A novel handheld robotic-assisted system for unicompartmental knee arthroplasty: surgical technique and early survivorship.

Technology, including robotics, has been developed for use in unicompartmental knee arthroplasty (UKA) to improve accuracy and precision of bone preparation, implant positioning, and soft tissue balance. The NAVIO™ System (Smith and Nephew, Pittsburgh, PA, United States) is a handheld robotic system that assists surgeons in planning implant positioning based on an individual patient\u27s anatomy and then preparing the bone surface to accurately achieve the plan. The surgical technique is presented herein. In addition, initial results are presented for 128 patients (mean age 64.7 years; 57.8% male) undergoing UKA with NAVIO. After a mean of follow-up period of 2.3 years, overall survivorship of the knee implant was 99.2% (95% confidence interval 94.6-99.9%). There was one revision encountered during the study, which was due to persistent soft tissue pain, without evidence of loosening, subsidence, malposition or infection. These initial results suggest a greater survivorship than achieved in the same follow-up time intervals in national registries and cohort studies, though further follow-up is needed to confirm whether this difference is maintained at longer durations

3D-printing techniques in a medical setting : a systematic literature review

Background: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results: 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion: 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D- printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis

Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.Web of Science1923art. no. 519

A gyroscope-based system for intraoperative measurement of tibia coronal plane alignment in total knee arthroplasty

Coronal plane alignment in total knee arthroplasty (TKA) is an important predictor of clinical outcomes including patient satisfaction and device longevity. Radiography and computer assisted navigation are the two primary technologies currently available to surgeons for intraoperative assessment of alignment; however, neither is particularly well-suited for use in this increasingly high volume procedure. Herein we propose a novel gyroscope-based instrument for intraoperative validation of tibia coronal plane alignment, and provide initial analytical and experimental performance assessments. The gyroscope-based alignment estimate is derived from simplified joint geometry and verified experimentally using a custom tibial trial insert containing a consumer-grade inertial measurement unit (IMU). Average accuracy of the gyroscope-based tibia coronal angle estimate was found to be within ±1° in mechanical leg jig and cadaver testing. These results indicate that the proposed gyroscope-based method shows promise for low cost, accurate intraoperative validation of limb alignment in TKA patients. Integrating IMU technology into the TKA surgical workflow via low-cost instrumentation will enable surgeons to easily validate implant alignment in real time, thereby reducing cost, operating room time, and future revision burden

Innovations in total knee replacement: new trends in operative treatment and changes in peri-operative management

The human knee joint can sustain damage due to injury, or more usually osteoarthritis, to one, two or all three of the knee compartments: the medial femorotibial, the lateral femorotibial and the patellofemoral compartments. When pain associated with this damage is unmanageable using nonsurgical techniques, knee replacement surgery might be the most appropriate course of action. This procedure aims to restore a pain-free, fully functional and durable knee joint. Total knee replacement is a well-established treatment modality, and more recently, partial knee replacement—more commonly known as bi- or unicompartmental knee replacement—has seen resurgence in interest and popularity. Combined with the use of minimally invasive surgery (MIS) techniques, gender-specific prosthetics and computer-assisted navigation systems, orthopaedic surgeons are now able to offer patients knee replacement procedures that are associated with (1) minimal risks during and after surgery by avoiding fat embolism, reducing blood loss and minimising soft tissue disruption; (2) smaller incisions; (3) faster and less painful rehabilitation; (4) reduced hospital stay and faster return to normal activities of daily living; (5) an improved range of motion; (6) less requirement for analgesics; and (7) a durable, well-aligned, highly functional knee. With the ongoing advancements in surgical technique, medical technology and prosthesis design, knee replacement surgery is constantly evolving. This review provides a personal account of the recent innovations that have been made, with a particular emphasis on the potential use of MIS techniques combined with computer-assisted navigation systems to treat younger, more physically active patients with resurfacing partial/total implant knee arthroplasty

The value of medical 3D printing : hope versus hype

3D printing has been growing fast in the medical field. While preliminary clinical results have been reported in the literature, it’s health economic value has not been analyzed yet. Medical 3D printing has found its main applications in surgery; especially orthopedics and reconstructive surgery. Its applications rage from anatomic models to surgical guides and implants. All of these can be seen as consecutive levels of integration. While papers often report improved clinical results, a great accuracy and an acceptable price, few of these are backed with numbers. We performed 3 health economic analyses using Markov models using a payer perspective on each of these 3 levels of integration. As a first level, we analyzed the impact of using anatomic models as a tool for surgical planning in congenital heart diseases for 9 different procedures. Results varied from not being cost effective for atrial septum defects, to being highly cost-effective in highly complex procedures such as a Norwood repair. Second, we analyzed the already well integrated use of surgical guides for primary total knee arthroplasty using Belgian registry data. The database approach showed an significantly reduced revision rate in the group using custom guides compared to the conventional approach. The Markov models showed the technology to be cost-effective if CT-based guides are used. At last, we analyzed the use of custom 3D printed acetabular implants for revision surgery in patients with acetabular defects compared to non-3D printed custom implants. The 3D printed implants showed to be cost effective, especially in younger patients. The final chapter gives an overview of the pitfalls encountered during these preliminary analyses and gives a glance at possible solutions to allow better analysis and faster adoption of medical innovations

A new mini-navigation tool allows accurate component placement during anterior total hip arthroplasty.

Introduction: Computer-assisted navigation systems have been explored in total hip arthroplasty (THA) to improve component positioning. While these systems traditionally rely on anterior pelvic plane registration, variances in soft tissue thickness overlying anatomical landmarks can lead to registration error, and the supine coronal plane has instead been proposed. The purpose of this study was to evaluate the accuracy of a novel navigation tool, using registration of the anterior pelvic plane or supine coronal plane during simulated anterior THA. Methods: Measurements regarding the acetabular component position, and changes in leg length and offset were recorded. Benchtop phantoms and target measurement values commonly seen in surgery were used for analysis. Measurements for anteversion and inclination, and changes in leg length and offset were recorded by the navigation tool and compared with the known target value of the simulation. Pearson\u27s Results: The device accurately measured cup position and leg length measurements to within 1° and 1 mm of the known target values, respectively. Across all simulations, there was a strong, positive relationship between values obtained by the device and the known target values ( Conclusion: The preliminary findings of this study suggest that the novel navigation tool tested is a potentially viable tool to improve the accuracy of component placement during THA using the anterior approach

Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis

We report a case of a 38 year-old engineer presented with left ankle pain for 2 years and initially treated as gouty arthritis because of high serum uric acid. A year later his left ankle become swollen and plain radiograph showed soft tissue swelling around the ankle with normal articular surface and bone. An MRI investigation reported as gouty arthritis of ankle with tophi. While on treatment for gouty arthritis, he developed pus discharge from the swelling. The ankle pain also worsen and he was unable to weight bear on the affected leg. An incision and drainage shown pus from the ankle joint which grew pseudomonas aeruginosa. He was treated with intravenous followed by oral ciprofloxacin 250 mg bd. However his condition does not improved and a month after antibiotic treatment a repeated radiograph shows narrowing of joint space with irregular cortical destruction, osteopenic bone . suggestive of worsening of his septic arthritis. During this period he deny of having any fever, cough or night sweats. However he did notice some loss of weight and loss of appetite. He has worked in Africa and Russia before in petroleum industry. After 4 months of antibiotic and no sign of improvement, a biopsy and repeat culture was taken from the ankle which reveal tuberculous arthritis and positive for AFB culture. A plain chest radiograph revealed miliary tuberculosis picture. He was started on a anti TB treatment and the wound healed after a few weeks. After 4 months of treatment he was able to walk without support with reduce ankle range of motion. This case illustrate that the diagnosis was delay because tuberculosis was not suspected in a young professionals with ankle pain and elevated serum uric acid level. Further delay in diagnosis because MRI report also suggestive of gouty tophi and the pus culture and sensitivity grew pseudomonas aeruginosa