A Successful Case of TKA With Complex Deformity And Retained Hardware Using Computer Navigation.
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ABSTRACT:
SUBMITTER: Cerny J
PROVIDER: S-EPMC8666612 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:UNLABELLED: Computer-navigated and minimally invasive TKAs are emerging technologies that have distinct strengths and weaknesses. We compared duration of surgery, length of hospitalization, Knee Society scores, radiographic alignments, and complications in two unselected groups of 81 consecutive knees that underwent TKA using either a minimally invasive approach or computer navigation. The two groups were operated on by two different surgeons over differing timeframes. The mean surgical time was longer in the navigated group by 63 minutes. The Knee Society scores and lengths of hospitalization of the two groups were similar. The postoperative component alignments of the two groups were similar; the mean femoral valgus and tibial varus angles of the navigation group changed from 96 degrees and 88 degrees preoperatively to 95 degrees and 89 degrees postoperatively, respectively, and in the minimally invasive group, the mean femoral valgus angles and tibial varus angles changed from 97 degrees and 88 degrees preoperatively to 95 degrees and 89 degrees postoperatively, respectively. There were 11 major and three minor complications in the navigation group, including one revision, two femoral shaft fractures, four reoperations for knee stiffness, and four instances of bleeding from tracker sites. We believe the higher incidence of complications in addition to the longer operative time in the navigated group may outweigh any potential radiographic benefits. LEVEL OF EVIDENCE: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC2565050 | biostudies-other
Project description:UNLABELLED: Femoral intramedullary canal referencing is used by most knee arthroplasty systems. Fat embolism, activation of coagulation, and bleeding may occur from the reamed canal. The purpose of our study was to evaluate a new extramedullary device that relies on templated data. We randomized 100 consecutive patients undergoing primary total knee arthroplasty through a limited parapatellar approach to use of either standard intramedullary femoral instruments (IM group) or a new extramedullary device (EM group). The extramedullary instrument was calibrated using templated data obtained from a preoperative full-limb weightbearing anteroposterior view of the knee. In both groups, an intraoperative double check was performed using an extramedullary rod referring to the anterosuperior iliac spine. Femoral component coronal alignment was within 0 degrees +/- 2 degrees of the mechanical axis in 84% of the IM group and 86% of the EM group. Sagittal alignment of the femoral component was 0 degrees +/- 2 degrees in 78% of the IM group and 90% of the EM group. We observed no difference in the average operative time between the two groups. The two groups showed similar postoperative blood loss. Extramedullary reference with careful preoperative templating can be safely used during TKA. LEVEL OF EVIDENCE: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC2565017 | biostudies-other
Project description:Due to the explosive increase of digital data creation, demand on advancement of computing capability is ever increasing. However, the legacy approaches that we have used for continuous improvement of three elements of computer (process, memory, and interconnect) have started facing their limits, and therefore are not as effective as they used to be and are also expected to reach the end in the near future. Evidently, it is a large challenge for computer hardware industry. However, at the same time it also provides great opportunities for the hardware design industry to develop novel technologies and to take leadership away from incumbents. This paper reviews the technical challenges that today's computing systems are facing and introduces potential directions for continuous advancement of computing capability, and discusses where computer hardware designers find good opportunities to contribute.
| S-EPMC8022507 | biostudies-literature
Project description:BACKGROUND: Joint-preserving surgery is performed in select patients with bone sarcomas of extremities and allows patients to retain the native joint with better joint function. However, recurrences may relate to achieving adequate margins and there is frequently little room for error in tumors close to the joint surface. Further, the tumor margin on preoperative CT and/or MR images is difficult to transpose to the actual extent of tumor in the bone in the operating room. QUESTIONS/PURPOSES: We therefore determined whether joint-preserving tumor surgery could be performed accurately under image-guided computer navigation and determined local recurrences, function, and complications. METHODS: We retrospectively studied eight patients with bone sarcoma of extremities treated surgically by navigation with fused CT-MR images. We assessed the accuracy of resection in six patients by comparing the cross sections at the resection plane with complementary prosthesis templates. Mean age was 17 years (range, 6-46 years). Minimum followup was 25 months (mean, 41 months; range, 25-60 months). RESULTS: The achieved resection was accurate, with a difference of 2 mm or less in any dimension compared to that planned in patients with custom prostheses. We noted no local recurrence at latest followup. The mean Musculoskeletal Tumor Society score was 29 (range, 28-30). There were no complications related to navigation planning and procedures. There was no failure of fixation at the remaining epiphysis. CONCLUSIONS: In selected patients, the computer-assisted approach facilitates precise planning and execution of joint-preserving tumor resection and reconstruction. Further followup assessment in a larger study population is required in these patients. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
| S-EPMC3563823 | biostudies-other
Project description:Opening-wedge high tibial osteotomy is an increasingly performed procedure for treatment of varus gonarthrosis and correction of malalignment during meniscal transplantation or cartilage restoration. Precise preoperative planning and meticulous surgical technique are required to achieve an appropriate mechanical axis correction. We describe our technique of arthroscopic and computer-assisted high tibial osteotomy using commonly available total knee arthroplasty navigation software as an intraoperative goniometer. We believe that our technique, by providing intraoperative real-time guidance of the degree of correction that is accurate and reliable, represents a useful tool for the surgeon who uncommonly performs high tibial osteotomy.
| S-EPMC3716232 | biostudies-literature
Project description:PurposeTo evaluate whether the bony impingement lesion in elbow osteoarthritis can be removed accurately, as planned during arthroscopy, by using the computer-aided navigation system and performing mock surgery using 3-dimensional (3D)-printed bone models for clinical applications.MethodsWe performed mock surgery using 3D-printed plaster bone models of the humerus of 15 actual patients with elbow osteoarthritis. Two types of experiments were conducted to evaluate the surgical accuracy. Three surgeons performed the mock surgery, each with 15 bone models (total, 45 trials). Surgical accuracy was based on the mean of 45 trials. The differences in surgical accuracy among the 3 surgeons were also evaluated (mean 15 trials). The same surgeon performed 30 trials, and the difference in surgical accuracy between the first and the second halves was also evaluated (mean 15 trials).ResultsThe spatial error in the entire elbow joint was 1.13 mm. In terms of resection volume, a mean of 8% more volume was resected than was planned, and 85% of the planned area was resected. In our experiments, the surgical accuracy was significantly lower in the anterior than in the posterior joint. Intrarater reliability was intraclass correlation (ICC)2,1 0.81 and inter-rater reliability was ICC1,1 0.87.ConclusionsSurgery using computer-aided navigation systems for arthroscopic debridement of the elbow provided accuracy comparable to that in other joints.Clinical relevanceArthroscopic debridement of elbow osteoarthritis requires advanced surgical skills because accurate identification of the bony impingement legion is difficult during surgery. Surgery using computer-aided navigation systems for arthroscopic debridement of the elbow will provide real-time tracking of both the surgical instruments and bony impingement lesions as well as solve the technical difficulties of arthroscopic surgery of the elbow joint.
| S-EPMC8689228 | biostudies-literature
Project description:BackgroundAccelerometer-based computer-assisted navigation systems (ABCANSs) have been shown to improve alignment accuracy in total knee arthroplasty (TKA) and are effective in treating complex extra-articular deformity. We present an ABCANS-assisted TKA performed in a 68-year-old male with end-stage arthritis of the right knee, in the setting of a severe valgus deformity secondary to multiple hereditary exostoses.MethodsThe KneeAlign 2 system (OrthAlign, Inc.; Aliso Viejo, CA) was used to perform the TKA in this clinical scenario, given its functionality, which allows angular correction to be tailored to a given deformity, and its reported accuracy in performance of bony resection in TKA. The patient was prospectively followed up for one year postoperatively. Radiographs, PROMs, and patient satisfaction were reported.ResultsAfter the ABCANS-assisted TKA, the patient's alignment was improved from 25° to 4° of valgus. His final range of motion was 0-135° without an instability. In addition, the patient reported excellent scores on multiple joint-specific outcome measures, including the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, the Forgotten Joint Score, and the Oxford Knee Score.ConclusionThis case report illustrates the rationale, technique, and the excellent clinical outcomes achieved in a complex patient with extra-articular deformity using an ABCANS-assisted TKA.
| S-EPMC7490588 | biostudies-literature
Project description:Colorectal cancer is the second leading cause of death from cancer in the United States. Two major barriers to successful colorectal cancer screening are appointment keeping and proper bowel preparation. The purpose of this study is to test the efficacy of a patient navigation program to increase colorectal cancer screening at Rush University Medical Center. The investigators hypothesize that colorectal cancer screening will be improved for subjects who utilize a patient navigator.
| 2170703 | ecrin-mdr-crc
Project description:Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures.A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction.Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years.Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation or robotics.
| S-EPMC5532908 | biostudies-other
Project description:BackgroundACL status varies in the arthritic knee during TKA.Questions/purposesThe purpose of this study was to examine clinical features and intraoperative findings associated with stages of ACL degeneration.MethodsCoronal deformity, ROM, intra-articular degenerative patterns, and ligament releases were assessed for 1656 knees during TKA. Common patterns of deformity and severity of degenerative change were assessed as a function of the severity of ACL deficiency.ResultsOf the 1656 knees assessed, 27% had a normal ACL, 55% exhibited damage, and 18% exhibited complete absence of the ACL. Increased coronal deformity and lower preoperative ROM was associated with ACL deficiency. Increased chondral and meniscal damage and more extensive osteophyte formation were also found. More extensive ligament releases were required in ACL-deficient knees.ConclusionsThe status of the ACL is predictive of the need for increased surgical deformity correction. A better understanding of ACL status is an important consideration during in choosing TKA as opposed to unicompartmental arthroplasty. The status of the ACL should be considered in planning for implant choice in TKA.
| S-EPMC5026658 | biostudies-literature