scholarly journals A study on radiological outcomes of accelerometer based hand held navigation system in total knee arthroplasty

2020 ◽  
Vol 6 (3) ◽  
pp. 556
Author(s):  
Hiranyakumar S. ◽  
Shivaraj Nadagouda ◽  
Vishnu Harikrishnan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Mechanical Axis ◽  
Patient Specific ◽  
Computer Assisted ◽  
Component Alignment ◽  
Patient Specific Instrumentation ◽  
Wear And Tear ◽  
Total Knee

<p class="abstract"><strong>Background:</strong> The goal of obtaining more accurate component alignment in total knee arthroplasty (TKA) has led to the development of techniques like portable accelerometer-based handheld navigation system, computer assisted system, patient specific instrumentation. Among which hand held navigation has showed promising results for achieving accurate resection and alignment and only few studies were done to assess radiological outcome or the effective component alignment using portable accelerometer-based hand held navigation system in TKA.</p><p class="abstract"><strong>Methods:</strong> TKA using portable accelerometer-based hand held navigation system (Smith and Nephew- knee align) was done on 25 knees with primary osteoarthritis. Preoperative and post-operative mechanical axis and component alignments were measured using hip-to-ankle radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the femoral components, 92.0% were placed within 90°±2° to the femoral mechanical axis in the coronal and   96.0% of the tibial components were placed within 90°±2° to the mechanical axis in the coronal plane, 94.3% of the TKAs had an overall lower extremity alignment within 3° of neutral to the mechanical axis, based on postoperative hip-to-ankle radiographs.</p><p class="abstract"><strong>Conclusions:</strong> The degree of accuracy in positioning the femoral and tibial component in TKA using portable accelerometer-based hand held navigation system (knee align) is very much promising and is an effective intraoperative tool for reducing the proportion of outliers for component placement and thus decreasing the chances of instability and early wear and tear of the components in TKA.</p>

scholarly journals Patient-specific instrumentation improved three-dimensional accuracy in total knee arthroplasty: a comparative radiographic analysis of 1257 total knee arthroplasties

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Leo Pauzenberger ◽  
Martin Munz ◽  
Georg Brandl ◽  
Julia K. Frank ◽  
Philipp R. Heuberer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Three Dimensional ◽  
Mobile Bearing ◽  
Patient Specific ◽  
Limb Alignment ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
Total Knee

Abstract Background The purpose of this study was to compare restoration of mechanical limb alignment and three-dimensional component-positioning between conventional and patient-specific instrumentation in total knee arthroplasty. Methods Radiographic data of patients undergoing mobile-bearing total knee arthroplasty (n = 1257), using either conventional (n = 442) or patient-specific instrumentation (n = 812), were analyzed. To evaluate accuracy of axis restoration and 3D-component-positioning between conventional and patient-specific instrumentation, absolute deviations from the targeted neutral mechanical limb alignment and planned implant positions were determined. Measurements were performed on standardized coronal long-leg and sagittal knee radiographs. CT-scans were evaluated for accuracy of axial femoral implant rotation. Outliers were defined as deviations from the targeted neutral mechanical axis of > ± 3° or from the intraoperative component-positioning goals of > ± 2°. Deviations greater than ± 5° from set targets were considered to be severe outliers. Results Deviations from a neutral mechanical axis (conventional instrumentation: 2.3°± 1.7° vs. patient-specific instrumentation: 1.7°± 1.2°; p < 0.001) and numbers of outliers (conventional instrumentation: 25.8% vs. patient-specific instrumentation: 10.1%; p < 0.001) were significantly lower in the patient-specific instrumentation group. Significantly lower mean deviations and less outliers were detected regarding 3D-component-positioning in the patient-specific instrumentation compared to the conventional instrumentation group (all p < 0.05). Conclusions Patient-specific instrumentation prevented from severe limb malalignment and component-positioning outliers (> ± 5° deviation). Use of patient-specific instrumentation proved to be superior to conventional instrumentation in achieving more accurate limb alignment and 3D-component positioning, particularly regarding femoral component rotation. Furthermore, the use of patient-specific instrumentation successfully prevented severe (> 5° deviation) outliers.

scholarly journals Blood Loss in Total Knee Arthroplasty

2016 ◽  
Vol 30 (05) ◽  
pp. 452-459 ◽  
Author(s):  
William Cundy ◽  
Annika Theodoulou ◽  
Chi Ling ◽  
Jeganath Krishnan ◽  
Christopher Wilson
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
Patient Specific ◽  
Computer Assisted ◽  
Routine Practice ◽  
Patient Specific Instrumentation ◽  
Transfusion Requirements ◽  
Total Knee

AbstractPatients undergoing total knee arthroplasty (TKA) have expected blood loss during and after surgery. The morbidity associated with blood loss and the burden of blood transfusions in adult arthroplasty necessitates preoperative optimization as routine practice. Current literature remains inconclusive on which TKA surgical instrumentation techniques are effective in minimizing perioperative blood loss, and consequently lower transfusion rates. The primary objective of this retrospective review, of a prospective randomized cohort study, was to compare surgical and patient factors, and their influence on blood loss and transfusions rates, between one type of patient-specific instrumentation (PSI), navigated computer-assisted surgery (CAS), and conventional TKA surgical techniques.A cohort of 128 matched patients (38 PSI, 44 CAS, 46 conventional surgeries) were compared. Preoperative factors analyzed included; age, gender, body mass index, preoperative hemoglobin (Hb) (g/L), international normalized ratio, use of anticoagulants and comorbid bleeding diathesis. Maximal Hb drop and transfusion requirements were compared on day 1 to 3. Perioperative factors collected included: surgical time, tourniquet time, drain output, in situ drain time, order of tibia or femoral cut, and intraoperative loss from suction.The three groups did not differ on the preoperative patient demographics examined. The difference between preoperative Hb and the lowest postoperative Hb readings did not differ between study groups (p = 0.39).There are no statistically significant differences in blood loss when comparing PSI versus CAS versus conventional TKA. Although emerging evidence on PSI is encouraging, the PSI technique for TKA does not result in reduced blood loss. The study was registered with ClinicalTrials.gov: NCT01145157.

Patient-Specific Instrumentation in Total Knee Arthroplasty Provides No Improvement in Component Alignment

2014 ◽  
Vol 29 (9) ◽  
pp. 1705-1708 ◽  
Author(s):  
Benjamin M. Stronach ◽  
Christopher E. Pelt ◽  
Jill A. Erickson ◽  
Christopher L. Peters
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Component Alignment ◽  
Patient Specific Instrumentation ◽  
Total Knee

scholarly journals Should we abandon the patient-specific instrumentation ship in total knee arthroplasty? Not quite yet!

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
László Török ◽  
Péter Jávor ◽  
Petra Hartmann ◽  
László Bánki ◽  
Endre Varga
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Patient Specific ◽  
Transfusion Rate ◽  
Component Alignment ◽  
Patient Specific Instrumentation ◽  
Patient Reported ◽  
Total Knee

AbstractPatient-specific Instrumentation (PSI) is an innovative technique aiding the precise implementation of the preoperative plan during total knee arthroplasty (TKA) by using patient-specific guides and cutting blocks. Despite of the theoretical advantages, studies have reported contradictory results, thus there is no consensus regarding the overall effectiveness of PSI. Through the critical assessment of a meta-analysis published lately, this correspondence aims to highlight the complexity of comparing the efficacy of PSI to standard instrumentation (SI). The accuracy of component alignment, patient-reported outcome measures (PROMs), surgery time, blood loss, transfusion rate, and postoperative complications are commonly used outcomes for investigating the efficacy of PSI-aided TKA. By assessing component alignment, the expertise of the surgeon(s) should be taken into consideration, since PSI may not provide benefits for expert surgeons but might improve accuracy and patient safety during the learning curve of novice surgeons. With respect to PROMs and postoperative complications, PSI may not improve short-term results; however, long-term follow up data is missing. Regarding transfusion rates, favorable trends can be observed, but further studies utilizing recent data are needed for a clear conclusion. When assessing surgery time, we suggest focusing on operating room turnover instead of procedure time.

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