Mixed Reality has the potential to improve accuracy and reduce required dissection for the performance of peri-acetabular osteotomy. The current work assesses initial proof of concept of MR guidance for PAO. A PAO planning module, based on preoperative computed tomography (CT) imaging, allows for the planning of PAO cut planes and repositioning of the acetabular fragment. 3D files (holograms) of the cut planes and native and planned acetabulum positions are exported with the associated spatial information. The files are then displayed on mixed reality head mounted device (HoloLens2, Microsoft) following intraoperative registration using an FDA-cleared mixed reality application designed primary for hip arthroplasty (HipInsight). PAO was performed on both sides of a bone model (Pacific Research). The osteotomies and acetabular reposition were performed in accordance with the displayed holograms. Post-op CT imaging was performed for analysis. Cutting plane-accuracy was evaluated using a best-fit plane and 2D angles (°) between the planned and achieved supra (SA)- and retroacetabular (RA) osteotomy and retroacetabular and ischial osteotomies (IO) were measured. To evaluate the accuracy of acetabular reorientation, we digitized the acetabular rim and calculated the acetabular opening plane. Absolute errors of planned and achieved operative inclination and anteversion (°) of the acetabular fragment, as well as 3D lateral-center-edge (LCE) angles were calculated. The mean absolute difference between the planned and performed osteotomy angles was 3 ± 3°. The mean absolute error between planned and achieved operative anteversion and inclination was 1 ± 0° and 0 ± 0° respectively. Mean absolute error between planned and achieved 3D LCE angle was 0.5 ± 0.7°. Mixed-reality guidance for the performance of pelvic osteotomies and acetabular fragment reorientation was feasible and highly accurate. This solution may improve the current standard of care by enabling reliable and precise reproduction of the desired acetabular realignment.
An osteochondral defect greater than 3cm in diameter and 1cm in depth is best managed by an osteochondral allograft. If there is an associated knee deformity, then an osteotomy is performed. In our series of osteochondral allografts for large post-traumatic knee defects realignment osteotomy is performed about 60% of the time in order to off-load the transplant. To correct varus we realign the proximal tibia with an opening wedge osteotomy. To correct valgus, we realign the distal femur with a closing wedge osteotomy. Our results with osteochondral allografts for the large osteochondral defects of the knee both femur and tibia, have been excellent in 85% of patients at an average follow-up of 10 years. The Kaplan-Meier survivorship at 15 years is 72%. At an average follow-up of 22 years in 58 patients with distal femoral osteochondral allograft, 13 have been revised (22%). The 15-year survivorship was 84%. Retrieval studies of 24 fresh osteochondral grafts obtained at graft revision or conversion total knee replacement at an average of 12 years (5 – 25) revealed the following. In the areas where the graft was still intact, the cartilage was of normal thickness and architecture. Matrix staining was normal except in the superficial and upper mid zones. Chondrocytes were mostly viable but there was chondrocyte clusters and loss of chondrocyte polarity. Host bone had extended to the calcified cartilage but variable remnants of dead bone surrounded by live bone persisted. With a stable osseous base the hyaline cartilage portion of the graft can survive for up to 25 years.
Intraoperative balancing of total knee arthroplasty (TKA) can be accomplished by either more prevalent but less predictable soft tissue releases, implant realignment through adjustments of bone resection or a combination of both. Robotic TKA allows for quantifiable precision performing bone resections for implant realignment within acceptable final component and limb alignments. To provide a direct comparison of patient reported outcomes between implant realignment and traditional ligamentous release for soft tissue balancing in TKA.Background
Objective
Intraoperative balancing can be accomplished by either more prevalent but less predictable soft tissue releases, implant realignment through adjustments of bone resection or a combination of both. There is no published study directly comparing these methods. To provide a direct comparison between implant realignment and traditional ligamentous release for soft tissue balancing in total knee arthroplasty using both objective kinematic sensor data to document final balance and patient reported outcomes.Background
Objective
An osteochondral defect greater than 3cm in diameter and 1cm in depth is best managed by an osteochondral allograft. If there is an associated knee deformity, then an osteotomy was performed. In our series of osteochondral allografts for large post-traumatic knee defects, realignment osteotomy is performed about 60% of the time in order to off load the transplant. To correct varus we realign the proximal tibia with an opening wedge osteotomy. To correct valgus, we realign the distal femur with a closing wedge osteotomy. Our results with osteochondral allografts for the large osteochondral defects of the knee both femur and tibia, have been excellent in 85% of patients at an average follow-up of 10 years. The Kaplan-Meier survivorship at 15 years is 72%. At an average follow-up of 22 years in 58 patients with distal femoral osteochondral allograft, 13 have been revised (22%). The 15-year survivorship was 84%. Retrieval studies of 24 fresh osteochondral grafts obtained at graft revision or conversion to total knee replacement at an average of 12 years (5 – 25) revealed the following. In the areas where the graft was still intact, the cartilage was of normal thickness and architecture. Matrix staining was normal except in the superficial and upper mid-zones. Chondrocytes were mostly viable but there was chondrocyte clusters and loss of chondrocyte polarity. Host bone had extended to the calcified cartilage but variable remnants of dead bone surrounded by live bone persisted. With a stable osseous base the hyaline cartilage portion of the graft can survive for up to 25 years.
In total knee arthroplasty (TKA), component realignment with bone-based surgical correction (BBSC) can provide soft tissue balance and avoid the unpredictability of soft tissue releases (STR) and potential for more post-operative pain. Robotic-assisted TKA enhances the ability to accurately control bone resection and implant position. The purpose of this study was to identify preoperative and intraoperative predictors for soft tissue release where maximum use of component realignment was desired. This was a retrospective, single center study comparing 125 robotic-assisted TKAs quantitatively balanced using load-sensing tibial trial components with BBSC and/or STR. A surgical algorithm favoring BBSC with a desired final mechanical alignment of between 3° varus and 2° valgus was utilized. Component realignment adjustments were made during preoperative planning, after varus/valgus stress gaps were assessed after removal of medial and lateral osteophytes (pose capture), and after trialing. STR was performed when a BBSC would not result in knee balance within acceptable alignment parameters. The predictability for STR was assessed at four steps of the procedure: Preoperatively with radiographic analysis, and after assessing static alignment after medial and lateral osteophyte removal, pose capture, and trialing. Cutoff values predictive of release were obtained using receiver operative curve analysis.Introduction
Methods
The aim of this study was to determine the association between knee alignment and the vertical orientation of the femoral neck in relation to the floor. This could be clinically important because changes of femoral neck orientation might alter chondral joint contact zones and joint reaction forces, potentially inducing problems like pain in pre-existing chondral degeneration. Further, the femoral neck orientation influences the ischiofemoral space and a small ischiofemoral distance can lead to impingement. We hypothesized that a valgus knee alignment is associated with a more vertical orientation of the femoral neck in standing position, compared to a varus knee. We further hypothesized that realignment surgery around the knee alters the vertical orientation of the femoral neck. Long-leg standing radiographs of patients undergoing realignment surgery around the knee were used. The hip-knee-ankle angle (HKA) and the vertical orientation of the femoral neck in relation to the floor were measured, prior to surgery and after osteotomy-site-union. Linear regression was performed to determine the influence of knee alignment on the vertical orientation of the femoral neck.Aims
Methods
Wrist malalignment, in cases of malunited fractures of the distal radius, is not always a consequence of adaptation of the wrist to new conditions, but an expression of non-diagnosed ligamentous injuries. The aim of our study is to examine if the wrist malalignment is correctable with radius osteotomy. Twenty nine patients (17 female, 12 male) of mean age 51 years, with symptomatic malunited fracture of the distal radius with dorsal angulation, of duration 3 months -47 years, were examined. Twenty seven patients underwent corrective radius osteotomy (open dorsally in 26 cases and closed palmarly in 1 case). Fixation material (plate and screws) was placed on the dorsal side in 23 cases and on the volar side in 4 cases. In all patients measurements on the lateral X-ray view, concerning the reversal of the normal palmar tilt of the radius, the radiolunate and lunocapitate angles, were performed before and after surgery. Based on those measurements patients were divided in two groups:
a) In group A (23 patients) the malalignment concerned the midcarpal joint, and b) In group B (6 patients) the malalignment concerned the radiocarpal joint. The radiographic element of evaluation was the radiolunate angle. Radiolunate angle greater than 25° indicated malalignment at the radiocarpal level while radiolunate angle less than 25° indicated malalignment at the mid-carpal level. In 5 patients post-operative measurements were not performed because in addition to the radial osteotomy they were subjected to operative correction of wrist malalignment. Results estimated immediately postoperative and at the final follow-up, 6 months later. In patients with midcarpal malalignment, correction was possible, under the condition of a sufficient radius osteotomy and a non fixed midcarpal deformity. In patients with radiocarpal malalignment the deformity persisted despite the correction of the radial osteotomy. We conclude that correction of wrist malalignment is not always achieved with corrective osteotomy of the radius and that preoperative radiological control may be indicative of the possibility of correcting the deformity.
The Author presents results 2–4 years following treatment of seven patients with complicated hip impingements with this new combination of operations. Seven patients, aged 15–35yrs were treated by contemporaneous surgical dislocation and debridement of the hip with contemporaneous corrective subtrochanteric femoral osteotomy.. The dislocation and dedridement were performed in the usual way, but the seating chisel for a 95deg blade plate was introduced(to correct varus/valgus) before the trochanter was osteotomised. After debridement, the blade plate was used to transfix the trochanter in position. A separate subtrochanteric osteotomy was then performed at the upper end of the gluteus maximus insertion to provide correction of version and/or valgus/varus where indicated. The plate was removed six to twelve months later. There were no perioperative complications. Weight-bearing was restricted until bone healing was complete [8–13wks]. Thereafter patients mobilised normally.. At review, all patients were pleased with the outcome. Pre-operative HHS was 62–70: at review it was 90– 96. There were no complications in the medium-term. All patients experienced an improvement in range of movement and exercise tolerance. Avascular necrosis has not occurred overtly and the six patients who had post-operative MRI scans showed no evidence of it. This new combination of established operations combines the joint conserving benefits of debridement with realignment of the femur in patients with complicated impingements of the hip. The report is preliminary, but the combination of operations appears to be safe in terms of the absence of AVN and effective in its relief of symptoms.
Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure. We included patients who underwent concurrent pelvic and proximal femoral osteotomies by the senior surgeon (JNOH) with a minimum follow-up of 5 years. A modified triple pelvic interlocking osteotomy was performed to correct acetabular inclination and/or version with a concurrent proximal femoral osteotomy to correct valgus/varus and/or rotational alignment. We assessed functional scores, radiological paramenters, arthroplasty conversion rate, time interval before conversion to arthroplasty and other associated complications.Introduction
Methods
We share our experience in management of failed in-situ pinning in severe unstable Slipped Capital Femoral Epiphysis (SCFE) by surgical dislocation approach. A retrospective review of hip database from 2006 to 2013 showed 41 children underwent surgical dislocation for SCFE. We identified seven who had severe slip with failed in-situ pinning.Purpose
Method
Resection arthroplasty has been accepted as the treatment of choice for forefoot deformities in RA patients. Recent advance of drug therapy against RA encouraged us to preserve the joint in correction of forefoot deformities. Our technique aimed at preservation of the function of the MTP joints and is suitable for mild deformities in which only one or two rays are involved. Furthermore it is easy to correct the deformity of spray foot and reduce the plantar prominence of metatarsal head. This study revealed the good clinical result in short term follow-up. Although the long term result must to be waited, this method is one of recommendable options for RA patients with forefoot deformities.
The mean Oxford Knee Society ratings was 52 (range 47–55; SD, 3.18) preoperatively, and 19 (range 14–24; SD, 3.72) at final follow up. The pre op mean range motion was 84.28° (range 45°–120°; SD 21.73). At final follow up the average range of motion was 107.5° (range 95°–120°; SD 8.93). Accord There were no clinical failures or cases of postoperative instability and no cases of radiographic loosening or wear.
In developed nations Charcot arthropathy is most commonly caused by diabetes mellitus. Worldwide, leprosy remains the primary cause. All evidence points to a relationship between neurologic loss, continued loading activities and the development of unrecognized bone fragmentation. In type 2 diabetes, dysregulation of leptin biology causes bone loss and may be an important factor in precipitating Charcot events. Bone density studies show massive loss of bone in patients with ankle and hindfoot Charcot problems, but not midfoot problems. This suggests a different mechanism for collapse. Stable collapse with ulcer development in the midfoot can be treated with exostectomy.
Introduction. Young, high-demand patients with large post-traumatic tibial osteochondral defects are difficult to treat. Fresh osteochondral allografting is a joint-preserving treatment option that is well-established for such defects. Our objectives were to investigate the long-term graft survivorships, functional outcomes and associated complications for this technique. Methods. We prospectively recruited patients who had received fresh osteochondral allografts for post-traumatic tibial plateau defects over 3cm in diameter and 1cm in depth with a minimum of 5 years follow-up. The grafts were retrieved within 24 hours, stored in cefalozolin/bacitracin solution at 4°C, non-irradiated and used within 72 hours. Tissue matching was not performed but joints were matched for size and morphology.