Since the COVID-19 pandemic of 2020, there has been a marked rise in the use of telemedicine to evaluate patients following total knee arthroplasty (TKA). Telemedicine is helpful to maintain patient contact, but it cannot provide objective functional TKA data. External monitoring devices can be used, but in the past have had mixed results due to patient compliance and data continuity, particularly for monitoring over numerous years. This novel stem is a translational product with an embedded sensor that can remotely monitor patient activity following TKA The Canturio™ TE∗ System (Canary Medical) functions structurally as a tibial extension for the Persona® cemented tibial plate (Zimmer Biomet). The stem is instrumented with internal motion sensors (3-D accelerometer and gyroscope) and telemetry that collects and transmits kinematic data. Raw data is converted by analytics into clinically relevant gait metrics using a proprietary algorithm. The Canturio™ TE∗ will monitor the patient's gait daily for the first year and then with lower frequency thereafter to conserve battery power enabling the potential for 20 years of longitudinal data collection and analysis. A base station in the OR activates the device and links the stem and data to the patient. A base station in the patient's home collects and uploads data to the Cloud Based Canary Data Management Platform (Canary Medical). The Canary Cloud is structured as an FDA regulated and HIPPA-compliant database with cybersecurity protocols integrated into the architecture. A third base station is an accessory used in the health care professional's office to perform an on-demand gait analysis of a patient. A dashboard allows the health care professional and patient to monitor objective data of the patient's activity and progress post treatment.PROBLEM
SOLUTION
For preoperative planning of Total Hip Arthroplasty (THA) it is paramount to choose the correct implant size to avoid subsidence with too small a component or fracture with too large a component. This planning can be done either in 2D or 3D. 2D templating from X-rays frontal images remains the gold standard technique in THA preoperative planning despite the lower accuracy with uncemented components. 3D planning techniques require a CT-Scan examination overexposing patients to radiation. Biplanar EOS® radiographs are an alternative to obtain bone 3D reconstructions with a very low dose of radiation. The objective of this study was to evaluate the accuracy and reproducibility a novel 3D technique for THA preoperative planning based on biplanar low-dose radiographs. 31 patients (20 women, 11 men, average age 66.1 y/o) who underwent a primary THA (Hardinge anterolateral approach) were included. Two senior orthopedic surgeons (Op_1 and Op_2) performed the pre-operative planning: (1) In 2D superimposing templates of the cup and the stem on CR radiographs. The CR images had a magnification coefficient of 1.15. (2) In 3D using dedicated hipEOS (EOS Imaging, France) software. 2D planning was performed once by each operator, 3D planning twice. 3D planning with hipEOS [Figure 1] was performed by importing 3D models of the stem and cup and superimposing them on frontal-lateral EOS® radiographs. This software proposes an initial estimate of the components size and position. If necessary, the user can correct the size of the stem and perform translations and rotations of the 3D models in order to correct the position, while clinical parameters such as the cup anteversion and inclination, as well as the femoral offset and leg length are automatically recalculated. To evaluate the accuracy, we have compared the 2D and 3D planning with respect to the actual size implanted during the surgery. To evaluate reproducibility we have calculated the Intra-class Correlation Coefficient (ICC) of both techniques.Introduction
Materials and methods
Total endoprosthetic replacement of hip and knee joints in patients with degenerative or inflammatory disease is a reliable treatment in orthopedic surgery since many years. However patients with oligo- or polyarticular disease are still a problem because of several operations within repeated periods of hospitalisation. Patients who need multiple joint replacements reject surgical procedures considering long time of suffering and hospitalisation by being treated in following one step after the other. Offering simultaneous surgery in two joints is often a probate opportunity to avoid this problem. To resolve this problem we decided one stage procedure in selected cases.
Between 01. 01. 99 and 31. 12. 01 we supplied 57 patients with 2 endoprosthesis (hip or knee) in one single surgical procedure. In 26 cases we implanted total hip replacement bilateral. 11 patients were female and 15 patients were male. The age differed between 26 and 73 years with an average of 64 years. One patient got hybridendoprosthesis (Muenchner socket/MEM stem). The others got a cementless model (Fitek or ACA socket/Weill or Spotorno stem). The average time of hospitalisation was 23, 5 days. In 3 cases allogenic packed human bloodcells (up to 960 ml in one case) were necessary. The mean time of operation was 142 min. In 25 cases we did total knee alloarthroplasty on both sides. 17 patients received all cemented Wallaby-I knees and 1 patient received all cemented PFC prosthesis. 7 patients got got an all cemented Scorpio knee prsthesis. 14 of these patients were female and 11 patients were male. The age differed between 35 and 75 years with an average of 66. The average time of hospitalisation was 21, 5 days and the average time of operation took 123 min. Allogenic packed human bloodcells were not necessary in any case. In 6 cases we did total alloarthroplasty on knee and hip simultaneous. All patients received all cemented Wallaby-I knees and different cementless or hybrid-hip-prosthesis (Fitek or ACA socket/MEM, Weill or Spotorno stem). 4 of these patients were female and 2 patients were male. The age differed between 39 and 79 years with anaverage of 61. The average time of hospitalisation was 24, 5 days. The mean time of operation was 132 min. Transfusion of allogenic packed human blood-cells was necessary in one case. By standard all patients underwent praeoperative blood donation and postoperative autologous retransfusion (mean 640 ml) within 6 hours. In four cases we saw an increase of the inflammatory test results one week postoperative, which we treated with Tavanic 500 1 - 0 - 0 orally. Other complications didn′t occur. All patients were able to leave the hospital with full weight bearing.
Compared to single hip joint replacement the average time of hospitalisation was only 4, 1 days longer, in case of simultaneous knee replacement we saw an increase of 3, 3 days. Considering the high acceptance due to the above mentioned advantages we recomand simultaneous replacement of two joints as an approbiate procedure in patients suffering from multiple joint destructions.
