight can influence gap balancing in navigated TKA. Present study is done to determine if computer navigated TKA using a gap balancing technique can achieve consistent accuracy for limb and component alignment, and similar clinical and functional results in obese patients like in non-obese patients. METHODS We prospectively compared the radiological, clinical, and functional results of 78 knees in 57 non-obese patients and 79 knees in 58 obese patients who underwent computer-assisted TKA. Non-obese individuals were defined as those having BMI of <30 kg/m2 and obese individuals as BMI ≥30 kg/m2. The degree of knee deformity was calculated by Hip - Knee - Ankle (HKA) angle and clinical and functional assessment was done using the Knee Society Score - clinical knee score and Knee Society Score - function score, respectively. All these were documented before and at 6 months, 2 year, and 5 years after TKA. RESULTS The outlier rate of postoperative limb alignment (HKA angle) was 8.9% in the obese group which was not significantly different (p =1.00) from that of the non-obese group (7.7%). Mean clinical knee scores were not significantly different between the non-obese and obese groups preoperatively (58.8 vs 57.4, p = 0.14) and at 6 months (92.7 vs 91, p = 0.06), 2 years (91.4 vs 90, p = 0.07), and 5 years (92.4 vs 91.3, p = 0.1) post-surgery. Similarly, mean functional scores were not significantly different between the non-obese and obese groups preoperatively (50.9 vs 49.9, p = 0.31) and at 6 months (92.7 vs 90.9, p = 0.06), 2 years (91.3 vs 92, p = 0.44), and 5 years (90.6 vs 91.1, p = 0.51) post-surgery. CONCLUSION Obesity has no influence on mid-term clinical, functional, and radiological results after computer navigated TKA, done by gap balancing technique. LEVEL OF EVIDENCE Therapeutic level II.
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Affiliation(s)
- Raj Kanna
- Department of Orthopaedic Surgery, Prashanth Super Speciality Hospital, Chennai, India,Corresponding author. Prashanth Super Speciality Hospital, Velachery Main Road, Chennai- 600042, India.
| | - Ananth Brasanna
- Department of Orthopaedic Surgery, Prashanth Super Speciality Hospital, Chennai, India
| | - Gautam M. Shetty
- Knee & Orthopaedic Clinic, Head of Clinical Research, AIMD Research, Mumbai, India
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Gao J, Dong S, Li JJ, Ge L, Xing D, Lin J. New technology-based assistive techniques in total knee arthroplasty: A Bayesian network meta-analysis and systematic review. Int J Med Robot 2020; 17:e2189. [PMID: 33108058 DOI: 10.1002/rcs.2189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/18/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The radiological and clinical efficiency among robot-assisted surgery (RAS), computer-assisted navigation system (CAS) and conventional (CON) total knee arthroplasty (TKA) remains controversial. METHODS Bayesian network meta-analysis (NMA) and systematic review were performed to investigate radiological and clinical efficiency respectively. The certainty of the evidence was evaluated using GRADE and CERQual tool. RESULTS Thirty-four RCTs (7289 patients and 7424 knees) were included. The NMA showed that RAS-TKA had the highest probability for mechanical axis restoration (odds ratio for RAS vs. CAS 3.79, CrI 1.14 to 20.54, very low certainty), followed by CAS-TKA (odds ratio for CAS vs. CON 2.55, CrI 1.67 to 4.01, very low certainty) and then CON-TKA, without significant differences in other radiological parameters. No differences were found in clinical outcomes after qualitative systematic review (overall low certainty). CONCLUSIONS Technology-based assistive techniques (CAS and RAS) may surpass the CON-TKA, when considering higher radiological accuracy and comparable clinical outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jiaxiang Gao
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
- Arthritis Institute, Peking University, Beijing, China
| | - Shengjie Dong
- Orthopedic department, Yantaishan Hospital, Yantai, Shandong, China
| | - Jiao Jiao Li
- Kolling Institute, University of Sydney, Sydney, NSW, 2006, Australia
| | - Long Ge
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Gansu, China
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Dan Xing
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
- Arthritis Institute, Peking University, Beijing, China
| | - Jianhao Lin
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
- Arthritis Institute, Peking University, Beijing, China
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Smith CS, Mollon B, Vannabouathong C, Fu JM, Sales B, Bhandari M, Whelan DB. An Assessment of Randomized Controlled Trial Quality in The Journal of Bone & Joint Surgery: Update from 2001 to 2013. J Bone Joint Surg Am 2020; 102:e116. [PMID: 33086352 DOI: 10.2106/jbjs.18.00653] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The quality of reporting of randomized controlled trials (RCTs) published in The Journal of Bone & Joint Surgery (JBJS) from 1988 to 2000 was previously analyzed. The purpose of this current study was to analyze the quality of reporting of RCTs published in JBJS from 2001 to 2013 to identify trends over time and potential areas of improvement for future clinical trials. METHODS A manual search of the JBJS database identified RCTs published between January 2001 and December 2013. Quality assessments, using the Detsky quality-of-reporting index (Detsky score), a modified Cochrane risk-of-bias tool, and abstraction of relevant data identifying predictors of quality, were conducted. RESULTS A total of 5,780 publications were identified in JBJS from 2001 to 2013, with 285 RCTs (4.9%), representing an increase from the prior 13-year period. The overall mean transformed Detsky score (and standard error) increased significantly (p < 0.001) from 68.1% ± 1.67% to 76.24% ± 0.72%. The percentage of multicenter RCTs decreased from 67% to 31%. The percentage of positive trials also decreased from 80% to 50.5%, as did the mean sample size (212 to 166). Regression analysis indicated that trials with an epidemiologist as the first author and nonsurgical trials were significantly associated (p = 0.001) with a higher overall trial quality score. The categories of the lowest mean methodology scores were randomization and concealment, eligibility criteria, and reasons for patient exclusion, as identified with the Detsky score, and patient and assessor blinding, as identified with the risk-of-bias assessment. CONCLUSIONS The quantity and quality of published RCTs in JBJS have increased in the 2001 to 2013 time period compared with the previous time period. Although these improvements are encouraging, trends to smaller, single-center trials were also observed. To efficiently determine the efficacy of orthopaedic treatments and limit bias, high-quality randomized trials of appropriate sample size and rigorous design are needed.
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Affiliation(s)
| | - Brent Mollon
- Soldiers' Memorial Hospital, Orillia, Ontario, Canada
| | | | - Joyce M Fu
- Department of Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | | | - Mohit Bhandari
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Daniel B Whelan
- University of Toronto Orthopaedic Sports Medicine, St. Michael's and Women's College Hospitals, Toronto, Ontario, Canada
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Population-based Survivorship of Computer-navigated Versus Conventional Total Knee Arthroplasty. J Am Acad Orthop Surg 2020; 28:857-864. [PMID: 31934926 DOI: 10.5435/jaaos-d-19-00548] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The goal of computer navigation in total knee arthroplasty (TKA) is to improve the accuracy of alignment. However, the relationship between this technology and implant longevity has not been established. The purpose of this study was to analyze survivorship of computer-navigated TKAs compared with traditionally instrumented TKAs. METHODS The PearlDiver Medicare database was used to identify patients who underwent a primary TKA using conventional instrumentation versus computer navigation between 2005 and 2014. Conventional and computer-navigated cohorts were matched by age, sex, year of procedure, comorbidities, and geographic region. Kaplan-Meier curves were generated to estimate survivorship with aseptic mechanical complications, periprosthetic joint infection, and all-cause revision as end points. RESULTS During the study period, 75,709 patients who underwent a computer-navigated TKA were identified and matched to a cohort of 75,676 conventional TKA patients from a cohort of 1,607,803 conventional TKA patients. No difference existed in survival between conventional instrumentation (94.7%) and navigated TKAs (95.1%, P = 0.06) at 5 years. A modest decrease was found in revisions secondary to mechanical complications associated with navigation (96.1%) compared with conventional instrumentation (95.7%, P = 0.02) at 5 years. No differences in revision rates because of periprosthetic joint infection were observed (97.9% versus 97.9% event-free survival, P = 0.30). In a subgroup of Medicare patients younger than 65 years of age, use of computer navigation was associated with a decrease in all-cause revision (91.4% versus 89.6% event free survival, P = 0.01) and revision secondary to mechanical complications (89.6% versus 87.8% event-free survival, P = 0.01) at 5 years. DISCUSSION Among Medicare patients, no notable difference existed in TKA survival associated with the use of computer navigation at the 5-year follow-up. Use of computer navigation was associated with a slight decrease in revisions secondary to mechanical failure. Although improved survivorship was associated with patients younger than 65 years of age who had a navigated TKA, generalizability of these findings is limited given the unique characteristics of this Medicare subpopulation.
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Zhao L, Xu F, Lao S, Zhao J, Wei Q. Comparison of the clinical effects of computer-assisted and traditional techniques in bilateral total knee arthroplasty: A meta-analysis of randomized controlled trials. PLoS One 2020; 15:e0239341. [PMID: 32976534 PMCID: PMC7518627 DOI: 10.1371/journal.pone.0239341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 09/03/2020] [Indexed: 12/29/2022] Open
Abstract
Background It is unclear whether there are individual differences in the long-term efficacy of computer-assisted and traditional total knee arthroplasty. The purpose of this study was to perform a meta-analysis comparing the same individuals undergoing computer-assisted and traditional total knee arthroplasty separately to determine whether computer-assisted total knee arthroplasty can provide better lower extremity radiographic results and clinical outcomes. Methods We searched literatures to identify relevant randomized controlled trials comparing the effects of computer-assisted and traditional methods in bilateral total knee arthroplasty. After screening, quality evaluation and data extraction according to inclusion and exclusion criteria, the quality and bias risks of the included studies were evaluated. The meta-analysis compared the radiographic results, functional outcomes and complications of the two techniques. Results Six clinical controlled trials were included, with total of 1098 patients. The meta-analysis showed that the accuracy in terms of the mechanical axis of the lower extremity, the sagittal alignment of the femoral component and the coronal alignment of the tibial component in computer-assisted total knee arthroplasty was significantly better than those in traditional total knee arthroplasty. There were no differences in the functional results, revision rates or aseptic loosening rates between the two techniques. Conclusion After excluding individual differences such as bone development and bone quality, although computer-assisted techniques can better accurately correct the mechanical axis of the lower extremity and the position of prosthesis implantation than traditional techniques, there is no significant difference in the functional results and revision rate of bilateral total knee arthroplasty in the same individual.
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Affiliation(s)
- Liangjun Zhao
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fang Xu
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shan Lao
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jingmin Zhao
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingjun Wei
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Chen Z, Deng Z, Li Q, Chen J, Ma Y, Zheng Q. How to predict early clinical outcomes and evaluate the quality of primary total knee arthroplasty: a new scoring system based on lower-extremity angles of alignment. BMC Musculoskelet Disord 2020; 21:518. [PMID: 32746812 PMCID: PMC7397679 DOI: 10.1186/s12891-020-03528-3] [Citation(s) in RCA: 4] [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: 01/21/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022] Open
Abstract
Background A method that can accurately predict the outcome of surgery can give patients timely feedback. In addition, to some extent, an objective evaluation method can help the surgeon quickly summarize the patient’s surgical experience and lessen dependence on the long wait for follow-up results. However, there was still no precise tool to predict clinical outcomes of total knee arthroplasty (TKA). This study aimed to develop a scoring system to predict clinical results of TKA and then grade the quality of TKA. Methods We retrospectively reviewed 98 primary TKAs performed between April 2013 and March 2017 to determine predictors of clinical outcomes among lower-extremity angles of alignment. Applying multivariable linear-regression analysis, we built Models (i) and (ii) to predict detailed clinical outcomes which were evaluated using the Knee Society Score (KSS). Multivariable logistic-regression analysis was used to establish Model (iii) to predict probability of getting a good clinical outcome (PGGCO) which was evaluated by Knee Injury and Osteoarthritis Outcome Score (KOOS) score. Finally, we designed a new scoring system consisting of 3 prediction models and presented a method of grading TKA quality. Thirty primary TKAs between April and December 2017 were enrolled for external validation. Results We set up a scoring system consisting of 3 models. The interpretations of Model (i) and (ii) were good (R2 = 0.756 and 0.764, respectively). Model (iii) displayed good discrimination, with an area under the curve (AUC) of 0.936, and good calibration according to the calibration curve. Quality of surgery was stratified as follows: “A” = PGGCO ≥0.8, “B” = PGGCO ≤0.6 but < 0.8, and “C” = PGGCO < 0.6. The scoring system performed well in external validation. Conclusions This study first developed a validated, evidence-based scoring system based on lower-extremity angles of alignment to predict early clinical outcomes and to objectively evaluate the quality of TKA.
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Affiliation(s)
- Ziming Chen
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou City, 510080, Guangdong Province, China.,Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia
| | - Zhantao Deng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou City, 510080, Guangdong Province, China
| | - Qingtian Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou City, 510080, Guangdong Province, China
| | - Junfeng Chen
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou City, 510080, Guangdong Province, China
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou City, 510080, Guangdong Province, China.
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou City, 510080, Guangdong Province, China.
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Matar HE, Platt SR, Gollish JD, Cameron HU. Overview of Randomized Controlled Trials in Total Knee Arthroplasty (47,675 Patients): What Have We Learnt? J Arthroplasty 2020; 35:1729-1736.e1. [PMID: 32088054 DOI: 10.1016/j.arth.2020.01.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to provide an overview of randomized controlled trials (RCTs) in primary total knee arthroplasty summarizing the available high-quality evidence. METHODS Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2019, Issue 3), Ovid MEDLINE, and Embase. We excluded nonrandomized trials, trials on unicompartmental knee arthroplasty or revision surgery, systematic reviews, and meta-analyses. Trials that met our inclusion criteria were assessed using a binary outcome measure of whether they reported statistically significant findings. These were then classified according to the intervention groups (surgical approach, tourniquet use, design, etc.). RESULTS Four hundred and three RCTs met the inclusion criteria and were included. The total number of patients in those 403 RCTs was 47,675. Only 33 RCTs (8.2%) reported significant differences between the intervention and the control groups. The trials were grouped into surgical approach 34, tourniquet 31, minimally invasive surgery 13, patient specific instrumentation 30, knee design 37, fixation 27, mobile bearing 47, navigation 50, polyethylene 19, technique 27, patella resurfacing 26, drain 19, closure 16, and others 27 RCTs. CONCLUSION For the vast majority of patients, a standard conventional total knee arthroplasty with a surgical approach familiar to the surgeon using standard well-established components, with or without tourniquet, without surgical drain leads to satisfactory long-term clinical outcomes.
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Affiliation(s)
- Hosam E Matar
- Sunnybrook Holland Centre, University of Toronto, Toronto, ON, Canada; Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, ON, Canada
| | - Simon R Platt
- Department of Orthopaedic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jeffrey D Gollish
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, ON, Canada
| | - Hugh U Cameron
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, ON, Canada
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Li JT, Gao X, Li X. Comparison of iASSIST Navigation System with Conventional Techniques in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Radiographic and Clinical Outcomes. Orthop Surg 2019; 11:985-993. [PMID: 31755245 PMCID: PMC6904605 DOI: 10.1111/os.12550] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022] Open
Abstract
The iASSIST navigation system is a handheld accelerometer‐based navigation system that has been applied in clinical practice in recent five years. This meta‐analysis aimed to compare the radiographic and clinical outcomes of iASSIST navigation with conventional surgical techniques for patients undergoing total knee arthroplasty (TKA) and to compare the surgery time between an iASSIST group and a conventional treatment group. This systematic review and meta‐analysis included all comparative prospective and retrospective studies published in Pubmed, Embase, the Cochrane Central Register of Controlled Trials, the Web of Science and the CNKI databases over the past 20 years. Inclusion criteria were studies that compared the iASSIST navigation system with conventional TKA. The primary outcomes were mechanical axis (MA) and outliers, which means postoperative MA varus or valgus of more than 3°. Secondary outcomes were coronal femoral angle (CFA) and coronal tibial angle (CTA). Knee Society Score (KSS) was used to evaluate functional outcome. The Newcastle–Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Eight studies involving 558 knees were included in this meta‐analysis. Of these, 275 patients used the iASSIST navigation system and 283 used conventional surgical techniques. A total of 5 studies were considered high quality and the other 3 were considered to be of moderate quality. The occurrence of malalignment of >3° in the iASSIST group was 13.3%, compared with 29.04% in the conventional group. Postoperative MA of the iASSIST group was significantly better than that of the conventional group (I2 = 19%, OR = −0.92, 95% CI = −1.09 to −0.75, P < 0.00001). The iASSIST navigation system provided significantly increased accuracy in the coronal femoral angle (I2 = 79%, OR = −0.88, 95% CI = −1.21 to −0.54, P < 0.00001) and the coronal tibial angle (I2 = 34%, OR = 0.39, 95% CI = −0.48 to −0.30, P < 0.00001) compared with conventional techniques. However, the duration of surgery using the iASSIST procedure was longer and there was no significant difference in the short‐term KSS in the iASSIST group compared with the conventional group. We found that when pooling the data of included studies, the number of outliers was fewer in the iASSIST group, and compared with conventional TKA techniques, the iASSIST system significantly improved the accuracy of lower limb alignment but the duration of surgery was prolonged in addition to there being no apparent advantage in terms of short‐term functional score.
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Affiliation(s)
- Jun-Tan Li
- Department of Orthopaedics, The First Hospital of China Medical University, Shenyang, China
| | - Xiang Gao
- Department of Orthopaedics, The First Hospital of China Medical University, Shenyang, China
| | - Xu Li
- Department of Orthopaedics, The First Hospital of China Medical University, Shenyang, China
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Hsu RWW, Hsu WH, Shen WJ, Hsu WB, Chang SH. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty: The outcomes at mid-term follow-up. Medicine (Baltimore) 2019; 98:e18083. [PMID: 31764842 PMCID: PMC6882567 DOI: 10.1097/md.0000000000018083] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/26/2019] [Accepted: 10/23/2019] [Indexed: 12/03/2022] Open
Abstract
It remains unclear if computer-assisted surgery (CAS) technique actually improves the clinical outcomes of total knee arthroplasty (TKA) and decreases the failure rate. The purpose of this retrospective study was to compare the functional results of TKA in a series of patients who underwent staged bilateral TKAs with CAS TKA in 1 knee and conventional TKA in the contralateral knee.From January 1997 to December 2010, we collected 60 patients who were randomly assigned to receive CAS TKA in 1 limb and conventional TKA in the other. The Brainlab Vector Vision navigation system was used for CAS TKA, and the DePuy press-fit condylar sigma guide system was used for conventional TKA. Patients were assessed before surgery, 3 months and 1 year after surgery, and annually thereafter. IKS criteria were used for radiographic evaluation. Clinical and functional evaluation using the scoring system of hospital for special surgery (HSS), international knee society (IKS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form-36 (SF-36) were obtained on each knee, before surgery, and at each follow-up visit. Pertinent statistical methods were adopted for data analysis.Fifty-six patients were available for analysis and 44 of the patients were female. The mean duration of follow-up was 8.1 years. Less blood loss (P = .007) and longer operation time were noted for CAS TKAs when compared with conventional TKAs. Precise alignment and fewer outliers of the lower limb and prosthetic component positions were found for CAS TKAs (P < .001). There were no differences between the 2 groups before surgery and at the latest follow-up with regard to scores for HSS, IKS, WOMAC, and SF-36 as well as active range of motion.The clinical outcomes of CAS TKAs at the 8-year follow-up were similar to those of conventional TKAs despite the better radiographic alignment and fewer outliers achieved with navigation assistance.
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Affiliation(s)
- Robert Wen-Wei Hsu
- Sports Medicine Center
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Chang Gung University, Taoyuan
| | - Wei-Hsiu Hsu
- Sports Medicine Center
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Chang Gung University, Taoyuan
| | - Wun-Jer Shen
- Po Cheng Orthopedic Institute, Kaohsiung, Taiwan
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Shigemura T, Murata Y, Yamamoto Y, Mizuki N, Toki Y, Wada Y. No definite advantage of a portable accelerometer-based navigation system over conventional technique in total knee arthroplasty: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2019; 105:619-626. [PMID: 31040097 DOI: 10.1016/j.otsr.2019.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Precise implant alignment is a crucial prognostic factor in total knee arthroplasty (TKA). Portable navigation systems (PN-TKA) were reported to be better than the conventional technique (CON-TKA). We hypothesized that PN-TKA offered greater radiologic precision than CON-TKA in mechanically aligning components. We investigated whether (1) it improved global mechanical alignment, and (2) optimized component placement with respect to the tibial and femoral mechanical axes. PATIENTS AND METHODS A systematic literature review compared PN-TKA versus CON-TKA. PubMed, Web of Science and Cochrane Library search retrieved ten studies. Their data were pooled using RevMan 5.3. Odds ratios (OR) for dichotomous data were calculated with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed as I2 using a standard χ2 test. I2>50% denoted significant heterogeneity requiring a random effects model; otherwise, a fixed effects model was applied. RESULTS There were significantly fewer outliers for mechanical axis (I2=24%, OR=0.62, 95% CI=0.42-0.91, p=0.02) and coronal femoral component angle (I2=58%, OR=0.31, 95% CI=0.13-0.73, p=0.007) using PN-TKA; however, no significant difference was observed for coronal tibial component angle outliers (I2=0%, OR=0.66, 95% CI=0.38-1.15, p=0.14). DISCUSSION Although PN-TKA appeared to improve global alignment, it had no effect on coronal tibial alignment, which is a key factor in predicting the long-term success of component fixation. There thus appeared to be no definite advantage of PN-TKA over CON-TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tomonori Shigemura
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan.
| | - Yasuaki Murata
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan
| | - Yohei Yamamoto
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan
| | - Norichika Mizuki
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan
| | - Yasunori Toki
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan
| | - Yuichi Wada
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan
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Weber M, Worlicek M, Voellner F, Woerner M, Benditz A, Weber D, Grifka J, Renkawitz T. Surgical training does not affect operative time and outcome in total knee arthroplasty. PLoS One 2018; 13:e0197850. [PMID: 29856769 PMCID: PMC5983555 DOI: 10.1371/journal.pone.0197850] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 05/09/2018] [Indexed: 12/19/2022] Open
Abstract
Training the next generation of orthopaedic surgeons in total knee arthroplasty (TKA) is crucial, but might affect operative time and outcome. We hypothesized that the learning curve of residents in TKA has an impact on (1) operative time, (2) complication rates and (3) early postoperative outcome. In a retrospective analysis of 738 primary TKAs from our institutional joint registry, operative time, complication rates, patient-reported outcome measures (EQ-5D, WOMAC) within the first year and responder rates for positive outcome as defined by the OMERACT-OARSI criteria were compared between trainee and senior surgeons differentiating between conventional and navigated TKA. Mean operative time was 69.5±18.5min for trainees compared to 77.3±25.8min for senior surgeons (95%CI of the difference 1.5-13.9min, p = 0.02) in conventional TKA and 80.4±22.1min to 84.1±27.6min (95%CI of the difference -0.9-8.2min, p = 0.12) for navigated TKA, respectively. Intraoperative fracture (p≥0.36), thrombosis (p≥0.90), neurological deficits (p≥0.90) and infection rates (p≥0.28) were comparably low in both groups. Patient-reported outcome measures one year after TKA were similar for trainee and senior surgeons with EQ-5D 0.83±0.17 to 0.80±0.21 (p = 0.25) and WOMAC 74.85±18.60 to 72.77±20.12 (p = 0.44) for conventional TKA and EQ-5D 0.80±0.20 to 0.82±0.18 (p = 0.23) and WOMAC 72.71±18.52 to 75.77±17.78 (p = 0.07) for navigated TKA, respectively. Similarly, responder rates for positive outcome were comparable between trainees and senior surgeons (90.7% versus 87.0% p = 0.39 for conventional TKA, 88.7% versus 89.4% p = 0.80 for navigated TKA). Supervised TKA is a safe procedure during the learning curve of young orthopaedic surgeons.
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Affiliation(s)
- Markus Weber
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
- * E-mail:
| | - Michael Worlicek
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
| | - Florian Voellner
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
| | - Michael Woerner
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
| | - Daniela Weber
- Department of Hematology and Oncology, Regensburg University, Medical Center, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
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Does final component alignment correlate with alignment of the bone resection surfaces in cemented total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 2018; 26:1436-1444. [PMID: 27826637 DOI: 10.1007/s00167-016-4371-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/24/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To examine, with a navigation, whether the final component alignments correlate with alignment of the bone resection surfaces in cemented total knee arthroplasty (TKA), and to evaluate the factors affecting alignment deviation. METHODS A total of 222 patients (276 knees) who underwent navigation-assisted TKA between September 2012 and January 2014 due to osteoarthritis were retrospectively reviewed. The deviation between the alignment of bone resection surfaces and the final alignment of femoral and tibial components was measured. Factors associated with alignment deviation of greater than 2° (outliers) were evaluated. These included age, sex, body mass index, bone mineral density (T score), preoperative and postoperative mechanical femorotibial angle, preoperative and postoperative flexion contractures, and the difference between medial and lateral gaps in knee extension or flexion. RESULTS Outliers consisted of 24 cases (8.6%) on the femoral coronal plane, 4 cases (1.4%) on the tibial coronal plane, and 48 cases (17.4%) on the tibial sagittal plane. In the coronal plane (femur and tibia), the outliers were associated with preoperative [p < 0.001; odds ratio (OR) 0.774; 95% confidence interval (CI) 0.672-0.891] and postoperative (p < 0.001; OR 0.240; 95% CI 0.123-0.468) flexion contractures; a difference of 3 mm or more between the medial and lateral gaps in knee extension (p < 0.041; OR 5.805; 95% CI 1.075-31.343); and a T score of less than -2.5(p < 0.024; OR 5.899; 95% CI 1.258-27.664). In the sagittal plane of the tibia, the outliers were associated with preoperative (p < 0.001; OR 0.886; 95% CI 0.829-0.946) and postoperative (p < 0.031; OR 0.803; 95% CI 0.659-0.980) flexion contractures. CONCLUSION There was a deviation between the alignments of the bone resection surfaces and the final alignments of components. With larger preoperative and postoperative flexion contractures in the coronal and sagittal planes, there were more outlier risks. The outliers in the coronal plane were associated with a difference of 3 mm or more between the medial and lateral gaps in knee extension and poor bone quality. Awareness of such alignment deviation and related factors can help diminish the outliers after TKA. LEVEL OF EVIDENCE IV.
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Combined CT-based and image-free navigation systems in TKA reduces postoperative outliers of rotational alignment of the tibial component. Arch Orthop Trauma Surg 2018; 138:259-266. [PMID: 29177541 DOI: 10.1007/s00402-017-2837-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Rotational malpositioning of the tibial component can lead to poor functional outcome in TKA. Although various surgical techniques have been proposed, precise rotational placement of the tibial component was difficult to accomplish even with the use of a navigation system. The purpose of this study is to assess whether combined CT-based and image-free navigation systems replicate accurately the rotational alignment of tibial component that was preoperatively planned on CT, compared with the conventional method. MATERIALS AND METHODS We compared the number of outliers for rotational alignment of the tibial component using combined CT-based and image-free navigation systems (navigated group) with those of conventional method (conventional group). Seventy-two TKAs were performed between May 2012 and December 2014. In the navigated group, the anteroposterior axis was prepared using CT-based navigation system and the tibial component was positioned under control of the navigation. In the conventional group, the tibial component was placed with reference to the Akagi line that was determined visually. Fisher's exact probability test was performed to evaluate the results. RESULTS There was a significant difference between the two groups with regard to the number of outliers: 3 outliers in the navigated group compared with 12 outliers in the conventional group (P < 0.01). CONCLUSIONS We concluded that combined CT-based and image-free navigation systems decreased the number of rotational outliers of tibial component, and was helpful for the replication of the accurate rotational alignment of the tibial component that was preoperatively planned.
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CORR Insights®: No Benefit of Computer-assisted TKA: 10-year Results of a Prospective Randomized Study. Clin Orthop Relat Res 2018. [PMID: 29529628 PMCID: PMC5919236 DOI: 10.1007/s11999.0000000000000094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Figueroa F, Parker D, Fritsch B, Oussedik S. New and evolving technologies for knee arthroplasty—computer navigation and robotics: state of the art. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Slevin O, Amsler F, Hirschmann MT. No correlation between coronal alignment of total knee arthroplasty and clinical outcomes: a prospective clinical study using 3D-CT. Knee Surg Sports Traumatol Arthrosc 2017; 25:3892-3900. [PMID: 28005142 DOI: 10.1007/s00167-016-4400-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to evaluate femoral and tibial as well as whole leg coronal TKA alignment using 3D-reconstructed CTs and to assess the relationship of coronal TKA alignment and clinical outcome in a large prospective series of patients. It was hypothesized that a coronal deviation of TKA position and leg alignment from the mechanical axis is correlated with poorer patients' outcome after TKA. METHODS A total of 81 consecutive patients who underwent primary TKA were prospectively included. The patient's demographics such as age, gender and time from primary TKA were noted. All patients underwent clinical and radiological examination including standardized radiographs (anteroposterior and lateral weight-bearing, patellar skyline view) and CT as part of their postoperative follow-up. For assessment of TKA component position and orientation 3D-reconstructed CT was used. For clinical outcome scoring the Knee Society Score (KSS) was used at 1 and 2 years postoperatively. Linear and quadratic regression models were used to test for correlations between alignment variables and KSS (p < .05). RESULTS The mean Knee Society Score was 181 ± 28 (range 52-200) 2 years postoperatively, while 78% of the patients were completely pain free and 22% had some persisting pain interfering with their daily activities. The mean mechanical whole limb alignment (HKA angle), femoral component alignment and tibial component alignment were 0°, 0.1° and -0.7°, respectively. The component position parameters, as well as the whole limb alignment measurements, did not show any statistically significant correlation with the KSS, after 1 and 2 years postoperatively. CONCLUSION In this prospective study, using 3D-CT to measure the component position, the postoperative outcome was not influenced by coronal TKA component position as well as the whole leg alignment. The findings challenge the current target of neutral coronal alignment and point towards a more individualized mechanical alignment target. LEVEL OF EVIDENCE Prognostic study, Level I.
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Affiliation(s)
- Omer Slevin
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
| | | | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.
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Batash R, Rubin G, Lerner A, Shehade H, Rozen N, Rothem DE. Computed navigated total knee arthroplasty compared to computed tomography scans. Knee 2017; 24:622-626. [PMID: 28400204 DOI: 10.1016/j.knee.2017.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/27/2017] [Accepted: 03/16/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Successful total knee arthroplasty (TKA) includes accurate alignment. Controversy remains as to whether computer-navigated TKA improves the overall result and clinical outcome. Our aim is to compare the limb alignment and prosthesis positioning according to the pre- and postoperative computed tomography (CT) scans with the data collected from the navigation system. METHODS We compared the pre- and postoperative limb alignments and prosthesis alignment provided by the Orthopilot navigation system, Aesculap®, with CT scans measured by the Traumacad® software of 70 TKAs. RESULTS A positive correlation with statistical significance (P=0.00001, r=0.874) between the navigation system data and the CT images was found. Mean femoral cut was five degrees (valgus), and mean tibial cut was one degree (varus). Our study revealed that the navigation system assisted the surgeon to implant the prosthesis at a good acceptable alignment. CONCLUSION We found that the navigation system is accurate and correlates to the pre- and postoperative CT scans. Furthermore, the navigation system can assist the surgeon to achieve good limb alignment and cutting planes of the prosthesis.
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Affiliation(s)
- Ron Batash
- Faculty of Medicine, Bar-Ilan, Zeffat, Israel
| | - Guy Rubin
- Orthopedic Department, Emek Medical Center, Afula, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - Alexander Lerner
- Faculty of Medicine, Bar-Ilan, Zeffat, Israel; Orthopedic Department, Ziv Medical Center, Zefat, Israel
| | | | - Nimrod Rozen
- Orthopedic Department, Emek Medical Center, Afula, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - David E Rothem
- Faculty of Medicine, Bar-Ilan, Zeffat, Israel; Orthopedic Department, Ziv Medical Center, Zefat, Israel.
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Ueyama H, Matsui Y, Minoda Y, Matsuura M, Nakamura H. Using Accelerometer-Based Portable Navigation to Perform Accurate Total Knee Arthroplasty Bone Resection in Asian Patients. Orthopedics 2017; 40:e465-e472. [PMID: 28241085 DOI: 10.3928/01477447-20170223-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/17/2017] [Indexed: 02/03/2023]
Abstract
Implant alignment is an important factor affecting clinical results associated with total knee arthroplasty (TKA). No report exists showing the utility of an accelerometer-based portable navigation system among patients with marked femoral bowing. The aim of this study was to evaluate the accuracy of a portable navigation system for implant alignment in Asian patients with marked femoral bowing. The authors evaluated 142 consecutive TKAs performed for primary osteoarthritis since July 2013. A portable navigation system was used in 67 knees, and a conventional jig was used in 75 knees. The authors measured the mechanical axis and femoral/tibial component alignments on long-leg radiographs obtained 2 weeks after TKA. In addition, coronal bowing of the lower limb was evaluated. The results were analyzed in the general and marked femoral bowing subgroups. There were no significant differences between the 2 groups for demographic data. The rates of femoral component outliers in the coronal plane for the navigation system and conventional technique were 1.5% and 13.3% (P=.01), respectively. Marked femoral bowing was observed in 73 knees. In the subgroup of patients with marked femoral bowing, femoral coronal alignment and its outliers were more accurate in the navigation group (0%) than in the conventional group (16.2%) (P=.025). This is the first report to show the utility of an accelerometer-based portable navigation system for accurate prosthetic alignment among Asian patients with marked femoral bowing. The navigation system decreased outliers in coronal alignment of the femur, even in cases of marked femoral bowing, but did not increase complications. [Orthopedics. 2017; 40(3):e465-e472.].
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Hood B, Blum L, Holcombe SA, Wang SC, Urquhart AG, Goulet JA, Maratt JD. Variation in Optimal Sagittal Alignment of the Femoral Component in Total Knee Arthroplasty. Orthopedics 2017; 40:102-106. [PMID: 27841930 DOI: 10.3928/01477447-20161108-04] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/26/2016] [Indexed: 02/03/2023]
Abstract
Accurate sagittal alignment of the femoral component in total knee arthroplasty is crucial for prosthesis longevity, improved function, and patient satisfaction. However, there is variation in the techniques used to attain optimal sagittal femoral component placement in total knee arthroplasty. Femoral component flexion in imageless navigation is based on the mechanical axis rather than the distal femoral anatomy, and there is significant variability in the anatomy of the distal femur. The purpose of this study was to accurately determine the mean distal femoral flexion angle of a representative population and whether variability of the distal femoral flexion angle correlates with race, femur length, or radius of curvature. The mean degree of distal femoral flexion was determined by assessing distal femoral anatomy on computed tomography scans of paired femurs of 1235 patients without evidence of previous fracture, deformity, or surgical implants. The mean±SD distal femoral flexion angle was 2.90°±1.52°, with 80.2% of knees within 3°±2°. Therefore, placing the component in 3° of flexion from the mechanical axis would attain a satisfactory position in most cases. However, further analysis of the patient data revealed 11.4% of Asians, 7.3% of African Americans, and 8.3% of whites had a distal femoral flexion angle greater than 5°. Additionally, the data revealed a moderately strong negative correlation between the distal femoral flexion and the overall radius of curvature of the femur. This preliminary study highlights the need for improved methods for selecting femoral component position in the sagittal plane when using navigation for total knee arthroplasty. [Orthopedics. 2017; 40(2):102-106.].
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Song EK, Agrawal PR, Kim SK, Seo HY, Seon JK. A randomized controlled clinical and radiological trial about outcomes of navigation-assisted TKA compared to conventional TKA: long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2016; 24:3381-3386. [PMID: 26831857 DOI: 10.1007/s00167-016-3996-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 01/13/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Well balanced knees with good alignment are essential for a well-functioning TKA with long survival of its implants. This prospective randomized study comparing navigation-assisted TKA and conventional TKA reported the clinical and radiological outcomes at a follow-up of 9 years. The purpose of this study was to compare the clinical and radiological outcomes for patients who underwent navigation-assisted TKA or conventional TKA after long-term follow-up. METHODS A total of 80 patients (88 knees) were available for physical and radiological examination 9 years after TKA. Clinical outcomes were evaluated using HSS, WOMAC, and KS function and pain scores. And radiological outcomes of the component loosening and its survivorship during 9-year follow-up were also evaluated. RESULTS There were no significant differences in the field of clinical outcomes between the two groups. In terms of radiological outcomes, the navigation group had fewer alignment outliers (7.3 vs 20 %, p = 0.006). Although the clinical outcomes showed no differences between the two groups, the survival rate was slightly better in the navigation group than in the conventional group without statistical significance (best-case scenario 100 vs 95.3 %, n.s., worst-case scenario 95.6 vs 88.4 %, n.s.). CONCLUSION Navigation-assisted TKA produced better alignment outcomes and better survival rates than conventional instruments although some of the differences were not statistically significant. LEVEL OF EVIDENCE I.
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Affiliation(s)
- E K Song
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 160Ilsimri, Hwasun-eup, Hwasun-gun, Jeollanamdo, 519-809, South Korea
| | - Pranav R Agrawal
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 160Ilsimri, Hwasun-eup, Hwasun-gun, Jeollanamdo, 519-809, South Korea
| | - S K Kim
- Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, South Korea
| | - H Y Seo
- Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, South Korea
| | - J K Seon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 160Ilsimri, Hwasun-eup, Hwasun-gun, Jeollanamdo, 519-809, South Korea.
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Seo JG, Kim SM, Shin JM, Kim Y, Lee BH. Safety of simultaneous bilateral total knee arthroplasty using an extramedullary referencing system: results from 2098 consecutive patients. Arch Orthop Trauma Surg 2016; 136:1615-1621. [PMID: 27687177 DOI: 10.1007/s00402-016-2573-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Simultaneous bilateral total knee arthroplasty (TKA) has been associated with a high risk of morbidity and mortality. The orthopedic surgeon must, therefore, decide whether bilateral simultaneous TKA is a safe operation to perform and endeavor to decrease the risk of serious complications or even death. METHODS This retrospective review included 2098 consecutive patients who underwent bilateral simultaneous TKAs by the protocol used in our institution, including the use of extramedullary instruments to minimize medullary canal invasion and overlapping procedures for both knees to decrease operation time. RESULTS The incidence rate of occurred complications was 0.33 % for symptomatic pulmonary embolism, 0.62 % for deep surgical infection requiring revision surgery, 0.05 % for 14-day mortality, 1.14 % for adverse cardiac events, and 0.76 % for postsurgical delirium within the 1-year follow-up. CONCLUSIONS Our protocols, including the use of an extramedullary referencing system and overlapping procedures for both knees, may be considered to decrease the perioperative short-term morbidity and 14-day mortality rates in simultaneous bilateral TKA.
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Affiliation(s)
- Jai Gon Seo
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Kim
- Seoul Medical Center, Sinnae 1-dong, Jungnang-gu, Seoul, Korea
| | - Jung Min Shin
- Hanyang Medical Center, Hanyang University School of Medicine, Seoul, Korea
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical School, 134-701, Gil-dong, Seoul, Korea.
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Liodakis E, Antoniou J, Zukor DJ, Huk OL, Epure LM, Bergeron SG. Navigated vs Conventional Total Knee Arthroplasty: Is There a Difference in the Rate of Respiratory Complications and Transfusions? J Arthroplasty 2016; 31:2273-7. [PMID: 27133926 DOI: 10.1016/j.arth.2016.03.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/07/2016] [Accepted: 03/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Proponents of navigation in total knee arthroplasty (TKA) report lower rates of systemic embolization and perioperative bleeding compared to conventional TKA given that breeching the intramedullary canal is not required. METHODS We queried the National Surgical Quality Improvement Program to compare perioperative respiratory complications and transfusions between navigated and conventional TKA. We identified 2008 patients who underwent navigated TKA. These patients were matched 4:1 to a control group of 8026 patients. RESULTS Conventional TKA resulted in similar odds of having a respiratory complication compared to navigated TKA (odds ratio = 1.35, P = .44). However, conventional TKA was found to be an independent predictor for requiring a transfusion perioperatively (odds ratio = 1.90, P < .001). CONCLUSION Use of navigation in TKA results in less perioperative transfusions but has no influence on the rate of respiratory complications.
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Affiliation(s)
- Emmanouil Liodakis
- Department of Orthopedic Surgery, Jewish General Hospital, McGill University, Montreal, Canada
| | - John Antoniou
- Department of Orthopedic Surgery, Jewish General Hospital, McGill University, Montreal, Canada
| | - David J Zukor
- Department of Orthopedic Surgery, Jewish General Hospital, McGill University, Montreal, Canada
| | - Olga L Huk
- Department of Orthopedic Surgery, Jewish General Hospital, McGill University, Montreal, Canada
| | - Laura M Epure
- Department of Orthopedic Surgery, Jewish General Hospital, McGill University, Montreal, Canada
| | - Stephane G Bergeron
- Department of Orthopedic Surgery, Jewish General Hospital, McGill University, Montreal, Canada
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Mugnai R, Zambianchi F, Digennaro V, Marcovigi A, Tarallo L, Del Giovane C, Catani F. Clinical outcome is not affected by total knee arthroplasty alignment. Knee Surg Sports Traumatol Arthrosc 2016; 24:3339-3345. [PMID: 27034086 DOI: 10.1007/s00167-016-4094-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aims to analyse the influence on total knee arthroplasty (TKA) clinical outcomes of biomechanical intra-operative computer-assisted surgery-measured parameters, together with radiographic and demographical data. METHODS Between 2007 and 2009, 227 computer-assisted surgery (CAS) primary TKAs were performed in 219 consecutive patients. Information about gender, age and body mass index (BMI) was collected for each patient. Before knee replacement, all patients underwent a complete radiographic examination and passive flexion-extension range of motion was recorded. All TKAs were implanted using an image-free knee navigation system. Patients included in the study were evaluated at 3, 6 and 12 months of follow-up and then yearly. At each follow-up, subjects were asked to answer the validated Italian version of the Knee Injury and Osteoarthritis Outcome Score. RESULTS One hundred and eighty patients (187 knees) had data available for analysis. Complications were reported in 13 patients (7.0 %). Intra-operative CAS-measured parameters, together with age, BMI, gender, pre- and post-operative radiographic alignment, did not influence TKA clinical results at a mean 2 years of follow-up. On the other hand, higher post-operative flexion arc of movement was suggestive of better clinical outcomes. CONCLUSION TKA clinical outcome is influenced by post-operative knee flexion, other than neutral mechanical limb alignment. Therefore, it is recommended to prefer TKA designs that allow high flexion and to encourage early physical rehabilitation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Raffaele Mugnai
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Francesco Zambianchi
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Vitantonio Digennaro
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Andrea Marcovigi
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Luigi Tarallo
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Cinzia Del Giovane
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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Pourgiezis N, Reddy SP, Nankivell M, Morrison G, VanEssen J. Alignment and component position after patient-matched instrumentation versus conventional total knee arthroplasty. J Orthop Surg (Hong Kong) 2016; 24:170-4. [PMID: 27574257 DOI: 10.1177/1602400210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare patient-matched instrumentation (PMI) with conventional total knee arthroplasty (TKA) in terms of limb alignment and component position. METHODS Nine men and 36 women (mean age, 69.5 years) who underwent PMI TKA were compared with 20 men and 25 women (mean age, 69.3 years) who underwent conventional TKA by the same team of surgeons with the same prosthesis and protocols in terms of limb alignment and component position using the Perth protocol computed tomography, as well as bone resection measurements, operating time, and the number of trays used. RESULTS The PMI and conventional TKA groups were comparable in terms of age, body mass index, tourniquet time, operating time, and the number of trays used. For limb alignment and component position, the 2 groups differed significantly in sagittal femoral component position (2.4º vs. 0.9º, p=0.0008) and the percentage of knees with femoral component internally rotated ≥1° with respect to the transepicondylar axis (20% vs. 55%, p=0.001). The difference was not significant in terms of limb alignment, coronal and rotational femoral component position, or coronal and sagittal tibial component position. Intra-operatively, all patient-matched cutting blocks demonstrated acceptable fit and stability. No instrument-related adverse events or complications were encountered. One (2.2%) femur and 6 (13.3%) tibiae were recut 2 mm for optimal ligament balancing. Two femoral components were upsized to the next size, and 2 tibial components were upsized and 2 downsized to the next size. CONCLUSION PMI was as accurate as conventional instrumentation in TKA. There was no significant difference in limb alignment or femoral and tibial component position in the coronal and sagittal planes between PMI and conventional TKA. PMI had a higher tendency to achieve correct femoral component rotation.
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Affiliation(s)
- N Pourgiezis
- Department of Orthopaedics, The Queen Elizabeth Hospital, Adelaide, SA, Australia
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The Impact of Personality Traits on the Outcome of Total Knee Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5282160. [PMID: 26989686 PMCID: PMC4775792 DOI: 10.1155/2016/5282160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/02/2016] [Indexed: 01/13/2023]
Abstract
Ten to twenty percent of patients with total knee arthroplasty (TKA) are dissatisfied with their clinical outcome. Aim of this study was to investigate the impact of personality traits on the subjective outcome of TKA. We investigated 80 patients with 86 computer navigated TKAs. We asked for patients satisfaction and divided patients into two groups (satisfied or dissatisfied). 12 personality traits were tested by the Freiburg Personality Inventory (FPI-R). Postoperative examination included Knee Society Score (KSS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Visual Analogue Scale (VAS). Radiologic investigation was done in all patients. 84% of our patients were satisfied, while 16% were not satisfied. The FPI-R showed statistical significant influence of four personality traits on patient satisfaction: life satisfaction (p = 0.006), performance orientation (p = 0.015), somatic distress (p = 0.001), and emotional stability (p = 0.002). All clinical scores (VAS, WOMAC, and KSS) showed significantly better results in the satisfied patient. Radiological examination showed optimal alignment of all TKAs. There were no complications requiring revision surgery. The results of our study show that personality traits may influence patients satisfaction and clinical outcome after TKA. Therefore patients personality traits may be a useful predictive factor for postoperative satisfaction after TKA.
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Dahabreh Z, Scholes CJ, Giuffre B, Coolican MRJ, Parker DA. Lack of agreement between computer navigation and post-operative 2-dimensional computed tomography (CT) measurements for component and limb alignment in total knee arthroplasty (TKA). Knee 2016; 23:137-43. [PMID: 26282326 DOI: 10.1016/j.knee.2015.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/01/2015] [Accepted: 07/15/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to assess the degree of mismatch between intraoperative navigation data using imageless computer navigation and post-operative CT scan measurements with respect to bone cuts, component and limb alignment during TKA. METHODS Intraoperative navigation data including bone cut verification and overall limb alignment during TKA was compared to postoperative CT measurements of component and limb alignment according to the Perth protocol. The proportion of cases with mismatch between navigation and CT measurements at two and three degree thresholds was identified. RESULTS In a total sample of 50 primary TKAs, 20% of cases showed a mismatch of more than two degrees between navigation and CT obtained measurements for coronal femoral alignment, 42% for femoral rotation, 16% for tibial component coronal alignment and 32% for overall limb alignment. CONCLUSION Mismatch between intraoperative navigation data and postoperative CT measurements suggests that postoperative CT scan alignment data should be interpreted with caution. A surgeon should consider a multitude of factors when analysing component and limb alignment postoperatively.
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Affiliation(s)
- Ziad Dahabreh
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia
| | - Corey J Scholes
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia.
| | - Bruno Giuffre
- Department of Radiology, Royal North Shore Hospital, NSW, Australia
| | | | - David A Parker
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia
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Khakha RS, Chowdhry M, Norris M, Kheiran A, Chauhan SK. Low incidence of complications in computer assisted total knee arthroplasty--A retrospective review of 1596 cases. Knee 2015; 22:416-8. [PMID: 25819156 DOI: 10.1016/j.knee.2015.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 01/30/2015] [Accepted: 02/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computer assisted total knee arthroplasty (CATKA) has its own unique complications. The aim of this study was to present our experience of early complications in a large consecutive series of CATKA. METHOD We investigated retrospective data on the complications specific to computer navigation that were encountered with a consecutive series of 1596 CATKA. RESULTS Intraoperatively, eight episodes of software failure occurred, two requiring conversion to conventional jig based TKA. There were four broken drill bits when positioning the pins for data entry. Repeat cuts of bone due to malalignment were required on two occasions. There were 17 episodes of superficial pin site infections at the tibial pin-site managed conservatively with antibiotics. One tibial fracture occurred through an old tibial tracker pin site hole. CONCLUSION This large study shows a low complication rate related to CATKA which is reassuring to the orthopaedic community. CLINICAL RELEVANCE Level of evidence: III.
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Affiliation(s)
- R S Khakha
- Brighton and Sussex University Hospitals, Eastern Road, Brighton BN2 5BE, United Kingdom.
| | - M Chowdhry
- Brighton and Sussex University Hospitals, Eastern Road, Brighton BN2 5BE, United Kingdom
| | - M Norris
- Brighton and Sussex University Hospitals, Eastern Road, Brighton BN2 5BE, United Kingdom
| | - A Kheiran
- Brighton and Sussex University Hospitals, Eastern Road, Brighton BN2 5BE, United Kingdom
| | - S K Chauhan
- Brighton and Sussex University Hospitals, Eastern Road, Brighton BN2 5BE, United Kingdom
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Donaldson J, Joyner J, Tudor F. Current Controversies of Alignment in Total Knee Replacements. Open Orthop J 2015; 9:489-94. [PMID: 26587067 PMCID: PMC4645928 DOI: 10.2174/1874325001509010489] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 05/21/2015] [Accepted: 06/05/2015] [Indexed: 12/19/2022] Open
Abstract
Total knee replacement is an increasingly popular operation for end stage knee arthritis. In the majority it alleviates pain and improves function. However up to 20% of patients remain dissatisfied, even with well-aligned and secure implants. Restoration of a neutral mechanical axis has traditionally been strived for, to improve both function and implant survival and there is historical data to support this. More recently this view has been questioned and some surgeons are trying to improve the function and outcomes by moving away from standard alignment principles in an attempt to reproduce the kinematics of the pre-arthritic knee of that individual. Others are using computers, robots and patient specific guides to improve accuracy. This article aims to review the traditional alignment concept and the newer techniques, along with the evidence behind it.
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Affiliation(s)
- James Donaldson
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences, Toronto, Canada
| | - James Joyner
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences, Toronto, Canada
| | - Francois Tudor
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences, Toronto, Canada
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Lin SJ, Lee CY, Huang KC, Peng KT, Huang TW, Lee MS, Hsu RWW, Shen WJ. Improved femoral component rotation in advanced genu valgum deformity using computer-assisted measured resection total knee arthroplasty. J Orthop Surg Res 2015; 10:135. [PMID: 26328925 PMCID: PMC4557226 DOI: 10.1186/s13018-015-0279-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 08/16/2015] [Indexed: 11/15/2022] Open
Abstract
Background Accurate femoral rotational alignment is of vital importance for successful total knee arthroplasty (TKA). The value of computer-assisted surgery TKA (CAS-TKA) in increasing the accuracy of femoral rotational alignment remains controversial. We hypothesize that outcomes are related to the severity of preoperative varus and valgus deformity and that CAS-TKA may be beneficial under certain circumstances. Methods Between January 2007 and December 2013, patients with osteoarthritis and varus angulation in the mechanical axis (MA) ≥ 15° and valgus angulation in the MA ≥ 10° (based on hip-to-ankle standing radiography) who underwent TKA were divided into four groups. CAS-TKA and conventional TKA outcomes were compared in patients who had preoperative advanced genu varum and advanced genu valgum deformities. The accuracy of component alignment and postoperative limb alignment was determined using radiographic parameters and computed tomography (CT). Results One hundred and eight patients (144 knees) were included in the analysis. For patients with preoperative advanced genu varum deformity, a significant difference was detected in the sagittal femoral angle (p < 0.001), but no significant improvement of femoral rotational alignment was noted (p = 0.127). In patients with preoperative advanced genu valgum deformity, a significant difference was found in the sagittal femoral angle (p = 0.034). The femoral rotational angle was significantly closer to the proper position in the CAS-TKA group (p < 0.001). When comparing the percentage of knees achieving the proper alignment, there was a decrease in the amount of outlier for the femoral rotational angle for CAS-TKA in advanced genu valgum deformity (p = 0.011). Conclusions Our data demonstrate that CAS-TKA is beneficial in obtaining proper femoral rotational alignment in patients with advanced genu valgum deformity (preoperative MA ≥ 10° valgus). In patients with advanced genu varum deformity (preoperative MA ≥ 15° varus), CAS-TKA did not improve the femoral rotational alignment.
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Affiliation(s)
- Shih-Jie Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan.
| | - Chien-Ying Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan.
| | - Kuo-Chin Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan. .,Chang Gung University, Taoyuan, Taiwan, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan.
| | - Kuo-Ti Peng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan. .,Chang Gung University, Taoyuan, Taiwan, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan.
| | - Tsan-Wen Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan. .,Chang Gung University, Taoyuan, Taiwan, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan.
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, DAPI Rd. Niaosng Dist., Kaohsiung City, 83301, Taiwan. .,Chang Gung University, Taoyuan, Taiwan, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan.
| | - Robert Wen-Wei Hsu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan. .,Chang Gung University, Taoyuan, Taiwan, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan.
| | - Wun-Jer Shen
- Po-Cheng Orthopedic Institute, 100 Bo-ai, 2nd Road, Zuoying District, Kaohsiung, Taiwan.
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Abstract
Successful outcomes after orthopedic surgical procedures are believed to be highly dependent on reproducible anatomic accuracy. Immediate intraoperative feedback helps surgeons to achieve this accuracy as has been demonstrated with the use of fluoroscopy. Non-image-based computer navigation has been used in joint arthroplasty, anterior cruciate ligament reconstruction, high tibial osteotomy, and cartilage procedures along with applications in hip and shoulder arthroscopy. Most short-term studies have demonstrated superior accuracy when compared with conventional techniques; however, very few studies have shown better clinical outcomes. Robotic-assisted surgery has been most popular in total and unicompartmental arthroplasty, which again has greater accuracy but similar clinical outcomes when compared with conventional techniques. Economic analyses indicate that these high-cost technologies may only be cost-effective in high-volume centers. Other studies have shown that computer navigation improves the accuracy of lower volume surgeons to a greater degree than higher volume surgeons allowing the former to have results similar to the latter.
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Sheehy L, Cooke TDV. Radiographic assessment of leg alignment and grading of knee osteoarthritis: A critical review. World J Rheumatol 2015; 5:69-81. [DOI: 10.5499/wjr.v5.i2.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Knee osteoarthritis (OA) is a progressive joint disease hallmarked by cartilage and bone breakdown and associated with changes to all of the tissues in the joint, ultimately causing pain, stiffness, deformity and disability in many people. Radiographs are commonly used for the clinical assessment of knee OA incidence and progression, and to assess for risk factors. One risk factor for the incidence and progression of knee OA is malalignment of the lower extremities (LE). The hip-knee-ankle (HKA) angle, assessed from a full-length LE radiograph, is ideally used to assess LE alignment. Careful attention to LE positioning is necessary to obtain the most accurate measurement of the HKA angle. Since full-length LE radiographs are not always available, the femoral shaft - tibial shaft (FS-TS) angle may be calculated from a knee radiograph instead. However, the FS-TS angle is more variable than the HKA angle and it should be used with caution. Knee radiographs are used to assess the severity of knee OA and its progression. There are three types of ordinal grading scales for knee OA: global, composite and individual feature scales. Each grade on a global scale describes one or more features of knee OA. The entire description must be met for a specific grade to be assigned. The Kellgren-Lawrence scale is the most commonly-used global scale. Composite scales grade several features of knee OA individually and sum the grades to create a total score. One example is the compartmental grading scale for knee OA. Composite scales can respond to change in a variety of presentations of knee OA. Individual feature scales assess one or more OA features individually and do not calculate a total score. They are most often used to monitor change in one OA feature, commonly joint space narrowing. The most commonly-used individual feature scale is the OA Research Society International atlas. Each type of scale has its advantages; however, composite scales may offer greater content validity. Responsiveness to change is unknown for most scales and deserves further evaluation.
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Angibaud LD, Dai Y, Liebelt RA, Gao B, Gulbransen SW, Silver XS. Evaluation of the Accuracy and Precision of a Next Generation Computer-Assisted Surgical System. Clin Orthop Surg 2015. [PMID: 26217470 PMCID: PMC4515464 DOI: 10.4055/cios.2015.7.2.225] [Citation(s) in RCA: 9] [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] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Computer-assisted orthopaedic surgery (CAOS) improves accuracy and reduces outliers in total knee arthroplasty (TKA). However, during the evaluation of CAOS systems, the error generated by the guidance system (hardware and software) has been generally overlooked. Limited information is available on the accuracy and precision of specific CAOS systems with regard to intraoperative final resection measurements. The purpose of this study was to assess the accuracy and precision of a next generation CAOS system and investigate the impact of extra-articular deformity on the system-level errors generated during intraoperative resection measurement. METHODS TKA surgeries were performed on twenty-eight artificial knee inserts with various types of extra-articular deformity (12 neutral, 12 varus, and 4 valgus). Surgical resection parameters (resection depths and alignment angles) were compared between postoperative three-dimensional (3D) scan-based measurements and intraoperative CAOS measurements. Using the 3D scan-based measurements as control, the accuracy (mean error) and precision (associated standard deviation) of the CAOS system were assessed. The impact of extra-articular deformity on the CAOS system measurement errors was also investigated. RESULTS The pooled mean unsigned errors generated by the CAOS system were equal or less than 0.61 mm and 0.64° for resection depths and alignment angles, respectively. No clinically meaningful biases were found in the measurements of resection depths (< 0.5 mm) and alignment angles (< 0.5°). Extra-articular deformity did not show significant effect on the measurement errors generated by the CAOS system investigated. CONCLUSIONS This study presented a set of methodology and workflow to assess the system-level accuracy and precision of CAOS systems. The data demonstrated that the CAOS system investigated can offer accurate and precise intraoperative measurements of TKA resection parameters, regardless of the presence of extra-articular deformity in the knee.
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Affiliation(s)
| | - Yifei Dai
- Engineering and Development, Knee, Exactech Inc., Gainesville, FL, USA
| | | | - Bo Gao
- Engineering and Development, Knee, Exactech Inc., Gainesville, FL, USA
| | | | - Xeve S Silver
- Engineering and Development, Knee, Exactech Inc., Gainesville, FL, USA
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de Steiger RN, Liu YL, Graves SE. Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age. J Bone Joint Surg Am 2015; 97:635-42. [PMID: 25878307 DOI: 10.2106/jbjs.m.01496] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Computer navigation for total knee arthroplasty has improved alignment compared with that resulting from non-navigated total knee arthroplasty. This study analyzed data from the Australian Orthopaedic Association National Joint Replacement Registry to examine the effect of computer navigation on the rate of revision of primary total knee arthroplasty. METHODS The cumulative percent revision following all non-navigated and navigated primary total knee arthroplasties performed in Australia from January 1, 2003, to December 31, 2012, was assessed. In addition, the type of and reason for revision as well as the effect of age, surgeon volume, and use of cement for the prosthesis were examined. Kaplan-Meier estimates of survivorship were used to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazards models, with adjustment for age and sex, were used to compare revision rates. RESULTS Computer navigation was used in 44,573 (14.1% of all) primary total knee arthroplasties, and the rate of its use increased from 2.4% in 2003 to 22.8% in 2012. Overall, the cumulative percent revision following non-navigated total knee arthroplasty at nine years was 5.2% (95% confidence interval [CI] = 5.1 to 5.4) compared with 4.6% (95% CI = 4.2 to 5.1) for computer-navigated total knee arthroplasty (HR = 1.05 [95% CI = 0.98 to 1.12], p = 0.15). There was a significant difference in the rate of revision following non-navigated total knee arthroplasty compared with that following navigated total knee arthroplasty for younger patients (HR = 1.13 [95% CI = 1.03 to 1.25], p = 0.011). Patients less than sixty-five years of age who had undergone non-navigated total knee arthroplasty had a cumulative percent revision of 7.8% (95% CI = 7.5 to 8.2) at nine years compared with 6.3% (95% CI = 5.5 to 7.3) for those who had undergone navigated total knee arthroplasty. Computer navigation led to a significant reduction in the rate of revision due to loosening/lysis (HR = 1.38 [95% CI = 1.13 to 1.67], p = 0.001), which is the most common reason for revision of total knee arthroplasty. CONCLUSIONS Computer navigation reduced the overall rate of revision and the rate revision for loosening/lysis following total knee arthroplasty in patients less than sixty-five years of age.
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Affiliation(s)
- Richard N de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, School of Population Health and Clinical Practice, University of Adelaide, MDP DX650 511, Adelaide, SA 5005, Australia. E-mail address for R.N. de Steiger:
| | - Yen-Liang Liu
- Data Management and Analysis Centre, University of Adelaide, MDP DX650 511, Adelaide, SA 5005, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, School of Population Health and Clinical Practice, University of Adelaide, MDP DX650 511, Adelaide, SA 5005, Australia. E-mail address for R.N. de Steiger:
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Lee WT, Chin PL, Lo NN, Yeo SJ. Short-term outcome after computer-assisted versus conventional total knee arthroplasty: a randomised controlled trial. J Orthop Surg (Hong Kong) 2015; 23:71-5. [PMID: 25920649 DOI: 10.1177/230949901502300117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the short-term functional outcome after computer-assisted total knee arthroplasty (TKA) versus conventional TKA. METHODS 23 men and 67 women aged 48 to 80 years were randomised to undergo (1) conventional TKA using an intramedullary guide, (2) conventional TKA using an extramedullary guide, or (3) computer-assisted TKA. Two senior surgeons performed all the TKAs using the same TKA system and the standard anteromedial arthrotomy with eversion of the patella. Patients were assessed by physiotherapists before and 6 months and 2 years after TKA using the Short Form-36 Health Survey, Oxford Knee Score, and Knee Society Score. RESULTS Of the 90 patients, 67 and 70 were assessed at 6 months and 2 years after TKA, respectively. No patient developed deep infection or required revision surgery. Functional outcomes of the 3 groups did not differ significantly at the corresponding follow-ups. CONCLUSION Significant improvement in the functional outcome was not shown in patients treated with computer-assisted TKA, compared with conventional TKA. Thus, computer-assisted TKA has limited additional short-term benefits. Further studies with longer follow-up are required to examine the benefits of computer-assisted TKA.
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Affiliation(s)
- Wei Ting Lee
- Department of Orthopaedic Surgery, Singapore General Hospital
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Computer-assisted navigation in ACL reconstruction is attractive but not yet cost efficient. Knee Surg Sports Traumatol Arthrosc 2015; 23:1026-34. [PMID: 24441732 DOI: 10.1007/s00167-013-2831-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/28/2013] [Indexed: 01/30/2023]
Abstract
PURPOSE Conventional reconstruction of the anterior cruciate ligament (ACL) has a high success rate. Computer-assisted navigation systems (CANSs) have been developed to further improve the accuracy of tunnel positioning. What is the economic impact from the hospital perspective? METHODS Patients having a first ACL reconstruction procedure were included in a prospective multicentre open controlled study comparing two groups: CANS versus conventional surgery. The primary clinical efficacy criterion was the objective International Knee Documentation Committee score at 1-2-year follow-up. Costs were collected retrospectively nationwide. RESULTS No significant differences were found for the clinical effectiveness between conventional surgery (100 patients) and CANS (114 patients) at follow-up: ORadjusted 1.01 [0.36-2.84] (n.s). Junior surgeons achieved a significant mean decrease in operating time during the study period: 30 % in the CANS group compared with 10 % in the control group (p < 0.01). The average cost of surgery was 704<euro> for the control group and 1,158<euro> for the CANS group (p < 0.01). The cost of the operating room accounts for >70 % of the total cost. The surgeon's status and the technical CANS learning effect influenced this cost. The cost differential between the two groups decreased with 'CANS' expertise: 238<euro> and 271<euro> in 'expert' centres versus 427<euro> to 731<euro> in other centres. CONCLUSION While our study demonstrates the feasibility and the potential interest of CANS for training in ACL reconstruction, from a hospital perspective it is not cost efficient at present. LEVEL OF EVIDENCE Economic and decision analysis-developing an economic or decision model, Level II.
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Molicnik A, Naranda J, Dolinar D. Patient-matched instruments versus standard instrumentation in total knee arthroplasty: a prospective randomized study. Wien Klin Wochenschr 2015; 127 Suppl 5:S235-40. [PMID: 25732915 PMCID: PMC4689773 DOI: 10.1007/s00508-015-0703-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 01/16/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Optimal positioning of implants and restoration of neutral mechanical axis are two primary surgical goals in total knee arthroplasty (TKA). Despite modern instruments and improved surgical techniques, malalignment remains an important cause of early failure after TKA. The aim of this prospective randomized study was to compare the value of a new patient-matched instrument system (PMI) (Signature(TM); Biomet, Inc, Warsaw, Indiana) to that of standard TKA surgical instrumentation (STD) in terms of coronal mechanical alignment, time of operation and blood loss. PATIENTS AND METHODS A total of 38 patients waiting for primary TKA were enrolled and randomized into two groups (19 PMI and 19 STD). Magnetic resonance imaging was performed in all patients in the PMI group, and specific instruments for the femur and tibia were designed preoperatively. All patients were operated on using the standard medial parapatellar approach with no use of tourniquet. Mechanical axis, time for the operation, and blood loss were evaluated. RESULTS Patients in both groups had comparable age, body mass index, preoperative mechanical axis, Knee Society Score, and level of hemoglobin. Postoperative results showed that the PMI group fell significantly closer to neutral mechanical axis (STD: 2.7 ± 1.7, PMI: 1.7 ± 0.9; P = 0.013) with no outliers and a reduced time for the operation. There was no difference in the evaluation blood loss. CONCLUSIONS The use of PMI can contribute in achieving better mechanical axis with reduction in outliers and decreased operation time. Due to small differences between PMI and standard instruments, additional research are needed to confirm these preliminary results, and to discover potential benefits and functional improvements in the long-term outcome.
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Affiliation(s)
- Andrej Molicnik
- Orthopaedic Department, University Clinical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Jakob Naranda
- Orthopaedic Department, University Clinical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
- , Ljubljanska 3, 2000, Maribor, Slovenia.
| | - Drago Dolinar
- Departement of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia.
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Disparate postoperative results in the first and second knees on simultaneous bilateral total knee arthroplasty. J Arthroplasty 2014; 29:2331-6. [PMID: 25131798 DOI: 10.1016/j.arth.2014.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/25/2014] [Accepted: 07/19/2014] [Indexed: 02/01/2023] Open
Abstract
We hypothesized that the circumstances of the two consecutive operations of a simultaneous bilateral total knee arthroplasty (TKA) are different, and could lead to different outcomes of overlapping bilateral TKAs. Both knees of 420 subjects were evaluated in the current study. In the second TKA, there were more incidence rates of outlier in mechanical femoro-tibial angle (16.2% vs. 9.0%), more blood loss (735 vs. 656 mL), and longer operation time (61, 58 minutes respectively), as compared to the first TKA, while no significant differences in clinical outcomes. In conclusion, there were no significant differences in the clinical outcomes even though few distinct outcomes due to different circumstances of the surgery. Awareness of these findings can help the continued success of bilateral TKA in an increasing patient population.
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Chowdhry M, Bamne AB, Na YG, Kang YG, Kim TK. Prevalence and predictors of post-operative coronal alignment outliers and their association with the functional outcomes in navigated total knee arthroplasty. J Arthroplasty 2014; 29:2357-62. [PMID: 25113784 DOI: 10.1016/j.arth.2014.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/07/2014] [Accepted: 07/15/2014] [Indexed: 02/01/2023] Open
Abstract
We aimed to determine the prevalence and predictors for being an outlier after navigated TKA and asked whether navigated TKAs with perfect coronal alignment have better functional outcomes than those without it. Alignment was measured in 124 patients (191 knees) with navigated TKAs who were available for 1year functional outcome assessment. The outcomes were compared among the 3 subgroups divided by the deviation of mechanical axis from neutral (0°): the perfect, 0° or within 1°; the acceptable, 1°-3°; and the outlier, beyond 3°. The prevalence of outliers was 20.4%, and the severity of preoperative varus deformity was the strongest predictor. Accuracy of coronal alignment in radiographs did not correlate consistently with functional outcomes.
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Affiliation(s)
- Madhav Chowdhry
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Ankur B Bamne
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Korea
| | - Young Gon Na
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Korea
| | - Yeon Gwi Kang
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Korea
| | - Tae Kyun Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Korea.
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