scholarly journals Auto Strut: a novel smart robotic system for external fixation device for bone deformity correction, a preliminary experience

2021 ◽  
pp. 1-7
Author(s):  
Roy Gigi ◽  
Jacob Mor ◽  
Inbar Lidor ◽  
Dror Ovadia ◽  
Eitan Segev
Keyword(s):  
Treatment Plan ◽  
Deformity Correction ◽  
Robotic System ◽  
Computer Assisted ◽  
External Fixators ◽  
Level Of Evidence ◽  
Automatic Adjustment ◽  
Manual Adjustment ◽  
Level Ii ◽  
External Fixation Device

Purpose Several hexapod external fixators are used in the treatment of bone fracture and deformity corrections. One characteristic of all of them is the requirement for manual adjustment of the fixator struts. The purpose of this study was to introduce a novel robotic system that executes automatic adjustment of the struts. Methods Ten patients were treated for various bone deformities using a hexapod external fixator with the Auto Strut system. This new system automatically adjusts the fixator struts according to a hexapod computer-assisted correction plan. During each visit, the progress of the correction was assessed (clinically and radiographically) and reading of the strut scale numbers was performed and compared with the original treatment plan. Results All patients completed treatment during the follow-up period, achieving all planned correction goals, except from one patient who switched to manual struts due to personal preference. The device alarm system was activated once with no device-related adverse events. Duration of distraction ranged between ten and 90 days with a distraction index ranging between eight and 15 days/cm. Regenerate consolidation time between one and seven months. In total, 48 struts of eight patients were recorded and analyzed. In all, 94% of the final strut number readings presented a discrepancy of 0 mm to 1 mm between planned and actual readings, indicating high precision of the automatic adjustment. Conclusion This study presents preliminary results, showing that Auto Strut can successfully replace the manual strut adjustment providing important advantages that benefit the patient, the caregiver and the surgeon. Level of Evidence Level II

scholarly journals Conventional versus Smart Wireless Navigation in Total Knee Replacement: Similar Outcomes in a Randomized Prospective Study

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 090-094 ◽  
Author(s):  
Matteo Denti ◽  
Francesco Soldati ◽  
Francesca Bartolucci ◽  
Emanuela Morenghi ◽  
Laura De Girolamo ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Tibial Slope ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Assisted Navigation ◽  
Level Ii ◽  
Before And After ◽  
Total Knee ◽  
Generation Computer ◽  
Navigated Tka

Purpose The development of new computer-assisted navigation technologies in total knee arthroplasty (TKA) has attracted great interest; however, the debate remains open as to the real reliability of these systems. We compared conventional TKA with last generation computer-navigated TKA to find out if navigation can reach better radiographic and clinical outcomes. Methods Twenty patients with tricompartmental knee osteoarthritis were prospectively selected for conventional TKA (n = 10) or last generation computer-navigated TKA (n = 10). Data regarding age, gender, operated side, and previous surgery were collected. All 20 patients received the same cemented posterior-stabilized TKA. The same surgical instrumentation, including alignment and cutting guides, was used for both the techniques. A single radiologist assessed mechanical alignment and tibial slope before and after surgery. A single orthopaedic surgeon performed clinical evaluation at 1 year after the surgery. Wilcoxon's test was used to compare the outcomes of the two groups. Statistical significance was set at p < 0.05. Results No significant differences in mechanical axis or tibial slope was found between the two groups. The clinical outcome was equally good with both techniques. At a mean follow-up of 15.5 months (range, 13–25 months), all patients from both groups were generally satisfied with a full return to daily activities and without a significance difference between them. Conclusion Our data showed that clinical and radiological outcomes of TKA were not improved by the use of computer-assisted instruments, and that the elevated costs of the system are not warranted. Level of Evidence This is a Level II, randomized clinical trial.

scholarly journals Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Raj Kanna ◽  
Chandramohan Ravichandran ◽  
Gautam M. Shetty
Keyword(s):  
Femoral Component ◽  
Distal Femur ◽  
Mechanical Axis ◽  
Computer Assisted ◽  
Therapeutic Level ◽  
Level Of Evidence ◽  
Anterior Cortex ◽  
Level Ii ◽  
Navigated Tka ◽  
Very High

Abstract Purpose In navigated TKA, the risk of notching is high if femoral component sagittal positioning is planned perpendicular to the sagittal mechanical axis of femur (SMX). We intended to determine if, by opting to place the femoral component perpendicular to distal femur anterior cortex axis (DCX), notching can be reduced in navigated TKA. Methods We studied 171 patients who underwent simultaneous bilateral computer-assisted TKA. Femoral component sagittal positioning was planned perpendicular to SMX in one knee (Femur Anterior Bowing Registration Disabled, i.e. FBRD group) and perpendicular to DCX in the opposite knee (Femur Anterior Bowing Registration Enabled, i.e. FBRE group). Incidence and depth of notching were recorded in both groups. For FBRE knees, distal anterior cortex angle (DCA), which is the angle between SMX and DCX, was calculated by the computer. Results Incidence and mean depth of notching was less (p = 0.0007 and 0.009) in FBRE versus FBRD group, i.e. 7% versus 19.9% and 0.98 mm versus 1.53 mm, respectively. Notching was very high (61.8%) in FBRD limbs when the anterior bowing was severe (DCA > 3°) in the contralateral (FBRE) limbs. Conclusion Notching was less when femoral component sagittal positioning was planned perpendicular to DCX, in navigated TKA. Level of evidence Therapeutic level II.

First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction

2021 ◽  
pp. 107110072110345
Author(s):  
Chien-Shun Wang ◽  
Yun-Hsuan Tzeng ◽  
Tzu-Cheng Yang ◽  
Chun-Cheng Lin ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hallux Valgus ◽  
Reconstructive Surgery ◽  
Case Series ◽  
Deformity Correction ◽  
Level Of Evidence ◽  
Factors Affecting ◽  
Radiographic Parameters ◽  
Case Series Study ◽  
Adult Acquired Flatfoot Deformity

Background: Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. Methods: Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. Results: Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. Conclusion: In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. Level of Evidence: Level IV, case series study.

scholarly journals Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

2021 ◽  
Author(s):  
Gabriele Colo’ ◽  
Mattia Alessio Mazzola ◽  
Giulio Pilone ◽  
Giacomo Dagnino ◽  
Lamberto Felli
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Deformity Correction ◽  
Tibialis Posterior ◽  
Open Wedge ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

scholarly journals Significant increase in quantity and quality of knee arthroplasty related research in KSSTA over the past 15 years

2021 ◽  
Author(s):  
Stephanie Kirschbaum ◽  
Thilo Kakzhad ◽  
Fabian Granrath ◽  
Andrzej Jasina ◽  
Jakub Oronowicz ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Special Topic ◽  
Computer Assisted ◽  
Time Interval ◽  
Search Term ◽  
Level Of Evidence ◽  
The Past ◽  
Patient Reported ◽  
Over Time ◽  
Number Of Authors

Abstract Purpose This study aimed to evaluate both publication and authorship characteristics in Knee Surgery, Sports Traumatology, Arthroscopy journal (KSSTA) regarding knee arthroplasty over the past 15 years. Methods PubMed was searched for articles published in KSSTA between January 1, 2006, and December 31st, 2020, utilising the search term ‘knee arthroplasty’. 1288 articles met the inclusion criteria. The articles were evaluated using the following criteria: type of article, type of study, main topic and special topic, use of patient-reported outcome scores, number of references and citations, level of evidence (LOE), number of authors, gender of the first author and continent of origin. Three time intervals were compared: 2006–2010, 2011–2015 and 2016–2020. Results Between 2016 and 2020, publications peaked at 670 articles (52%) compared with 465 (36%) published between 2011 and 2016 and 153 articles (12%) between 2006 and 2010. While percentage of reviews (2006–2010: 0% vs. 2011–2015: 5% vs. 2016–2020: 5%) and meta-analyses (1% vs. 6% vs. 5%) increased, fewer case reports were published (13% vs. 3% vs. 1%) (p < 0.001). Interest in navigation and computer-assisted surgery decreased, whereas interest in perioperative management, robotic and individualized surgery increased over time (p < 0.001). There was an increasing number of references [26 (2–73) vs. 30 (2–158) vs. 31 (1–143), p < 0.001] while number of citations decreased [30 (0–188) vs. 22 (0–264) vs. 6 (0–106), p < 0.001]. LOE showed no significant changes (p = 0.439). The number of authors increased between each time interval (p < 0.001), while the percentage of female authors was comparable between first and last interval (p = 0.252). Europe published significantly fewer articles over time (56% vs. 47% vs. 52%), whereas the number of articles from Asia increased (35% vs. 45% vs. 37%, p = 0.005). Conclusion Increasing interest in the field of knee arthroplasty-related surgery arose within the last 15 years in KSSTA. The investigated topics showed a significant trend towards the latest techniques at each time interval. With rising number of authors, the part of female first authors also increased—but not significantly. Furthermore, publishing characteristics showed an increasing number of publications from Asia and a slightly decreasing number in Europe. Level of evidence IV.

Comparative Outcomes Between Step-Cut Lengthening Calcaneal Osteotomy vs Traditional Evans Osteotomy for Stage IIB Adult-Acquired Flatfoot Deformity

2017 ◽  
Vol 39 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Stuart M. Saunders ◽  
Scott J. Ellis ◽  
Constantine A. Demetracopoulos ◽  
Anca Marinescu ◽  
Jayme Burkett ◽  
...  
Keyword(s):  
Deformity Correction ◽  
Categorical Variables ◽  
Distributed Data ◽  
Level Of Evidence ◽  
Lateral Column ◽  
Calcaneal Osteotomy ◽  
Outcome Scores ◽  
Lateral Column Lengthening ◽  
Adult Acquired Flatfoot Deformity ◽  
Lateral Pain

Background: The forefoot abduction component of the flexible adult-acquired flatfoot can be addressed with lengthening of the anterior process of the calcaneus. We hypothesized that the step-cut lengthening calcaneal osteotomy (SLCO) would decrease the incidence of nonunion, lead to improvement in clinical outcome scores, and have a faster time to healing compared with the traditional Evans osteotomy. Methods: We retrospectively reviewed 111 patients (143 total feet: 65 Evans, 78 SLCO) undergoing stage IIB reconstruction followed clinically for at least 2 years. Preoperative and postoperative radiographs were analyzed for the amount of deformity correction. Computed tomography (CT) was used to analyze osteotomy healing. The Foot and Ankle Outcome Scores (FAOS) and lateral pain surveys were used to assess clinical outcomes. Mann-Whitney U tests were used to assess nonnormally distributed data while χ2 and Fisher exact tests were used to analyze categorical variables (α = 0.05 significant). Results: The Evans group used a larger graft size ( P < .001) and returned more often for hardware removal ( P = .038) than the SLCO group. SLCO union occurred at a mean of 8.77 weeks ( P < .001), which was significantly lower compared with the Evans group ( P = .02). The SLCO group also had fewer nonunions ( P = .016). FAOS scores improved equivalently between the 2 groups. Lateral column pain, ability to exercise, and ambulation distance were similar between groups. Conclusion: Following SLCO, patients had faster healing times and fewer nonunions, similar outcomes scores, and equivalent correction of deformity. SLCO is a viable technique for lateral column lengthening. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Inter-rater variability of three-dimensional fracture reduction planning according to the educational background

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Christoph Zindel ◽  
Philipp Fürnstahl ◽  
Armando Hoch ◽  
Tobias Götschi ◽  
Andreas Schweizer ◽  
...  
Keyword(s):  
Distal Radius ◽  
Clinical Experience ◽  
Three Dimensional ◽  
Computer Assisted Surgery ◽  
Educational Background ◽  
Fracture Reduction ◽  
Computer Assisted ◽  
Operation Planning ◽  
Level Of Evidence ◽  
Fragment Displacement

Abstract Background Computer-assisted three-dimensional (3D) planning is increasingly delegated to biomedical engineers. So far, the described fracture reduction approaches rely strongly on the performance of the users. The goal of our study was to analyze the influence of the two different professional backgrounds (technical and medical) and skill levels regarding the reliability of the proposed planning method. Finally, a new fragment displacement measurement method was introduced due to the lack of consistent methods in the literature. Methods 3D bone models of 20 distal radius fractures were presented to nine raters with different educational backgrounds (medical and technical) and various levels of experience in 3D operation planning (0 to 10 years) and clinical experience (1.5 to 24 years). Each rater was asked to perform the fracture reduction on 3D planning software. Results No difference was demonstrated in reduction accuracy regarding rotational (p = 1.000) and translational (p = 0.263) misalignment of the fragments between biomedical engineers and senior orthopedic residents. However, a significantly more accurate planning was performed in these two groups compared with junior orthopedic residents with less clinical experience and no 3D planning experience (p < 0.05). Conclusion Experience in 3D operation planning and clinical experience are relevant factors to plan an intra-articular fragment reduction of the distal radius. However, no difference was observed regarding the educational background (medical vs. technical) between biomedical engineers and senior orthopedic residents. Therefore, our results support the further development of computer-assisted surgery planning by biomedical engineers. Additionally, the introduced fragment displacement measure proves to be a feasible and reliable method. Level of Evidence Diagnostic Level II

scholarly journals Intra-operative Laxity Following Total Knee Arthroplasty is Highly Variable and Different Than Osteoarthritic and Normal Knees

2020 ◽  
Author(s):  
Robert A. Siston ◽  
Erin E. Hutter ◽  
Joseph A. Ewing ◽  
Rachel K. Hall ◽  
Jeffrey F. Granger ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Laxity ◽  
Maximum Load ◽  
Similar Data ◽  
Level Of Evidence ◽  
Large Variability ◽  
Level Ii ◽  
Total Knee ◽  
Manual Manipulation

AbstractBackgroundAchieving a stable joint is an important yet challenging part of total knee arthroplasty (TKA). Neither manual manipulation of the knee nor instrumented sensors biomechanically characterize knee laxity or objectively characterize how TKA changes the laxity of an osteoarthritic (OA) knee. Therefore, the purposes of this study were: 1) objectively characterize changes in knee laxity due to TKA, 2) objectively determine whether TKA resulted in equal amounts of varus-valgus motion under a given load (i.e., balance) and 3) determine how TKA knee laxity and balance differ from values seen in non-osteoarthritic knees.MethodsTwo surgeons used a custom navigation system and intra-operative device to record varus-valgus motion under quantified loads in a cohort of 31 patients (34 knees) undergoing primary TKA. Similar data previously were collected from a cohort of 42 native cadaveric knees.ResultsPerforming a TKA resulted in a “looser knee” on average, but great variability existed within and between surgeons. Under the maximum applied moment, 20 knees were “looser” in the varus-valgus direction, while 14 were “tighter”. Surgeon 1 generally “loosened” knees (OA laxity 6.1°±2.3°, TKA laxity 10.1°±3.6°), while Surgeon 2 did not substantially alter knee laxity (OA laxity 8.2°±2.4°, TKA laxity 7.5°±3.3°). TKA resulted in balanced knees, and, while several differences in laxity were observed between OA, TKA, and cadaveric knees, balance was only different under the maximum load between OA and cadaveric knees.ConclusionsLarge variability exists within and between surgeons suggests in what is considered acceptable laxity and balance of the TKA knee when it is assessed by only manual manipulation of the leg. Knees were “balanced” yet displayed different amounts of motion under applied load.Clinical RelevanceOur results suggest that current assessments of knee laxity may leave different patients with biomechanically different knees. Objective intra-operative measurements should inform surgical technique to ensure consistency across different patients.Level of EvidenceLevel II prospective observational study

scholarly journals Radiographic assessment of the percutaneous Bianchi system technique for treatment of hallux valgus

2021 ◽  
Vol 15 (2) ◽  
pp. 140-145
Author(s):  
Tércio Manoel de Vasconcelos Silva ◽  
Marcus Vinicius Mota Garcia Moreno ◽  
Janice de Souza Guimarães ◽  
Túlio Eduardo Vieira Marçal ◽  
Thiago Batista Faleiro ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Statistical Significance ◽  
Case Series ◽  
Deformity Correction ◽  
Level Of Evidence ◽  
Paired Samples ◽  
Valgus Angle ◽  
Assessment Period ◽  
System Technique ◽  
Student’S T

Objective: To present initial radiographic results of surgical correction of the hallux valgus angle (HVA) and the intermetatarsal angle (IMA) using the percutaneous Bianchi system (PBS) technique. Methods: Seventeen patients with moderate to severe hallux valgus (HV) were exclusively treated with the PBS technique and assessed radiographically preoperatively and during the postoperative period, from January 2019 to January 2020. The degree of deformity correction was recorded, based on the HVA and the IMA. Stata (v. 14.0) software was used for statistical analyses. Pre-surgical and post-surgical mean HVA and IMA were compared using Student’s t test for paired samples and the McNemar test was used to compare HVA and IMA categories. Statistical significance was set at 5% and 95% confidence intervals were estimated. Results: Both HVA and IMA were reduced significantly during the assessment period. Mean radiographic correction of the HVA was 15.1° and mean radiographic correction of the IMA was 7.3. Conclusions: According to the results presented, use of the PBS technique achieved adequate correction of the radiographic parameters of the patients who underwent the treatment as proposed, although it is necessary to conduct additional studies with longer follow-up to achieve a higher recommendation level. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Responsiveness of the PROMIS and FAAM Instruments in Foot and Ankle Orthopedic Population

2018 ◽  
Vol 40 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Man Hung ◽  
Judith F. Baumhauer ◽  
Frank W. Licari ◽  
Jerry Bounsanga ◽  
Maren W. Voss ◽  
...  
Keyword(s):  
T Test ◽  
Measurement Information ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Paired Samples ◽  
Level Ii ◽  
Patient Reported ◽  
Prospective Comparative Study ◽  
Ability Measure

Background: Investigating the responsiveness of an instrument is important in order to provide meaningful interpretation of clinical outcomes. This study examined the responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), the PROMIS Pain Interference (PI), and the Foot and Ankle Ability Measure (FAAM) Sports subscale in an orthopedic sample with foot and ankle ailments. Methods: Patients presenting to an orthopedic foot and ankle clinic during the years 2014–2017 responded to the PROMIS and FAAM instruments prior to their clinical appointments. The responsiveness of the PROMIS PF v1.2, PROMIS PI v1.1, and FAAM Sports were assessed using paired samples t test, effect size (ES), and standardized response mean (SRM) at 4 different follow-up points. A total of 785 patients with an average age of 52 years (SD = 17) were included. Results: The PROMIS PF had ESs of 0.95 to 1.22 across the 4 time points (3, >3, 6, and <6 months) and SRMs of 1.04 to 1.43. The PROMIS PI had ESs of 1.04 to 1.63 and SRMs of 1.17 to 1.23. For the FAAM Sports, the ESs were 1.25 to 1.31 and SRMs were 1.07 to 1.20. The ability to detect changes via paired samples t test provided mixed results. But in general, the patients with improvement had statistically significant improved scores, and the worsening patients had statistically significant worse scores. Conclusion: The PROMIS PF, PROMIS PI, and FAAM Sports were sensitive and responsive to changes in patient-reported health. Level of Evidence: Level II, prospective comparative study.

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