Application of Personalized Navigation Templates to Oxford Single Condylar Replacement in a Chinese Population

2020 ◽  
Author(s):  
Yudong Gan ◽  
Jian Zhuang ◽  
Wenxiao Jiang ◽  
Wei Sun ◽  
Yijun Zhang
Keyword(s):  
Conventional Method ◽  
Tibial Plateau ◽  
Operation Time ◽  
Flip Angle ◽  
Patient Specific ◽  
X Rays ◽  
Femoral Prosthesis ◽  
Valgus Angle ◽  
The Mean ◽  
Therapeutic Study

AbstractThe purpose of this study is to develop and validate a novel patient-specific navigational template for unicompartmental knee arthroplasty (UKA). A total of 120 patients who underwent UKA were randomized and divided into the conventional method and navigational template groups. In the navigational template group, patient-specific navigational templates were designed and used intraoperatively to assist 60 patients with UKA. Information on operation time and blood loss was recorded by an independent operating room nurse. After surgery, the positions of the prostheses were evaluated using X-rays. All navigation templates were found to fit its corresponding biomodel appropriately without any free movement. The navigational template exhibited significantly better accuracy than the conventional method. Statistically significant differences in the femoral prosthesis flip angle, femoral prosthesis flexion angle, and tibial plateau varus and valgus angle were observed between the two groups (p = 0.022, 0.042, 0.043, respectively). In addition, the mean operation time was statistically and significantly lower in the navigational template group than in the conventional group (p = 0.035). This study introduces a novel navigational template to UKA, the accuracy of which is proven by clinical operation. This is a Level III, therapeutic study.

Computed Tomography-Based Patient-Specific Instrumentation Loses Accuracy with Significant Varus Preoperative Misalignment

2020 ◽  
Author(s):  
Vicente Jesús León-Muñoz ◽  
Mirian López-López ◽  
Alonso José Lisón-Almagro ◽  
Francisco Martínez-Martínez ◽  
Fernando Santonja-Medina
Keyword(s):  
Computed Tomography ◽  
Deformity Correction ◽  
Patient Specific ◽  
Control Group ◽  
X Rays ◽  
Varus Alignment ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
The Mean ◽  
Valgus Alignment

AbstractPatient-specific instrumentation (PSI) has been introduced to simplify and make total knee arthroplasty (TKA) surgery more precise, effective, and efficient. We performed this study to determine whether the postoperative coronal alignment is related to preoperative deformity when computed tomography (CT)-based PSI is used for TKA surgery, and how the PSI approach compares with deformity correction obtained with conventional instrumentation. We analyzed pre-and post-operative full length standing hip-knee-ankle (HKA) X-rays of the lower limb in both groups using a convention > 180 degrees for valgus alignment and < 180 degrees for varus alignment. For the PSI group, the mean (± SD) pre-operative HKA angle was 172.09 degrees varus (± 6.69 degrees) with a maximum varus alignment of 21.5 degrees (HKA 158.5) and a maximum valgus alignment of 14.0 degrees. The mean post-operative HKA was 179.43 degrees varus (± 2.32 degrees) with a maximum varus alignment of seven degrees and a maximum valgus alignment of six degrees. There has been a weak correlation among the values of the pre- and postoperative HKA angle. The adjusted odds ratio (aOR) of postoperative alignment outside the range of 180 ± 3 degrees was significantly higher with a preoperative varus misalignment of 15 degrees or more (aOR: 4.18; 95% confidence interval: 1.35–12.96; p = 0.013). In the control group (conventional instrumentation), this loss of accuracy occurs with preoperative misalignment of 10 degrees. Preoperative misalignment below 15 degrees appears to present minimal influence on postoperative alignment when a CT-based PSI system is used. The CT-based PSI tends to lose accuracy with preoperative varus misalignment over 15 degrees.

scholarly journals Arthroscopic-Guided Balloon Tibioplasty in Schatzker III Tibial Plateau Fracture

Joints ◽  
2018 ◽  
Vol 06 (04) ◽  
pp. 220-227 ◽  
Author(s):  
Fabrizio Cuzzocrea ◽  
Eugenio Jannelli ◽  
Alessandro Ivone ◽  
Simone Perelli ◽  
Alberto Fioruzzi ◽  
...  
Keyword(s):  
Ct Scan ◽  
Tibial Plateau ◽  
Case Series ◽  
Clinical Score ◽  
Joint Surface ◽  
X Rays ◽  
Level Of Evidence ◽  
Significant Difference ◽  
The Mean

Abstract Purpose The study aims to present the results at a mean 28-months follow-up of arthroscopic-guided balloon tibioplasty and to spot some technical tricks and some practice using tools and materials. Methods The study relates to six patients with tibial plateau fractures type Schatzker III with tibial plateau depression more than 4 mm at preoperative computed tomography scan (CT-scan). The follow-up period ranged from 22 to 33 months, with a mean of 28 months. No patients were lost to follow-up. The patients were evaluated clinically using the Rasmussen score system and Lysholm score systems at 6 to 12 and 24 months, postoperatively. Radiographic evaluations (standard X-rays) were done preoperatively at 1, 3, and 12 months postoperatively while a CT-scan with 3D reconstruction was performed preoperatively, at the first day and 6 months, postoperatively. Results The mean Rasmussen clinical score at 6 months postoperatively was 26.3 while at 1-year postoperatively the mean Rasmussen clinical score was 28.33. At 2-year postoperatively the mean Rasmussen clinical score was 28.83. Statistically significant difference was found in 6-months and 2-years results (p < 0.05). CT-scan achieved the first postoperative day showed the recovery of approximately 70% of the area of the interested tibial plateau, restoring of the joint surface without articular bone free fragments. Conclusion The described surgical procedure, if correctly performed with proper indications (Schatzker III), respect the principles mentioned above and the clinical and radiological results confirm our purpose. Level of Evidence This is a therapeutic case series, level IV study.

scholarly journals Combined lateral peripatellar and posteromedial approaches for Schatzker type IV tibial plateau fractures involving posteromedial plane: A prospective study.

2020 ◽  
Author(s):  
Jun Zhang ◽  
Bo Yin ◽  
Jianmin Zhao ◽  
Yihan Li ◽  
Peng Yin ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Operation Time ◽  
Knee Extension ◽  
Tibial Plateau Fractures ◽  
Lower Limbs ◽  
Type Iv ◽  
Schatzker Type ◽  
Study Results ◽  
The Mean ◽  
A Prospective Study

Abstract Objective The objective of this study to evaluate prospectively the effectiveness of Schatzker type IV tibial plateau fractures involving posteromedial plane managed by combined lateral peripatellar and posteromedial approaches Materials and methods We analyzed 18 patients with Schatzker type IV tibial plateau fractures involving posteromedial plane. There were 12 males and 6 females with an average of 38.5 years (range, 25-60 years). The mechanism of injury included traffic accident in 15 patients and falling in 3 patients. The injured lower limbs were right in 11 patients and left in 7 patients. The mean time from injury to surgery was 6.78 days (range, 5-9 days). There were 8 patients with meniscus injuries in our study. Results The mean operation time was 3.41 hours (range, 3-4 hours). The mean blood loss was 352.78 ml (range, 300-410 ml). All the injured meniscuses were repaired. All patients were followed up, and the average time of follow up was 16.61 months (range, 14-22 months). Bone union was achieved at a mean of 12 weeks (range, 10-14 weeks). The mean degree of knee extension was 1.11° (range, 0-5°), and the mean degree of knee flexion was 120.56°(range, 110-130°). The mean points of KSS were 83 (range, 74-89 points). According to the criteria of KSS, 14 patients had clinical outcomes rated as excellent and 4 patients were rated as good. Conclusion Our results suggested that Combined lateral peripatellar and posteromedial approaches in the treatment of Schatzker type IV tibial plateau fractures involving posteromedial plane acquired satisfying outcomes. It was good for repairing the injured meniscus through our approaches.

scholarly journals A Deep Learning Approach for Single Shot C-Arm Pose Estimation

10.29007/6mkk ◽  
2020 ◽  
Author(s):  
Hooman Esfandiari ◽  
Sebastian Andreß ◽  
Maternus Herold ◽  
Wolfgang Böcker ◽  
Simon Weidert ◽  
...  
Keyword(s):  
Machine Learning ◽  
Deep Learning ◽  
Operation Time ◽  
Learning System ◽  
Patient Specific ◽  
Single Shot ◽  
X Rays ◽  
Similar Range ◽  
Deep Learning Network ◽  
Ionizing Radiation Exposure

During a typical fluoroscopic guided surgery, it is common to acquire multiple x-ray images to correctly position the C-arm. This can be a long process resulting in an in- crease in operation time and ionizing radiation exposure. Our purpose in this study is to implement a machine learning system for predicting the position of the C-arm based on the intraoperative radiographs. The prediction is achieved by training a Deep Learning Network based on Digitally Reconstructed Radiographs. We first showed a high prediction accuracy (4.5 mm and 1.1o) when patient-specific training was implemented. Additionally, we demonstrated a similar range of accuracy by applying transfer-learning on the last lay- ers of the network while reducing the processing time by 83%. In conclusion, in this study, we propose a C-arm position prediction system based on machine learning that can po- tentially reduce the number of intraoperatively acquired X-rays in a common orthopaedic surgical procedure.

scholarly journals Use of a 3D-Printed Patient-Specific Surgical Jig and Ready-Made Total Sacral Endoprosthesis for Total Sacrectomy and Reconstruction

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Qianyu Shi ◽  
Tao Ji ◽  
Siyi Huang ◽  
Xiaodong Tang ◽  
Rongli Yang ◽  
...  
Keyword(s):  
Surgical Margin ◽  
Operation Time ◽  
Patient Specific ◽  
En Bloc ◽  
Sacral Tumor ◽  
3D Printed ◽  
The Mean ◽  
Sacral Tumors ◽  
Single Posterior Approach ◽  
Total Sacrectomy

Objective. In the present study, the authors aimed to optimize the workflow of utilizing a 3D printing technique during surgical treatment for malignant sacral tumors, mainly on preparation of patient-specific surgical jigs and ready-made 3D-printed total sacral endoprosthesis. Methods. Three patients with a malignant sacral tumor received total sacrectomy with preoperative design of a patient-specific 3D-printed cutting jig and endoprosthetic reconstruction. Size of ready-made 3D-printed endoprosthesis was determined based on preoperative images, planned surgical margin, and size of the endoprosthesis. A patient-specific cutting jig was designed with a bilateral cutting slot matching the bilateral planes of the implant precisely. The tumor was removed en bloc through a single posterior approach only, being followed by reconstruction with ready-made total sacral endoprosthesis. Results. The mean time for preoperative design and manufacture of the surgical jig was 6.3 days. Surgical jigs were successfully used during surgery and facilitated the osteotomy. The mean operation time was 177 minutes (range 150-190 minutes). The mean blood loss was 3733 ml (range 3600-4000 ml). R0 resections were achieved in all the three cases proven by pathology. Evaluation of osteotomy accuracy was conducted by comparing preoperative plans and postoperative CT scans. The mean osteotomy deviation was 2.1 mm (range 0-4 mm), and mean angle deviation of osteotomy was 3.2° (range 0-10°). At a mean follow-up of 18.7 months, no local recurrence was observed. One patient had lung metastasis 15 months after surgery. Two patients were alive with no evidence of the disease. Conclusions. The patient-specific surgical jig and ready-made 3D-printed total sacral endoprosthesis can shorten the surgical preparation time preoperatively, facilitating accurate osteotomy and efficient reconstruction intraoperatively. The workflow seems to be feasible and practical.

scholarly journals Combined lateral peripatellar and posteromedial approaches for Schatzker type IV tibial plateau fractures involving posteromedial plane: A prospective study.

2020 ◽  
Author(s):  
Jun Zhang ◽  
Bo Yin ◽  
Jianmin Zhao ◽  
Yihan Li ◽  
Peng Yin ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Operation Time ◽  
Knee Extension ◽  
Tibial Plateau Fractures ◽  
Lower Limbs ◽  
Type Iv ◽  
Schatzker Type ◽  
The Mean ◽  
A Prospective Study

Abstract Background: The objective of this study to evaluate prospectively the effectiveness of Schatzker type IV tibial plateau fractures involving posteromedial plane managed by combined lateral peripatellar and posteromedial approaches.Methods: We analyzed 18 patients with Schatzker type IV tibial plateau fractures involving posteromedial plane. There were 12 males and 6 females with an average of 38.5 years (range, 25-60 years). The mechanism of injury included traffic accident in 15 patients and falling in 3 patients. The injured lower limbs were right in 11 patients and left in 7 patients. The mean time from injury to surgery was 6.78 days (range, 5-9 days). There were 8 patients with meniscus injuries in our study.Results: The mean operation time was 3.41 hours (range, 3-4 hours). The mean blood loss was 352.78 ml (range, 300-410 ml). All the injured meniscuses were repaired. All patients were followed up, and the average time of follow up was 16.61 months (range, 14-22 months). Bone union was achieved at a mean of 12 weeks (range, 10-14 weeks). The mean degree of knee extension was 1.11° (range, 0-5°), and the mean degree of knee flexion was 120.56° (range, 110-130°). The mean points of KSS were 83 (range, 74-89 points). According to the criteria of KSS, 14 patients had clinical outcomes rated as excellent and 4 patients were rated as good.Conclusion: Our results suggested that Combined lateral peripatellar and posteromedial approaches in the treatment of Schatzker type IV tibial plateau fractures involving posteromedial plane acquired satisfying outcomes. It was good for repairing the injured meniscus through our approaches.

scholarly journals Combined lateral peripatellar and posteromedial approaches for Schatzker type IV tibial plateau fractures involving posteromedial plane: A prospective study.

2020 ◽  
Author(s):  
Jun Zhang ◽  
Bo Yin ◽  
Jianmin Zhao ◽  
Yihan Li ◽  
Peng Yin ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Operation Time ◽  
Knee Extension ◽  
Tibial Plateau Fractures ◽  
Lower Limbs ◽  
Type Iv ◽  
Schatzker Type ◽  
The Mean ◽  
A Prospective Study

Abstract Objective The objective of this study to evaluate prospectively the effectiveness of Schatzker type IV tibial plateau fractures involving posteromedial plane managed by combined lateral peripatellar and posteromedial approaches Materials and methods We analyzed 18 patients with Schatzker type IV tibial plateau fractures involving posteromedial plane. There were 12 males and 6 females with an average of 38.5 years (range, 25-60 years). The mechanism of injury included traffic accident in 15 patients and falling in 3 patients. The injured lower limbs were right in 11 patients and left in 7 patients. The mean time from injury to surgery was 6.78 days (range, 5-9 days). There were 8 patients with meniscus injuries in our study. ResultsThe mean operation time was 3.41 hours (range, 3-4 hours). The mean blood loss was 352.78 ml (range, 300-410 ml). All the injured meniscuses were repaired. All patients were followed up, and the average time of follow up was 16.61 months (range, 14-22 months). Bone union was achieved at a mean of 12 weeks (range, 10-14 weeks). The mean degree of knee extension was 1.11° (range, 0-5°), and the mean degree of knee flexion was 120.56°(range, 110-130°). The mean points of KSS were 83 (range, 74-89 points). According to the criteria of KSS, 14 patients had clinical outcomes rated as excellent and 4 patients were rated as good. Conclusion Our results suggested that Combined lateral peripatellar and posteromedial approaches in the treatment of Schatzker type IV tibial plateau fractures involving posteromedial plane acquired satisfying outcomes. It was good for repairing the injured meniscus through our approaches.

scholarly journals The Accuracy of Patient-Specific Instrumentation with Laser Guidance in a Dynamic Total Hip Arthroplasty: A Radiological Evaluation

Sensors ◽  
2021 ◽  
Vol 21 (12) ◽  
pp. 4232
Author(s):  
Andrea Ferretti ◽  
Ferdinando Iannotti ◽  
Lorenzo Proietti ◽  
Carlo Massafra ◽  
Attilio Speranza ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Specific ◽  
X Rays ◽  
Surgical Time ◽  
Dynamic Planning ◽  
Total Hip ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
The Mean

The functional positioning of components in a total hip arthroplasty (THA) and its relationship with individual lumbopelvic kinematics and a patient’s anatomy are being extensively studied. Patient-specific kinematic planning could be a game-changer; however, it should be accurately delivered intraoperatively. The main purpose of this study was to verify the reliability and accuracy of a patient-specific instrumentation (PSI) and laser-guided technique to replicate preoperative dynamic planning. Thirty-six patients were prospectively enrolled and received dynamic hip preoperative planning based on three functional lateral spinopelvic X-rays and a low dose CT scan. Three-dimensional (3D) printed PSI guides and laser-guided instrumentation were used intraoperatively. The orientation of the components, osteotomy level and change in hip length and offset were measured on postoperative CT scans and compared with the planned preoperative values. The length of surgery was compared with that of a matched group of thirty-six patients who underwent a conventional THA. The mean absolute deviation from the planned inclination and anteversion was 3.9° and 4.4°, respectively. In 92% of cases, both the inclination and anteversion were within +/− 10° of the planned values. Regarding the osteotomy level, offset change and limb length change, the mean deviation was, respectively, 1.6 mm, 2.6 mm and 2 mm. No statistically significant difference was detected when comparing the planned values with the achieved values. The mean surgical time was 71.4 min in the PSI group and 60.4 min in the conventional THA group (p < 0.05). Patient-specific and laser-guided instrumentation is safe and accurately reproduces dynamic planning in terms of the orientation of the components, osteotomy level, leg length and offset. Moreover, the increase in surgical time is negligible.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Surgical treatment of fractures of the distal radius – ORIF vs external fixation with ligamentotaxis

2020 ◽  
Vol 99 (8) ◽  
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Locking Plates ◽  
X Rays ◽  
Ao Classification ◽  
Radial Inclination ◽  
First Choice ◽  
Sagittal Tilt ◽  
Radial Length ◽  
The Mean

Introduction: The study compares the results of open reduction using volar locking plates with ligamentotaxis by external fixation in fractures of distal radius type 2R3C according to AO classification. Methods: A retrospective study evaluating the results of osteosynthesis in patients with distal radius fractures type 2R3C according to AO classification, operated until December 2018. The ORIF method with volar locking plates (LCP) was used in 54 patients, and closed reduction with ligamentotaxis using external fixation (EF) was used in 33 patients. The mean age of the patients was 46.7 years in the LCP group and 59.6 years in the EF group. All were evaluated for their X-ray and functional outcomes and according to the Green and O’Brien score at 6 and 12 months after surgery. Results: According to X-rays at 12 months in the LCP group, the mean sagittal tilt was 10.13°, the mean radial inclination was 23.89°, and the mean radial length was 11.84 mm. In the EF group, the mean sagittal tilt was 6.32°, the mean radial inclination was 24.78°, and the mean radial length was 9.89 mm. According to the Green and O’Brien score, we recorded a mean score of 84.44 points in the LCP group at 12 month; we achieved good and excellent results in 83.33% of the patients and no poor result was observed. In the EF group the final mean score was 77.27; good and excellent results were achieved in 45.46% of the patients and a poor result in one patient. Conclusion: Based on the results in our group of patients, the internal type osteosynthesis using LCP implants can be recommended as a first-choice technique in the treatment of 2R3C fractures according to AO classification.

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