CAOS & TKA. A critical appraisal on computer navigation in total knee arthroplasty

In mijn proefschrift heb ik onderzocht wat de invloed is van het gebruik van navigatie bij het plaatsen van een knieprothese. Hiervoor zijn drie onderzoeksvragen opgesteld en beantwoord. Allereerst: leidt CAOS tot het nauwkeuriger plaatsen van een TKP? Op basis van de door mij gedane studies en analyse van de huidige literatuur concludeer ik dat juiste registratie tijdens CAOS essentieel is voor het bereiken van een goede stand van de TKP. Zolang hier nog onnauwkeurigheden in zitten leidt CAOS (nog) niet tot het nauwkeuriger plaatsen van de TKP, met name wat betreft de rotatie van de femurcomponent. Daarnaast heb ik onderzocht of CAOS leidt tot een juiste maatvoering van de TKP en patella tracking. Ik kom tot de conclusie dat men uit moet kijken voor het plaatsen van met name een te grote femurcomponent. De data die verkregen zijn middels het gebruik van de patella tracking module worden significant be_nvloed door de snelheid van bewegen van de knie en de zichtbaarheid van een markertree. Tot slot is bekeken wat de klinische en radiologische uitkomst is van een TKP geplaatst met CAOS. Hoewel er aanwijzingen zijn dat het aantal outliers wat betreft het alignment van de TKP met CAOS afneemt, kan er geen relatie aangetoond worden met de klinische uitkomst van de prothese. Momenteel is CAOS een bruikbare techniek voor onderzoeksdoeleinden, zoals de chirurgische techniek en kinematische analyse, en als onderwijsinstrument. Verder onderzoek is nodig om de exacte plaats van CAOS bij het plaatsen van TKP te bepalen. Tot die tijd moet men kritisch blijven wat betreft de toepassing van nieuwe technieken in de Orthopaedische Chirurgie, deze gefaseerd invoeren en de vraag stellen of iets een __tool__ of een __toy__ is.UBL - phd migration 201

Performing a knee arthroscopy among patients with degenerative knee disease: one-third is potentially low value care

Purpose The purpose of this study was to assess in which proportion of patients with degenerative knee disease aged 50+ in whom a knee arthroscopy is performed, no valid surgical indication is reported in medical records, and to explore possible explanatory factors.Methods A retrospective study was conducted using administrative data from January to December 2016 in 13 orthopedic centers in the Netherlands. Medical records were selected from a random sample of 538 patients aged 50+ with degenerative knee disease in whom arthroscopy was performed, and reviewed on reported indications for the performed knee arthroscopy. Valid surgical indications were predefined based on clinical national guidelines and expert opinion (e.g., truly locked knee). A knee arthroscopy without a reported valid indication was considered potentially low value care. Multivariate logistic regression analysis was performed to assess whether age, diagnosis ("Arthrosis" versus "Meniscal lesion"), and type of care trajectory (initial or follow-up) were associated with performing a potentially low value knee arthroscopy.Results Of 26,991 patients with degenerative knee disease, 2556 (9.5%) underwent an arthroscopy in one of the participating orthopedic centers. Of 538 patients in whom an arthroscopy was performed, 65.1% had a valid indication reported in the medical record and 34.9% without a reported valid indication. From the patients without a valid indication, a joint patient-provider decision or patient request was reported as the main reason. Neither age [OR 1.013 (95% CI 0.984-1.043)], diagnosis [OR 0.998 (95% CI 0.886-1.124)] or type of care trajectory [OR 0.989 (95% CI 0.948-1.032)] were significantly associated with performing a potentially low value knee arthroscopy.Conclusions In a random sample of knee arthroscopies performed in 13 orthopedic centers in 2016, 65% had valid indications reported in the medical records but 35% were performed without a reported valid indication and, therefore, potentially low value care. Patient and/or surgeons preference may play a large role in the decision to perform an arthroscopy without a valid indication. Therefore, interventions should be developed to increase adherence to clinical guidelines by surgeons that target invalid indications for a knee arthroscopy to improve care.Orthopaedics, Trauma Surgery and Rehabilitatio

Targeted lipidomics reveals activation of resolution pathways in knee osteoarthritis in humans

Proteomic

Frailty in end-stage hip or knee osteoarthritis: validation of the Groningen Frailty Indicator (GFI) questionnaire

Molecular Epidemiolog

Feasibility of collecting multiple patient-reported outcome measures alongside the Dutch arthroplasty register

Background: Compliance rates with patient-reported outcome measures (PROMs) collected alongside arthroplasty registries vary in the literature. We described the feasibility of a routinely collected set PROMs alongside the Dutch Arthroplasty Register. Methods: The longitudinal Leiden Orthopaedics Outcomes of OsteoArthritis Study is a multicenter (7 hospitals), observational study including patients undergoing total hip or total knee arthroplasty (THA or TKA). A set of PROMs: Short Form-12, EuroQol 5 Dimensions, Hip/Knee injury and Osteoarthritis Outcome Score, Oxford Hip/Knee Score was collected preoperatively and at 6, 12, 24 months, and every 2 years thereafter. Participation rates and response rates were recorded. Results: Between June 2012 and December 2014, 1796 THA and 1636 TKA patients were invited, of whom 1043 THA (58%; mean age 68 years [standard deviation, SD: 10]) and 970 TKA patients (59%; mean age 71 years [SD 9.5]) participated in the study. At 6 months, 35 THA/38 TKA patients were lost to follow-up. Response rates were 90% for THA (898/1000) and 89% for TKA (827/932) participants. At 1 and 2 years, 8 and 18 THA and 17 and 11 TKA patients were lost to follow-up, respectively. The response rates among those eligible were 87% (866/992) and 84% (812/972) for THA and 84% (771/917) and 83% (756/906) for TKA patients, respectively. The 2-year questionnaire was completed by 78.5% of the included THA patients and by 77.9% of the included TKA patients. Conclusions: About 60% of patients undergoing THA or TKA complete PROMs preoperatively, with more than 80% returning follow-up PROMs. To increase the participation rates, more efforts concerning the initial recruitment of patients are needed.Clinical epidemiolog

A computed tomography based study on rotational alignment accuracy of the femoral component in total knee arthroplasty using computer-assisted orthopaedic surgery

Rotation of the femoral component in total knee arthroplasty (TKA) is of high importance in respect of the balancing of the knee and the patellofemoral joint. Though it is shown that computer assisted surgery (CAOS) improves the anteroposterior (AP) alignment in TKA, it is still unknown whether navigation helps in finding the accurate rotation or even improving rotation. Therefore the aim of our study was to evaluate the postoperative femoral component rotation on computed tomography (CT) with the intraoperative data of the navigation system. In 20 navigated TKAs the difference between the intraoperative stored rotation data of the femoral component and the postoperative rotation on CT was measured using the condylar twist angle (CTA). This is the angle between the epicondylar axis and the posterior condylar axis. Statistical analysis consisted of the intraclass correlation coefficient (ICC) and Bland-Altman plot. The mean intraoperative rotation CTA based on CAOS was 3.5 degrees (range 2.4-8.6 degrees ). The postoperative CT scan showed a mean CTA of 4.0 degrees (1.7-7.2). The ICC between the two observers was 0.81, and within observers this was 0.84 and 0.82, respectively. However, the ICC of the CAOS CTA versus the postoperative CT CTA was only 0.38. Though CAOS is being used for optimising the position of a TKA, this study shows that the (virtual) individual rotational position of the femoral component using a CAOS system is significantly different from the position on a postoperative CT scan.Study of the normal and pathological locomotory syste

Integrated assessment techniques for linking kinematics, kinetics and muscle activation to early migration: a pilot study

The goal of this pilot study was to develop and test an integrated method to assess kinematics, kinetics and muscle activation of total knee prostheses during dynamic activities, by integrating fluoroscopic measurements with force plate, electromyography and external motion registration measurements. Subsequently, this multi-instrumental analysis was then used to assess the relationship between kinematics, kinetics and muscle activation and early migration of the tibial component of total knee prostheses. This pilot study showed that it is feasible to integrate fluoroscopic, kinematic and kinetic measurements and relate findings to early migration data. Results showed that there might be an association between deviant kinematics and early migration in patients with a highly congruent mobile-bearing total knee prosthesis. Patients that showed high levels of coactivation, diverging axial rotations of the insert and a deviant pivot point showed increased migration and might be at higher risk for tibial component loosening. In the future, to confirm our findings, the same integrated measurements have to be performed in larger patient groups and different prosthesis designs

Conversion from knee arthrodesis to arthroplasty: systematic review

Optimising joint reconstruction management in arthritis and bone tumour patient

Kinematics of a highly congruent mobile-bearing total knee prosthesis

Optimising joint reconstruction management in arthritis and bone tumour patient

AQUILA: Assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty

Background: In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. Methods: A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. Results: The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Conclusions: Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.Biomechanical EngineeringMechanical, Maritime and Materials Engineerin