CORR Insights®: Are There Differences in Accuracy or Outcomes Scores Among Navigated, Robotic, Patient-specific Instruments or Standard Cutting Guides in TKA? A Network Meta-analysis

Osteosarcoma (OS) is the most common primary bone cancer in children and, unfortunately, is associated with poor survival rates. OS most commonly arises around the knee joint, and was traditionally treated with amputation until surgeons began to favour limb-preserving surgery in the 1990s. Whilst improving functional outcomes, this was not without problems, such as implant failure and limb length discrepancies. OS can also arise in areas such as the pelvis, spine, head, and neck, which creates additional technical difficulty given the anatomical complexity of the areas. We reviewed the literature and summarised the recent advances in OS surgery. Improvements have been made in many areas; developments in pre-operative imaging technology have allowed improved planning, whilst the ongoing development of intraoperative imaging techniques, such as fluorescent dyes, offer the possibility of improved surgical margins. Technological developments, such as computer navigation, patient specific instruments, and improved implant design similarly provide the opportunity to improve patient outcomes. Going forward, there are a number of promising avenues currently being pursued, such as targeted fluorescent dyes, robotics, and augmented reality, which bring the prospect of improving these outcomes further.

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An Innovative and Cost-Advantage CAD Solution for Cubitus Varus Surgical Planning in Children

Applied Sciences ◽

10.3390/app11094057 ◽

2021 ◽

Vol 11 (9) ◽

pp. 4057

Author(s):

Leonardo Frizziero ◽

Gian Maria Santi ◽

Christian Leon-Cardenas ◽

Giampiero Donnici ◽

Alfredo Liverani ◽

...

Keyword(s):

Computer Aided Design ◽

Low Cost ◽

Cost Effective ◽

Varus Deformity ◽

Patient Specific ◽

Cubitus Varus ◽

Surgical Guide ◽

Traditional Procedure ◽

Custom Made ◽

Patient Specific Instruments

The study of CAD (computer aided design) modeling, design and manufacturing techniques has undergone a rapid growth over the past decades. In medicine, this development mainly concerned the dental and maxillofacial sectors. Significant progress has also been made in orthopedics with pre-operative CAD simulations, printing of bone models and production of patient-specific instruments. However, the traditional procedure that formulates the surgical plan based exclusively on two-dimensional images and interventions performed without the aid of specific instruments for the patient and is currently the most used surgical technique. The production of custom-made tools for the patient, in fact, is often expensive and its use is limited to a few hospitals. The purpose of this study is to show an innovative and cost-effective procedure aimed at prototyping a custom-made surgical guide for address the cubitus varus deformity on a pediatric patient. The cutting guides were obtained through an additive manufacturing process that starts from the 3D digital model of the patient’s bone and allows to design specific models using Creo Parametric. The result is a tool that adheres perfectly to the patient’s bone and guides the surgeon during the osteotomy procedure. The low cost of the methodology described makes it worth noticing by any health institution.

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Patient-specific instruments for total knee arthroplasty can accurately predict the component size as used peroperative

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-016-4345-1 ◽

2016 ◽

Vol 25 (12) ◽

pp. 3844-3848 ◽

Cited By ~ 10

Author(s):

Martijn G. M. Schotanus ◽

Daphne A. L. Schoenmakers ◽

Rob Sollie ◽

Nanne P. Kort

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Specific ◽

Component Size ◽

Patient Specific Instruments ◽

Total Knee

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Clinical Outcome of Total Knee Arthroplasty Performed Using Patient-Specific Cutting Guides

Medical Science Monitor ◽

10.12659/msm.908213 ◽

2017 ◽

Vol 23 ◽

pp. 6168-6173 ◽

Cited By ~ 2

Author(s):

Murat Çalbıyık

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcome ◽

Knee Arthroplasty ◽

Patient Specific ◽

Cutting Guides ◽

Total Knee

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Rates, predictors and mortality of sepsis-associated acute kidney injury: systematic review and meta-analysis

10.21203/rs.3.rs-18145/v3 ◽

2020 ◽

Author(s):

Jie feng Liu ◽

Hebin Xie ◽

ziwei ye ◽

Lesan Wang

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Septic Shock ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Kidney Injury ◽

Predisposing Factors ◽

Cochrane Library ◽

Patient Specific ◽

Cumulative Number

Abstract Objective:The incidence and mortality of sepsis-induced acute kidney injury is high. Many studies have explored the causes of sepsis-induced acute kidney injury (AKI). However, its predictors are still uncertain; additionally, a complete overview is missing. A systematic review and a meta-analysis were performed to determine the predisposing factors for sepsis-induced AKI. Method: A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed and Web of Science databases, with an end date parameter of May 25, 2019. Valid data were retrieved in compliance with the inclusion and exclusion criteria. Result: Forty-seven observational studies were included for analysis. A cumulative number of 55911sepsis patients were evaluated. The incidence of AKI caused by septic shock is the highest. 30 possible risk factors were included in the meta-analysis. The results showed that 20 factors were found to be significant. The odds ratio(OR),95% confidence interval (CI) and Prevalence of the most prevalent predisposing factors for sepsis-induced AKI were as the following: Septic shock[2.88(2.36-3.52), 60.47%], Hypertension[1.43(1.20-1.70),38.39%), Diabetes mellitus[1.59(1.47-1.71),27.57%],Abdominal infection[1.44(1.32-1.58),30.87%], Vasopressors use[2.95(1.67-5.22),64.61%],vasoactive drugs use [3.85(1.89-7.87),63.22%], Mechanical ventilation[1.64(1.24-2.16),68.00%), Positive blood culture[1.60(1.35-1.89), 41.19%], Smoke history[1.60(1.09-2.36),43.09%]. Other risk factors include cardiovascular, coronary artery disease, liver disease, unknow infection, diuretics use, ACEI or ARB, gram-negative bacteria and organ transplant. Conclusion: A large number of factors are associated with AKI development in sepsis patients. Our review can guide risk-reducing interventions, clinical prediction rules, and patient-specific treatment and management strategies for sepsis-induced acute kidney injury.

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Impact of Clinicians' Use of Electronic Knowledge Resources on Clinical and Learning Outcomes: Systematic Review and Meta-Analysis

Journal of Medical Internet Research ◽

10.2196/13315 ◽

2019 ◽

Vol 21 (7) ◽

pp. e13315 ◽

Cited By ~ 6

Author(s):

Lauren A Maggio ◽

Christopher A Aakre ◽

Guilherme Del Fiol ◽

Jane Shellum ◽

David A Cook

Keyword(s):

Patient Care ◽

Learning Outcomes ◽

Meta Analysis ◽

Implementation Strategies ◽

Cochrane Library ◽

Patient Specific ◽

Evidence Based ◽

Knowledge Resources ◽

Knowledge Resource ◽

Variable Impact

Background Clinicians use electronic knowledge resources, such as Micromedex, UpToDate, and Wikipedia, to deliver evidence-based care and engage in point-of-care learning. Despite this use in clinical practice, their impact on patient care and learning outcomes is incompletely understood. A comprehensive synthesis of available evidence regarding the effectiveness of electronic knowledge resources would guide clinicians, health care system administrators, medical educators, and informaticians in making evidence-based decisions about their purchase, implementation, and use. Objective The aim of this review is to quantify the impact of electronic knowledge resources on clinical and learning outcomes. Methods We searched MEDLINE, Embase, PsycINFO, and the Cochrane Library for articles published from 1991 to 2017. Two authors independently screened studies for inclusion and extracted outcomes related to knowledge, skills, attitudes, behaviors, patient effects, and cost. We used random-effects meta-analysis to pool standardized mean differences (SMDs) across studies. Results Of 10,811 studies screened, we identified 25 eligible studies published between 2003 and 2016. A total of 5 studies were randomized trials, 22 involved physicians in practice or training, and 10 reported potential conflicts of interest. A total of 15 studies compared electronic knowledge resources with no intervention. Of these, 7 reported clinician behaviors, with a pooled SMD of 0.47 (95% CI 0.27 to 0.67; P<.001), and 8 reported objective patient effects with a pooled SMD of 0.19 (95% CI 0.07 to 0.32; P=.003). Heterogeneity was large (I2>50%) across studies. When compared with other resources—7 studies, not amenable to meta-analytic pooling—the use of electronic knowledge resources was associated with increased frequency of answering questions and perceived benefits on patient care, with variable impact on time to find an answer. A total of 2 studies compared different implementations of the same electronic knowledge resource. Conclusions Use of electronic knowledge resources is associated with a positive impact on clinician behaviors and patient effects. We found statistically significant associations between the use of electronic knowledge resources and improved clinician behaviors and patient effects. When compared with other resources, the use of electronic knowledge resources was associated with increased success in answering clinical questions, with variable impact on speed. Comparisons of different implementation strategies of the same electronic knowledge resource suggest that there are benefits from allowing clinicians to choose to access the resource, versus automated display of resource information, and from integrating patient-specific information. A total of 4 studies compared different commercial electronic knowledge resources, with variable results. Resource implementation strategies can significantly influence outcomes but few studies have examined such factors.

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