1
|
Chen M, Yang D, Shao H, Rui S, Cao Y, Zhou Y. Using sequential bone cutting to titrate soft tissue balance in total knee arthroplasty effectively minimizes soft tissue release. BMC Musculoskelet Disord 2023; 24:866. [PMID: 37936113 PMCID: PMC10631050 DOI: 10.1186/s12891-023-07005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Achieving soft tissue balance while maintaining limb alignment within acceptable boundaries is crucial for successful total knee arthroplasty (TKA). We proposed a sequential bone cutting (SBC) technique to titrate the soft tissue balance in robot-assisted TKA to achieve the desired balance with minimum soft tissue release. METHODS In total, 106 robot-assisted TKAs using the SBC technique were included. The preoperative hip-knee-ankle angle (HKA) was < 10° in 76 and ≥ 10° in 30 knees. The gaps were initially balanced with the help of the pre-resection balancing provided by the robotic system. Soft tissue balance and alignment were quantitatively measured after the initial bone cutting and final bone cutting. Additional adjustments (bone recuts and soft tissue releases) required to address soft tissue imbalance after initial bone cutting were recorded. The frequencies of soft tissue releases, soft tissue balance, and resultant alignment ≤ 3° were compared between non-severe (HKA < 10°) and severe deformity (HKA ≥ 10°) groups. RESULTS Soft tissue balance was achieved in 45 knees (42.5%) after initial bone cutting and in 93 knees (87.7%) after final balancing. The postoperative alignment was within 3° from neutral in 87 knees (82.1%) and 3-5° in 17 knees (16.0%). For unbalanced knees (n = 61) after initial bone cutting, soft tissue release was avoided by SBC in 37 knees (60.7%) and was deemed necessary in 24 knees (39.3%). Soft tissue release was more likely to be avoided in the non-severe deformity cohort (86.8% [33 of 38]) than in the severe deformity cohort (17.4% [4 of 23]; p < 0.001). The non-severe deformity cohort showed a significantly higher rate of resultant alignment ≤ 3° from neutral than the severe deformity cohort (90.8% vs. 60.0%; p < 0.001). CONCLUSION Pre-resection balancing is inappropriate to ensure soft tissue balance. The SBC technique is effective in minimizing soft tissue release while maintaining overall alignment within acceptable boundaries.
Collapse
Affiliation(s)
- Mingxue Chen
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Shouwei Rui
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Yuefeng Cao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
| |
Collapse
|
2
|
He M, Zhang H, Hu P, Jing L, Shan P. Micro Electromechanical System Navigation Assists Femoral Extramedullary Alignment Osteotomy in Total Knee Arthroplasty: A Single-Blind Randomizing Study. Orthop Surg 2023; 15:2786-2793. [PMID: 37580853 PMCID: PMC10622280 DOI: 10.1111/os.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE A micro-electromechanical system (MEMS) was developed based on spatial alignment and navigation technology to assist femoral extramedullary alignment osteotomy (FEAO) in total knee arthroplasty (TKA). The system can locate and adjust the femoral distal condylar osteotomy (FDCO) to obtain a better femoral prosthesis placement. It is a portable navigation device and provides an innovative approach for FDCO. METHODS Sixty patients who suffered from severe knee osteoarthritis who underwent unilateral TKA from May 14, 2021 to May 30, 2022 were randomly divided into a MEMS-FEAO group and a conventional femoral intramedullary alignment osteotomy (FIAO) group, with 30 cases in each group for a controlled retrospective study. The hip-knee-ankle angle (HKAA) of the lower limb was measured before and after surgery, the femoral valgus angle (FVA) was measured preoperatively, and the femoral prosthesis valgus angle (FPVA) and the femoral prosthesis flexion angle (FPFA) were measured postoperatively following computed tomography imaging protocols. Measurement data is statistically described as mean ± standard deviation c. The count data is described by frequency (constituent ratio) using the rank sum test. RESULT A total of 6.7% (2/30) of FEAO compared to 20.0% (6/30) of FIAO cases were postoperative deviations where the HKAA exceeded ±3° of neutral alignment (p < 0.05). The postoperative HKAA was 178.74° ± 1.56° versus 176.64° ± 3.39° (p < 0.05), the HKAA deviation was 1.25° ± 1.56° versus 3.36° ± 3.40° (p < 0.05), and the FPFA was 4.85° ± 2.46° versus 6.60° ± 1.86°(p < 0.05). Therefore, the differences were all statistically significant between the two groups. However, the FPVA was -0.59° ± 2.73° versus -0.80° ± 2.85° (p > 0.05), and there was no statistical significance between the two groups. CONCLUSION The MEMS-FEAO system can improve the accurate alignment and can be utilized as a locator to obtain the best femoral prosthesis placement in TKA and significantly reduce the rate of poor force line of the lower limb.
Collapse
Affiliation(s)
| | | | - Peiyan Hu
- Wangjing Hospital of CACMSBeijingChina
| | - Lin Jing
- Wangjing Hospital of CACMSBeijingChina
| | | |
Collapse
|
3
|
Yang P, He R, Lei K, Liu L, Yang L, Guo L. Clinical evaluation of the first semi-active total knee arthroplasty assisting robot made in China: a retrospective propensity score-matched cohort study. Int J Surg 2023; 109:1552-1560. [PMID: 37131329 PMCID: PMC10389537 DOI: 10.1097/js9.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/24/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The precision of overall alignment and knee morphotype after robot-assisted total knee arthroplasty has been fully confirmed. This study aims to conduct a clinical evaluation of the first China-made semi-active total knee arthroplasty assisting robot. METHODS After a 1 : 2 propensity score matching, that is, a matched cohort study, patients were matched to the robot group (52 cases) and the conventional group (104 cases). The robot group received osteotomy according to preoperative planning, while the conventional group adopted preoperative planning based on the full-length radiograph and received conventional osteotomy. Perioperative clinical indicators, such as operation time, tourniquet time, hospitalization days, intraoperative bleeding, and hemoglobin level of the two groups were recorded; radiological indicators of postoperative prosthesis position, including hip-knee-ankle angle, frontal femoral component angle, frontal tibial component angle, lateral femoral component angle, and lateral tibial component angle were also recorded; deviations and outliers of the radiological indicators were calculated. RESULTS Compared with the conventional group, the operation time and tourniquet time of the robot group were longer, and the postoperative hemoglobin level decreased less, the differences were statistically significant; the lateral tibial component angle of the conventional group was 80.9°±3.6°, which was smaller than 86.7 °±2.3° of the robot group, the difference was statistically significant ( P <0.001); except for lateral femoral component angle, the absolute deviations of the radiological indicators in the robot group were significantly smaller than that in the conventional group ( P ≤0.001); the outliers of the radiological indicators in the robot group were significantly smaller than that in the conventional group with a statistical difference ( P <0.05). CONCLUSION Compared with the conventional group, the operation time of the robot group was relatively longer, but the perioperation blood loss was less. The robot group could better control the posterior inclination of the tibial prosthesis, and the absolute deviations and outliers of the prosthesis position were relatively smaller. There was no difference in short-term clinical score between the two groups.
Collapse
Affiliation(s)
| | | | | | | | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| |
Collapse
|
4
|
Shichman I, Rajahraman V, Chow J, Fabi DW, Gittins ME, Burkhardt JE, Kaper BP, Schwarzkopf R. Clinical, Radiographic, and Patient-Reported Outcomes Associated with a Handheld Image-free Robotic-Assisted Surgical System in Total Knee Arthroplasty. Orthop Clin North Am 2023; 54:141-151. [PMID: 36894287 DOI: 10.1016/j.ocl.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
One of the primary aims of total knee arthroplasty (TKA) is restoration of the mechanical axis of the lower limb. Maintenance of the mechanical axis within 3° of neutral has been shown to result in improved clinical results and implant longevity. Handheld image-free robotic-assisted total knee arthroplasty (HI-TKA) is a novel way of performing TKA in the era of modern robotic-assisted TKA. The aim of this study is to assess the accuracy of achieving targeted alignment, component placement, clinical outcomes, as well as patient satisfaction after HI-TKA.
Collapse
Affiliation(s)
- Ittai Shichman
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Floor Suite 1518, New York, NY 10003, USA
| | - Vinaya Rajahraman
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Floor Suite 1518, New York, NY 10003, USA
| | - James Chow
- Chow Surgical LLC, 3700 North 24th Street Suite 160, Phoenix, AZ 85016, USA
| | - David W Fabi
- San Diego Orthopaedic Associates Medical Group, Inc., 4060 Fourth Avenue 7th Floor, San Diego, CA 92103, USA
| | - Mark E Gittins
- OrthoNeuro, 5040 Forest Drive #300, New Albany, OH 43054, USA
| | - Joseph E Burkhardt
- Bronson Orthopedic Specialists, 3600 Capital Avenue Southwest # 101, Battle Creek, MI 49015, USA
| | - Bertrand P Kaper
- Orthopaedic Specialists of Scottsdale, 20401 North 73rd Street Suite 210, Scottsdale, AZ 85255, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Floor Suite 1518, New York, NY 10003, USA.
| |
Collapse
|
5
|
Ngim HLJ, Van Bavel D, De Steiger R, Tang AWW. Robotic-assisted revision total knee arthroplasty: a novel surgical technique. ARTHROPLASTY (LONDON, ENGLAND) 2023; 5:5. [PMID: 36691107 PMCID: PMC9872350 DOI: 10.1186/s42836-022-00160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Revision total knee arthroplasty is a challenging procedure. The robotic-assisted system has been shown to enhance the accuracy of preoperative planning and improve reproducibility in primary arthroplasty surgeries. The aim of this paper was to describe the surgical technique for robotic-assisted revision total knee arthroplasty and the potential benefits of this technique. METHOD This single-centre retrospective study included a total of 19 patients recruited from April 1, 2021 to April 30, 2022. Inclusion criteria were patients who had Mako™ robotic-assisted revision total knee arthroplasty done within the study period with a more than 6 months follow-up. Statistical analysis was done using Microsoft Excel 16.0. RESULTS All 19 patients were followed up for 6 to 18 months. All patients in this study had uneventful recoveries without needing any re-revision surgery when reviewed to date. CONCLUSION With the development of dedicated revision total knee software, robot-assisted revision TKA can be a promising technique that may improve surgical outcomes by increasing the accuracy of implant placement, and soft tissue protection and achieving a better well-balanced knee.
Collapse
Affiliation(s)
- Hui-Ling Joanne Ngim
- grid.414539.e0000 0001 0459 5396Epworth Healthcare, Melbourne, 3121 Victoria Australia
| | - Dirk Van Bavel
- grid.414539.e0000 0001 0459 5396Epworth Healthcare, Melbourne, 3121 Victoria Australia
| | - Richard De Steiger
- grid.414539.e0000 0001 0459 5396Epworth Healthcare, Melbourne, 3121 Victoria Australia
| | - Andrew W. W. Tang
- grid.414539.e0000 0001 0459 5396Epworth Healthcare, Melbourne, 3121 Victoria Australia
| |
Collapse
|
6
|
The evolution of robotic systems for total knee arthroplasty, each system must be assessed for its own value: a systematic review of clinical evidence and meta-analysis. Arch Orthop Trauma Surg 2022; 143:3369-3381. [PMID: 36153769 DOI: 10.1007/s00402-022-04632-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/18/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Robotic systems have been introduced to improve the precision of total knee arthroplasty. However, different robotic systems are available, each with unique features used to plan and execute the surgery. As such, due to this diversity, the clinical evaluation of each robotic platform should be separated. METHODS An extensive literature search of PubMed, Medline, Embase and Web of Science was conducted with subsequent meta-analysis. Randomised controlled trials, comparative studies, and cohort studies were included regarding robot-assisted total knee arthroplasty. Evaluated outcomes included clinical results, surgical precision, ligament balance, surgical time, learning curve, complications and revision rates. These were split up based on the robot-specific brand: ROBODOC (T-SOLUTION ONE), OMNIBOT, MAKO, NAVIO (CORI) and ROSA. RESULTS With a follow-up of more than 10 years, no improved clinical outcomes have been noted with the ROBODOC system compared to the conventional technique. If available, other platforms only present short-term clinical outcomes. Radiological outcomes are published for most robotic setups, demonstrating improved surgical precision compared to the conventional technique. Gap balance assessment is performed differently between all systems, leading to heterogeneous outcomes regarding its relationship on clinical outcomes. There is a similar learning curve based on operative time for all robotic platforms. In most studies, robot assistance requires longer operative time compared to the conventional technique. Complications and revision rates are published for ROBODOC and MAKO, without clear differences to conventional total knee arthroplasty. CONCLUSION The main finding of this systematic review is that the current evidence regarding each robotic system is diverse in quantity and quality. Each system has its own specificities and must be assessed for its own value. Regarding scientific literature, the generic term of robotic should be banned from the general conclusion. LEVEL OF EVIDENCE Systematic review level IV.
Collapse
|
7
|
Nan S, Cao Z, Song Y, Kong X, Li H, Chai W. Can mobile-bearing unicompartmental knee arthroplasty achieve natural gap-balancing? An observational study with a novel pressure sensor. J Orthop Surg Res 2022; 17:407. [PMID: 36064425 PMCID: PMC9446724 DOI: 10.1186/s13018-022-03255-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Mobile-bearing unicompartmental knee arthroplasty (MB-UKA) is an effective treatment for anteromedial knee osteoarthritis. Meticulous intraoperative soft tissue balancing remains challenging yet consequential for a successful operation. Currently, surgeons rely mostly on their experience during soft tissue balancing, yielding unreproducible results. The purpose of this study was to quantified measure the soft tissue tension of medial compartment and determine if an optimal "target" tension values with the natural state exists. Methods This was an observational study of 24 consecutive patients. All 30 UKAs were performed by a single surgeon. The piezoresistive sensor was custom designed to fit in the medial compartment gap. Contact pressures were measured at 5 angular positions of the knee intraoperatively: 0°, 20°, 45°, 90°, and 110° of flexion. The change in pressure from extension (20° position) and flexion (110° position) was also calculated (E-FPD). Data on age, sex, body mass index, operative side, and bearing size were collected. Outcome measures were measured at baseline and at the 6-month postoperative follow-up; Oxford Knee Score, visual analog scale score, and range of motion were compared to evaluate clinical outcomes. Results There was a significant improvement in patients in all measured outcomes at 6 months from baseline (P < 0.05). The E-FPD of 14.9 N (8.9, 24.6) was indicative of appropriate soft tissue balancing throughout the functional range of knee motion. Of 30 knees, 22 were 3-mm bearing and 8 were 4- or 5-mm bearing. The pressure data of the 3-mm bearing group was larger than that of the non-3-mm bearing group for each knee flexion degree, but the difference was not statistically significant (P > 0.05). Conclusions Objective data from sensor output may assist surgeons in decreasing loading variability during MB-UKA. The data suggested that MB-UKA could not accurately restore soft tissue tension to the natural state, which was related to the inability of MB-UKA surgical instruments to fine adjust the bone cut and soft tissue release. Study registration Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900024146. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03255-6.
Collapse
Affiliation(s)
- Shaokui Nan
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China.,National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Zheng Cao
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China.,National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Yue Song
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China.,National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Xiangpeng Kong
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China.,National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Haifeng Li
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China. .,National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China.
| | - Wei Chai
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China. .,National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China.
| |
Collapse
|
8
|
Current role of intraoperative sensing technology in total knee arthroplasty. Arch Orthop Trauma Surg 2021; 141:2255-2265. [PMID: 34427757 DOI: 10.1007/s00402-021-04130-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Sensors have been introduced within the last 10 years to quantify soft tissue balancing during total knee arthroplasty (TKA) and to give the surgeon objective data. These devices are fairly new and their impact on patient outcome remains uncertain. The aim of this systematic review was to summarize all the relevant surgical and clinical results of sensors for TKA. METHODS A PRISMA systematic review was conducted using five databases (PubMed, EMBASE, MEDLINE, GOOGLE SCHOLAR, and the COCHRANE LIBRARY) to identify all available literature that described the surgical and clinical results of sensors for TKA between 2000 and 2021. The main investigated outcome criteria were intraoperative data, postoperative functional and clinical outcome, knee range of motion, complications and revision rates. RESULTS Twenty-seven articles were finally included. The maximum reported follow-up was 26 months. A balanced knee with sensor corresponded to a mediolateral difference inferior to 15 lb and a stable posterior drawer test. The standard assessment of knee balance was a poor predictor of the true soft tissue balance when compared to sensor data. At least 60% of TKA needed an additional rebalancing procedure with the sensor, after conventional gap balancing. Achieving a quantitatively balanced knee resulted in a significantly higher patient satisfaction score. But the prospective comparative studies found no demonstrable improvement in clinical outcome, range of motion or complication rate at one year postoperatively for patients undergoing TKA using sensor-guided balancing compared with routine techniques. CONCLUSION Even though the use of the intraoperative sensing technology was not related to an improvement in clinical outcome, the current studies showed that using sensors facilitates the reproduction of natural joint stability, and improves the rate of achieving a balanced knee. Sensor use in complex cases could be particularly valuable, but their use in standard practice remains to be defined.
Collapse
|
9
|
Allom RJ, Wood JA, Chen DB, MacDessi SJ. Tibiofemoral dynamic stressed gap laxities correlate with compartment load measurements in robotic arm-assisted total knee arthroplasty. Bone Jt Open 2021; 2:974-980. [PMID: 34818899 PMCID: PMC8636298 DOI: 10.1302/2633-1462.211.bjo-2021-0066.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims It is unknown whether gap laxities measured in robotic arm-assisted total knee arthroplasty (TKA) correlate to load sensor measurements. The aim of this study was to determine whether symmetry of the maximum medial and lateral gaps in extension and flexion was predictive of knee balance in extension and flexion respectively using different maximum thresholds of intercompartmental load difference (ICLD) to define balance. Methods A prospective cohort study of 165 patients undergoing functionally-aligned TKA was performed (176 TKAs). With trial components in situ, medial and lateral extension and flexion gaps were measured using robotic navigation while applying valgus and varus forces. The ICLD between medial and lateral compartments was measured in extension and flexion with the load sensor. The null hypothesis was that stressed gap symmetry would not correlate directly with sensor-defined soft tissue balance. Results In TKAs with a stressed medial-lateral gap difference of ≤1 mm, 147 (89%) had an ICLD of ≤15 lb in extension, and 112 (84%) had an ICLD of ≤ 15 lb in flexion; 157 (95%) had an ICLD ≤ 30 lb in extension, and 126 (94%) had an ICLD ≤ 30 lb in flexion; and 165 (100%) had an ICLD ≤ 60 lb in extension, and 133 (99%) had an ICLD ≤ 60 lb in flexion. With a 0 mm difference between the medial and lateral stressed gaps, 103 (91%) of TKA had an ICLD ≤ 15 lb in extension, decreasing to 155 (88%) when the difference between the medial and lateral stressed extension gaps increased to ± 3 mm. In flexion, 47 (77%) had an ICLD ≤ 15 lb with a medial-lateral gap difference of 0 mm, increasing to 147 (84%) at ± 3 mm. Conclusion This study found a strong relationship between intercompartmental loads and gap symmetry in extension and flexion measured with prostheses in situ. The results suggest that ICLD and medial-lateral gap difference provide similar assessment of soft-tissue balance in robotic arm-assisted TKA. Cite this article: Bone Jt Open 2021;2(11):974–980.
Collapse
Affiliation(s)
| | - Jil A Wood
- Sydney Knee Specialists, Kogarah, New South Wales, Australia
| | - Darren B Chen
- Sydney Knee Specialists, Kogarah, New South Wales, Australia
| | - Samuel J MacDessi
- Sydney Knee Specialists, Kogarah, New South Wales, Australia.,University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Reproducibility of an Intraoperative Pressure Sensor in Total Knee Replacement. SENSORS 2021; 21:s21227679. [PMID: 34833754 PMCID: PMC8625639 DOI: 10.3390/s21227679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/23/2022]
Abstract
Appropriate soft tissue tension in total knee replacement (TKR) is an important factor for a successful outcome. The purpose of our study was to assess both the reproducibility of a modern intraoperative pressure sensor (IOP) and if a surgeon could unconsciously influence measurement. A consecutive series of 80 TKRs were assessed with an IOP between January 2018 and December 2020. In the first scenario, two blinded sequential measurements in 48 patients were taken; in a second scenario, an initial blinded measurement and a subsequent unblinded measurement in 32 patients were taken while looking at the sensor monitor screen. Reproducibility was assessed by intraclass correlation coefficients (ICCs). In the first scenario, the ICC ranged from 0.83 to 0.90, and in the second scenario it ranged from 0.80 to 0.90. All ICCs were 0.80 or higher, indicating reproducibility using a IOP and that a surgeon may not unconsciously influence the measurement. The use of a modern IOP to measure soft tissue tension in TKRs is a reproducible technique. A surgeon observing the measurements while performing IOP may not significantly influence the result. An IOP gives additional information that the surgeon can use to optimize outcomes in TKR.
Collapse
|
11
|
Li Z, Zhang X, Ding L, Du K, Yan J, Chan MTV, Wu WKK, Li S. Deep learning approach for guiding three-dimensional computed tomography reconstruction of lower limbs for robotically-assisted total knee arthroplasty. Int J Med Robot 2021; 17:e2300. [PMID: 34109730 DOI: 10.1002/rcs.2300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty (TKA) was performed to promote the accuracy of bone resection and mechanical alignment. Among these TKA system procedures, 3D reconstruction of CT data of lower limbs consumes significant manpower. Artificial intelligence (AI) algorithms applying deep learning has been proved efficient in automated identification and visual processing. METHODS CT data of a total of 200 lower limbs scanning were used for AI-based 3D model construction and CT data of 20 lower limbs scanning were utilised for verification. RESULTS We showed that the performance of an AI-guided 3D reconstruction of CT data of lower limbs for robotic-assisted TKA was similar to that of the operator-based approach. The time of 3D lower limb model construction using AI was 4.7 min. AI-based 3D models can be used for surgical planning. CONCLUSION AI was used for the first time to guide the 3D reconstruction of CT data of lower limbs for facilitating robotic-assisted TKA. Incorporation of AI in 3D model reconstruction before TKA might reduce the workload of radiologists.
Collapse
Affiliation(s)
- Zheng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Zhang
- BEIJING HURWA-ROBOT Medical Technology Co. Ltd, Beijing, China
| | - Lele Ding
- BEIJING HURWA-ROBOT Medical Technology Co. Ltd, Beijing, China
| | - Kebin Du
- BEIJING HURWA-ROBOT Medical Technology Co. Ltd, Beijing, China
| | - Jun Yan
- BEIJING HURWA-ROBOT Medical Technology Co. Ltd, Beijing, China
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong
| | - William K K Wu
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Diseases, Centre for Gut Microbiota Research, Institute of Digestive Diseases and LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Shugang Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|