Research

9 pages, 1878 KiB

Open AccessCommunication

Accuracy of Accelerometer-Based Navigation System Perseus for the Tibial Cut in Total Knee Arthroplasty: No Superiority Compared to Mechanical Instrumentation in Current Practice

by Léopold Joseph, Cécile Batailler, Sébastien Lustig and Elvire Servien

Appl. Sci. 2023, 13(5), 2952; https://doi.org/10.3390/app13052952 - 25 Feb 2023

Viewed by 1239

Abstract

Knee alignment after total knee arthroplasty (TKA) is essential for implant survival. Several studies on accelerometer-based navigation systems have given controversial results, with or without improvement in knee alignment. The aim was to evaluate the accuracy of an accelerometer-based navigation system for tibial [...] Read more.

Knee alignment after total knee arthroplasty (TKA) is essential for implant survival. Several studies on accelerometer-based navigation systems have given controversial results, with or without improvement in knee alignment. The aim was to evaluate the accuracy of an accelerometer-based navigation system for tibial resection during total knee arthroplasty. Twenty TKAs performed with an accelerometer-based navigation system were included in this prospective–comparative study. They were matched (on age, body mass index, and preoperative mechanical axis of the lower limb) in a 2:1 ratio with TKA performed with a conventional technique. The objective of this study was to determine the accuracy of the Perseus System for making the tibial cut on TKA. The primary endpoint was the tibial mechanical angle (TMA) measured on radiographic images at two months postoperatively. Secondary endpoints were the tibial slope and the mechanical axis of the lower limb (HKA angle, Hip-Knee-Ankle). The mean TMA in the accelerometer group was 87.6 ± 2.1° versus 89.1 ± 1.6° in the control group (p < 0.01). The tibial slope in the accelerometer group was 90.0 ± 1.9° versus 89.9 ± 1.3° in the control group (not significant). The mean HKA was 177.7 ± 1.8° in the accelerometer group and 177.5 ± 2.2° in the control group (not significant). This accelerometer-based navigation system during TKA did not improve the accuracy of the tibial cut compared to the conventional technique, but it restored the tibial slope. Full article

(This article belongs to the Special Issue Total Knee Arthroplasty: Improving Outcomes with New Technologies and a Multidisciplinary Approach)

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16 pages, 4159 KiB

Open AccessArticle

Dynamic Measurement of Patellofemoral Compression Forces: A Novel Method for Patient-Specific Patella Resurfacing in Total Knee Replacement

by Angela Brivio, David Barrett, Matthew F. Gong, Annabel Watson, Susie Naybour and Johannes F. Plate

Appl. Sci. 2022, 12(20), 10584; https://doi.org/10.3390/app122010584 - 20 Oct 2022

Cited by 1 | Viewed by 1350

Abstract

Functional dissatisfaction following total knee replacement (TKR) is recorded as high as 20%. The majority of these patients report anterior knee pain (AKP) as the main source of dissatisfaction. Elevated patellofemoral compression forces and soft tissue extensor hood strain have been implicated in [...] Read more.

Functional dissatisfaction following total knee replacement (TKR) is recorded as high as 20%. The majority of these patients report anterior knee pain (AKP) as the main source of dissatisfaction. Elevated patellofemoral compression forces and soft tissue extensor hood strain have been implicated in the generation of significant AKP. A novel method of assessing and measuring patellofemoral compression forces dynamically in the native and resurfaced patella for TKR in four different quadrants of the patella is described. Results are reported from an in vitro model and cadaveric studies in the native and resurfaced knee. Patellofemoral compression forces are shown to be characteristic and consistent over repeated assessments in the native knee. Placement of a TKR significantly alters this pattern. Furthermore, over-stuffing or under-stuffing the resurfaced patella also significantly alters the nature and magnitude of patellofemoral compression forces. These studies may lead to an improved understanding of the nature of AKP following TKR, and using this assessment tool presents an opportunity to more effectively balance the third space, reproduce the native patellofemoral forces, and subsequently reduce AKP following TKR. Full article

(This article belongs to the Special Issue Total Knee Arthroplasty: Improving Outcomes with New Technologies and a Multidisciplinary Approach)

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Review

Jump to: Research, Other

10 pages, 268 KiB

Open AccessReview

Perioperative Pain Management in Total Knee Arthroplasty: A Narrative Review of Current Multimodal Analgesia Protocols

by Simone Franzoni, Stefano Marco Paolo Rossi, Angela Cassinadri, Rudy Sangaletti and Francesco Benazzo

Appl. Sci. 2023, 13(6), 3798; https://doi.org/10.3390/app13063798 - 16 Mar 2023

Cited by 1 | Viewed by 4330

Abstract

Since there is no consensus on the optimal perioperative analgesic method, the present article provides a brief and practical synthesis on current multimodal pre–postsurgery analgesia protocols for primary TKA (excluding intraoperative anesthetic techniques) reported especially in recent meta-analyses and reviews. The focus is [...] Read more.

Since there is no consensus on the optimal perioperative analgesic method, the present article provides a brief and practical synthesis on current multimodal pre–postsurgery analgesia protocols for primary TKA (excluding intraoperative anesthetic techniques) reported especially in recent meta-analyses and reviews. The focus is not only on the traditional aims (pain scores and opioid sparing), but also the functional recovery and patient-reported outcomes. Multimodal analgesia (pre-emptive analgesia, local infiltration analgesia, peripheral nerve blocks, and specific systemic drugs) is considered the optimal regimen for perioperative pain management of TKA. Full article

(This article belongs to the Special Issue Total Knee Arthroplasty: Improving Outcomes with New Technologies and a Multidisciplinary Approach)

14 pages, 1926 KiB

Open AccessReview

Learning Curve in Robotic-Assisted Total Knee Arthroplasty: A Systematic Review of the Literature

by Giorgio Cacciola, Francesco Bosco, Fortunato Giustra, Salvatore Risitano, Marcello Capella, Alessandro Bistolfi, Alessandro Massè and Luigi Sabatini

Appl. Sci. 2022, 12(21), 11085; https://doi.org/10.3390/app122111085 - 01 Nov 2022

Cited by 10 | Viewed by 2236

Abstract

Several innovations have been introduced in recent years to improve total knee arthroplasty (TKA). Robotic-assisted surgery is gaining popularity for more precise implant placement while minimizing soft tissue injury. The main concerns are increased cost, operative time, and a significant learning curve. This [...] Read more.

Several innovations have been introduced in recent years to improve total knee arthroplasty (TKA). Robotic-assisted surgery is gaining popularity for more precise implant placement while minimizing soft tissue injury. The main concerns are increased cost, operative time, and a significant learning curve. This systematic review aims to analyze the surgical time learning curve, implant placement accuracy, and complications related to robotic-assisted TKA (raTKA). A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research was conducted up to September 2022 in four databases (PubMed/MEDLINE, Embase, Scopus, and the Cochrane Database of Systematic Reviews), with the following key terms: “robotic-assisted”, “total knee arthroplasty”, “robotic”, “TKA”, “learning”, and “TKR”. The methodology quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO), ID: CRD42022354797, in August 2022. Fifteen clinical studies that analyzed the raTKA learning curve of 29 surgeons and 2300 raTKAs were included in the systematic review. Fourteen surgeons reported the presence of an inflection point during the learning curve. Few studies have reported the learning curve of raTKA regarding lower limb alignment, component position, and intraoperative and postoperative complications. The main finding of this systematic review is that the procedure number required to reach the learning plateau is about 14.9 cases. Furthermore, an average decrease in surgical time of 23.9 min was described between the initial and proficiency phases; the average surgical time in the two phases was 98.8 min and 74.4 min, respectively. No learning curve was observed for implant placement and lower limb alignment because the implants were correctly placed from the first raTKAs. No significant complication rates were reported during the raTKA learning curve. Full article

(This article belongs to the Special Issue Total Knee Arthroplasty: Improving Outcomes with New Technologies and a Multidisciplinary Approach)

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16 pages, 1996 KiB

Open AccessReview

The Use of Artificial Intelligence in Orthopedics: Applications and Limitations of Machine Learning in Diagnosis and Prediction

by Bernardo Innocenti, Yanislav Radyul and Edoardo Bori

Appl. Sci. 2022, 12(21), 10775; https://doi.org/10.3390/app122110775 - 24 Oct 2022

Cited by 7 | Viewed by 2433

Abstract

Over the last several years, the impact of Artificial Intelligence on the world and on society has been undeniable. More specifically, a subfield, known as Machine Learning (ML), is driving innovation in a vast variety of fields as it denotes the ability of [...] Read more.

Over the last several years, the impact of Artificial Intelligence on the world and on society has been undeniable. More specifically, a subfield, known as Machine Learning (ML), is driving innovation in a vast variety of fields as it denotes the ability of a machine to identify relationships between data without explicit criteria, emulating a human-like type of learning. Over the last decade, research efforts have also been focused on orthopedics in order to provide help and assistance to surgeons and clinicians in their daily tasks. The purpose of this paper is to serve as a guide by presenting the most recent research and achievements in orthopedics concerning these new technologies, by exposing the main concepts and limitations of different applications, and tackling the main problems concerning both the field and the technology itself. The main ML techniques will be introduced and qualitatively explored, by considering the indexes that better identify the performance of the models; then, the main two applications will be addressed: diagnosis and prediction. Finally, a discussion about the limitations of the studies and technologies will be proposed. Full article

(This article belongs to the Special Issue Total Knee Arthroplasty: Improving Outcomes with New Technologies and a Multidisciplinary Approach)

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19 pages, 3335 KiB

Open AccessReview

Three-Dimensional Printed Models in Pre-Operative Planning of Complex Primary and Revision Total Knee Arthroplasty

by Federica Rosso, Roberto Rossi, Umberto Cottino, Federico Dettoni, Matteo Bruzzone and Davide Edoardo Bonasia

Appl. Sci. 2022, 12(19), 9618; https://doi.org/10.3390/app12199618 - 25 Sep 2022

Cited by 3 | Viewed by 1415

Abstract

Three-dimensional (3D) printing was introduced firstly for industrial use, but it gained popularity in different medical fields, including orthopedic surgeries. Particularly, 3D-printed models have been used in the pre-operative planning for spine surgery, oncology, acetabular fracture treatment and complex primary total hip arthroplasty [...] Read more.

Three-dimensional (3D) printing was introduced firstly for industrial use, but it gained popularity in different medical fields, including orthopedic surgeries. Particularly, 3D-printed models have been used in the pre-operative planning for spine surgery, oncology, acetabular fracture treatment and complex primary total hip arthroplasty (THA) or revision THA. In knee surgery, some authors described good accuracy with 3D-printed wedge for Opening Wedge High Tibial Osteotomy (OWHTO), but there are no studies describing its application in Total Knee Arthroplasty (TKA). In both primary and revision TKA, a 3D-printed model may be useful to better evaluate knee morphology and deformity, implants, bone losses and the compatibility between different components used. Furthermore, some companies provide a bone thickness evaluation, which may be useful to identify zones at risk of intra-operative fracture, especially in those cases in which a cone or sleeve must be used. The first aim of this manuscript was to evaluate possible application of 3D-printed model in pre-operative planning of both complex primary and revision TKA, compared to standard planning. Two clinical cases will also be described to show how these models can be used for planning purposes. Full article

(This article belongs to the Special Issue Total Knee Arthroplasty: Improving Outcomes with New Technologies and a Multidisciplinary Approach)

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15 pages, 1445 KiB

Open AccessReview

Augmented Reality in Orthopedic Surgery and Its Application in Total Joint Arthroplasty: A Systematic Review

by Stefano Marco Paolo Rossi, Fabio Mancino, Rudy Sangaletti, Loris Perticarini, Ludovico Lucenti and Francesco Benazzo

Appl. Sci. 2022, 12(10), 5278; https://doi.org/10.3390/app12105278 - 23 May 2022

Cited by 5 | Viewed by 2162

Abstract

The development of augmented reality (AR) and its application in total joint arthroplasty aims at improving the accuracy and precision in implant components’ positioning, hopefully leading to increased outcomes and survivorship. However, this field is far from being thoroughly explored. We therefore performed [...] Read more.

The development of augmented reality (AR) and its application in total joint arthroplasty aims at improving the accuracy and precision in implant components’ positioning, hopefully leading to increased outcomes and survivorship. However, this field is far from being thoroughly explored. We therefore performed a systematic review of the literature in order to examine the application, the results, and the different AR systems available in TJA. A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles on the application of augmented reality in total joint arthroplasty using various combinations of keywords since the inception of the database to 31 March 2022. Accuracy was intended as the mean error from the targeted positioning angle and compared as mean values and standard deviations. In all, 14 articles met the inclusion criteria. Among them, four studies reported on the application of AR in total knee arthroplasty, six studies on total hip arthroplasty, three studies reported on reverse shoulder arthroplasty, and one study on total elbow arthroplasty. Nine of the included studies were preclinical (sawbones or cadaveric), while five of them reported results of AR’s clinical application. The main common feature was the high accuracy and precision when implant positioning was compared with preoperative targeted angles with errors ≤2 mm and/or ≤2°. Despite the promising results in terms of increased accuracy and precision, this technology is far from being widely adopted in daily clinical practice. However, the recent exponential growth in machine learning techniques and technologies may eventually lead to the resolution of the ongoing limitations including depth perception and their high complexity, favorably encouraging the widespread usage of AR systems. Full article

(This article belongs to the Special Issue Total Knee Arthroplasty: Improving Outcomes with New Technologies and a Multidisciplinary Approach)

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Other

Jump to: Research, Review

11 pages, 569 KiB

Open AccessSystematic Review

Bicruciate-Retaining Total Knee Arthroplasty: State of the Art for the Younger and Active Population? A Systematic Review and Future Prospective

by Tommy S. De Windt, Simon N. Van Laarhoven and Gijs G. Van Hellemondt

Appl. Sci. 2022, 12(21), 10721; https://doi.org/10.3390/app122110721 - 22 Oct 2022

Viewed by 1693

Abstract

(1) Background: Total knee arthroplasty (TKA) is a well-established surgical treatment for end-stage osteoarthritis. While no leading factor can be identified, the high frequency of patient dissatisfaction (20%) pertains to several key features such as preoperative expectations and postoperative improvement in knee function. [...] Read more.

(1) Background: Total knee arthroplasty (TKA) is a well-established surgical treatment for end-stage osteoarthritis. While no leading factor can be identified, the high frequency of patient dissatisfaction (20%) pertains to several key features such as preoperative expectations and postoperative improvement in knee function. Bicruciate-retaining total knee arthroplasty (BCR-TKA) may improve kinematics and lead to improved clinical outcome in the higher-demanding patients. (2) Methods: A systematic review of the literature was performed to assess the best available preclinical and clinical literature on BCR-TKA for kinematics and clinical outcome and adverse events such as implant loosening. Articles were screened using predefined in- and exclusion criteria. The guidelines for Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were used. (3) Results: The literature search resulted in 352 articles which were screened for title and abstract. After application of the in- and exclusion criteria, 13 preclinical and 30 clinical articles were included. The methodological quality of studies was low, including mainly level IV studies. (4) Conclusions: This is the first report that provides a systematic description of the broad available preclinical and clinical literature on BCR-TKA. It underlines the current interest in improving kinematics and clinical outcome based on a more anatomical TKA design. The current review demonstrates the low methodological quality of clinical trials that have investigated BCR-TKA. Currently, there are insufficient data to support broad (“state of the art”) implantation of BCR-TKA. Preclinical and clinical research suggest, however, that the design has a potential benefit to achieve improved kinematics in the young and active arthroplasty patient and warrants future research for new-generation designs with optimal (tibial) fixation and reproducible (robot or navigated) surgical placement. Full article

(This article belongs to the Special Issue Total Knee Arthroplasty: Improving Outcomes with New Technologies and a Multidisciplinary Approach)

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