Aims. A significant percentage of patients remain dissatisfied after total knee arthroplasty (TKA). The aim of this study was to determine whether the sequential addition of accelerometer-based
Aims. Due to the complex anatomy of the pelvis, limb-sparing resections
of pelvic tumours achieving adequate surgical margins, can often
be difficult. The advent of computer
Aims. Intraoperative 3D
Aims. We compared the accuracy, operating time and radiation exposure
of the introduction of iliosacral screws using O-arm/Stealth Navigation
and standard fluoroscopy. Materials and Methods. Iliosacral screws were introduced percutaneously into the first
sacral body (S1) of ten human cadavers, four men and six women.
The mean age was 77 years (58 to 85). Screws were introduced using
a standard technique into the left side of S1 using C-Arm fluoroscopy
and then into the right side using O-Arm/Stealth
We compared lower limb coronal alignment measurements
obtained pre- and post-operatively with long-leg radiographs and
computer
INTRODUCTION. In gap balancing technique, we decided the femoral component rotation according to the ligament balance in flexion. Component and limb alignment are important considerations during TKA. Three-dimensional positioning of TKA implants and exact mechanical axis has an effect on implant loosening, polyethylene stresses, and gait. According to the recent report, the
Background. Variability in component alignment continues to be a major in total knee arthroplasty(TKA). In the long term, coronal plane malalignment has been associated with an increased risk of loosening, insatability, and wear. Recently portable
INTRODUCTION. Soft-tissue balancing of the knee is fundamental to the success of total knee arthroplasty(TKA). Preparing rectangular extension and flexion joint gaps in the most important goal in TKA, because it facilitates functional stability of the knee. In gap balancing technique, we decided the femoral component rotation according to the ligament balance in flexion. Component and limb alignment are important considerations during TKA. Three-dimensional positioning of TKA implants and exact mechanical axis has an effect on implant loosening, polyethylene stresses, and gait. According to the recent reports, the
Computer aided orthopaedic surgical (CAOS) technology has been around for over 20 years, and while it appears to provide better outcomes compared to conventional jigs, less than 1% of orthopaedic surgeons in USA have adopted it. This study surveyed the arguments against CAOS usage, highlighting those reasons which may continue to prevent CAOS from becoming truly widely accepted. The survey has identified several concerns with
Correct alignment of the leg and positioning of the implant has shown to be an important factor in the successful long term outcome of total knee arthroplasty and
Rotational acetabular osteotomy (RAO), one of periacetabular osteotomies, is an effective joint-preserving surgical treatment for developmental dysplasia of the hip. Since 2013, we have been using a CT-based
Introduction. Computer assisted surgery (CAS) systems have been shown to improve alignment accuracy in total knee arthroplasty (TKA), yet concerns regarding increased costs, operative times, pin sites, and the learning curve associated with CAS techniques have limited its widespread acceptance. The purpose of this study was to compare the alignment accuracy of an accelerometer-based, portable
Total hip arthroplasty (THA) is an effective treatment for symptomatic hip osteoarthritis (OA). While computer-navigation technologies in total knee arthroplasty show survivorship advantages and are widely used, comparable applications within THA show far lower utilisation. Using national registry data, this study compared patient reported outcome measures (PROMs) in patients who underwent THA with and without computer
Introduction. Re-revision due to instability and dislocation can occur in up to 1 in 4 cases following revision total hip arthroplasty (THA). Optimal placement of components during revision surgery is thus critical in avoiding re-revision. Computer-assisted
INTRODUCTION. The restoration of physiological kinematics is one of the goals of a total knee arthroplasty (TKA).
Aims.
The use of intraoperative
Imageless computer
Problem. Total hip replacement (THA) is among the most common and highest total spend elective operations in the United States. However, up to 7% of patients have 90-day complications after surgery, most frequently joint dislocation that is related to poor acetabular component positioning. These complications lead to patient morbidity and mortality, as well as significant cost to the health system. As such, surgeons and hospitals value
Objectives. We evaluated the accuracy of augmented reality (AR)-based
Cup orientation of total hip arthroplasty (THA) is critical for dislocation, range of motion, polyethylene wear, pelvic osteolysis, and component migration. But, substantial error under manual technique has been reported. Therefore, various
Total hip arthroplasty (THA) is an effective treatment for symptomatic hip osteoarthritis (OA). Computer-navigation technologies in total knee arthroplasty show evidence-supported survivorship advantages and are used widely. The aim of this study was to determine the revision outcome of hip commercially available
Introduction: Femoral neck fractures are common and percutaneous insertion of three cannulated screws is an accepted method of surgical treatment. The accuracy of surgical performance is highly correlated with the cut-out percentages of the screws. The conventional technique relies heavily on fiuoroscopy and could lead to inappropriate implant placement. Further, multiple guidewire passes might prolong the operation time and weaken the cancellous bone. A computer-assisted planning and
Image guided surgery (IGS), or “Navigation,” is now widely used in many areas of surgery including arthroplasty. However, the options for establishing, in real time, the veracity of the
We report our experience of using a computer
navigation system to aid resection of malignant musculoskeletal tumours
of the pelvis and limbs and, where appropriate, their subsequent
reconstruction. We also highlight circumstances in which navigation
should be used with caution. We resected a musculoskeletal tumour from 18 patients (15 male,
three female, mean age of 30 years (13 to 75) using commercially
available computer
Acetabular implant position is important for the stability, function, and long-term wear properties of a total hip arthroplasty (THA). Prior studies of acetabular implant positioning have demonstrated a high percentage of outliers, even in experienced hip surgeons, when conventional instruments are used. Computer
Imageless computer
Acetabular implant position is important for the stability, function, and long-term wear properties of a total hip arthroplasty (THA). Prior studies of acetabular implant positioning have demonstrated a high percentage of outliers, even in experienced hip surgeons, when conventional instruments are used. Computer
Intra-operative 3-D fluoroscopy has limitations, including low resolution images, little soft tissue information and small working volume. Fusion of 3D data sets (MRI/ CT) had been developed in pre-operative planners. We employed the same principle and developed a new technique of
Introduction. Computer-assisted hip
There are several methods for evaluating stability
of the joint during total knee replacement (TKR). Activities of daily
living demand mechanical loading to the knee joint, not only in
full extension, but also in mid-flexion. The purpose of this study
was to compare the varus-valgus stability throughout flexion in
knees treated with either cruciate-retaining or posterior-stabilised
TKR, using an intra-operative
Total hip replacement procedures are among the most frequent surgical interventions in all industrialized countries. Although it is a routine operationliterature reports that important parameters regarding for example cup orientation and leg length discrepancy often turn out to be not satisfying after surgery. This paper presents a novel concept to improve the reproducibility and accuracy for implantation of cup and stem prosthesis at exactly the desired locations. Existing computer- based commercial products either offer software solutions for just pre-operative planning, or imageless
Introduction. Total shoulder replacement is a successful treatment for gleno-humeral osteoarthritis. However, components loosening and painful prostheses, related to components wrong positioning, are still a problem for those patients who underwent this kind of surgery. CT-based intraoperative
In a prospective randomised clinical study acetabular components were implanted either freehand (n = 30) or using CT-based (n = 30) or imageless
Acetabular implant position is important for the stability, function, and long-term wear properties of a total hip arthroplasty (THA). Prior studies of acetabular implant positioning have demonstrated a high percentage of outliers, even for experienced hip surgeons, when conventional instruments are used. Computer
The object of this study was to develop a method to assess the accuracy of an image-free total knee replacement
Introduction. Reverse shoulder Arthroplasty is a successful treatment for gleno-humeral osteoarthritis. However, components loosening and painful prostheses, related to components wrong positioning, are still a problem for those patients who underwent this kind of surgery. Several new technology has been developed the improve the implant positioning. CT-based intraoperative
Accurate cup placement in total hip arthroplasty (THA) for the patients with developmental dysplasia of the hip (DDH) is one of the challenges due to distinctive bone deformity. Robotic-arm assisted system have been developed to improve the accuracy of implant placement. This study aimed to compare the accuracy of robotic-arm assisted (Robo-THA), CT-based navigated (Navi-THA), and manual (M-THA) cup position and orientation in THA for DDH. A total of 285 patients (335 hips) including 202 M-THAs, 45 Navi-THAs, and 88 Robo-THA were analyzed. The choice of procedure followed the patient's preferences. Horizontal and vertical center of rotation (HCOR and VCOR) were measured for cup position, and radiographic inclination (RI) and anteversion (RA) were measured for cup orientation. The propensity score-matching was performed among three groups to compare the absolute error from the preoperative target position and angle. Navi-THA showed significantly smaller absolute errors than M-THA in RI (3.6° and 5.4°) and RA (3.8° and 6.0°), however, there were no significant differences between them in HCOR (2.5 mm and 3.0 mm) or VCOR (2.2 mm and 2.6 mm). In contrast, Robo-THA showed significantly smaller absolute errors of cup position than both M-THA and Navi-THA (HCOR: 1.7 mm and 2.9 mm, vs. M-THA, 1.6 mm and 2.5 mm vs. Navi-THA, VCOR:1.7 mm and 2.4 mm, vs. M-THA, 1.4 mm and 2.2 mm vs. Navi-THA). Robo-THA also showed significantly smaller absolute errors of cup orientation than both M-THA and Navi-THA (RI: 1.4° and 5.7°, vs. M-THA, 1.5° and 3.6°, vs. Navi-THA, RA: 1.9° and 5.8° vs. M-THA, 2.1° and 3.8° vs. Navi-THA). Robotic-arm assisted system showed more accurate cup position and orientation compared to manual and CT-based
Acetabular cup positioning remains a real challenge and component malpositioning after total hip arthroplasty (THA) can lead to increased rates of dislocation and wear. It is a common cause for revision THA. A novel 3D imageless mini-optical
Aims. The purpose of this study was to compare the radiological outcomes of manual versus robotic-assisted medial unicompartmental knee arthroplasty (UKA). Methods. Postoperative radiological outcomes from 86 consecutive robotic-assisted UKAs (RAUKA group) from a single academic centre were retrospectively reviewed and compared to 253 manual UKAs (MUKA group) drawn from a prior study at our institution. Femoral coronal and sagittal angles (FCA, FSA), tibial coronal and sagittal angles (TCA, TSA), and implant overhang were radiologically measured to identify outliers. Results. When assessing the accuracy of RAUKAs, 91.6% of all alignment measurements and 99.2% of all overhang measurements were within the target range. All alignment and overhang targets were simultaneously met in 68.6% of RAUKAs. When comparing radiological outcomes between the RAUKA and MUKA groups, statistically significant differences were identified for combined outliers in FCA (2.3% vs 12.6%; p = 0.006), FSA (17.4% vs 50.2%; p < 0.001), TCA (5.8% vs 41.5%; p < 0.001), and TSA (8.1% vs 18.6%; p = 0.023), as well as anterior (0.0% vs 4.7%; p = 0.042), posterior (1.2% vs 13.4%; p = 0.001), and medial (1.2% vs 14.2%; p < 0.001) overhang outliers. Conclusion. Robotic system
Imageless
We investigated whether a novel, real-time fluoroscopy based
INTRODUCTION. Traditionally, acetabular component insertion in direct anterior approach (DAA) total hip arthroplasty (THA) has been performed using fluoroscopic guidance. Handheld
We have developed a CT-based
Introduction and Objective. The aim of this study was to evaluate whether CT-based pre-operative planning, integrated with intra-operative
Surgical
We evaluated the oncological and functional outcome
of 18 patients, whose malignant bone tumours were excised with the
assistance of
Introduction:. Restoration of normal hip biomechanics is vital for success of total hip arthroplasty (THA). This requires accurate placement of implants and restoration of limb length and offset. The purpose of this study was to assess the accuracy of computer
INTRODUCTION. Computer
BACKGROUNDS. Total knee arthroplasty (TKA) using an imageless
Objectives. Few reports were shown about the position of the cup in total hip arthroplasty (THA) with CT-based
Minimally invasive total knee replacement (MIS-TKR)
has been reported to have better early recovery than conventional
TKR. Quadriceps-sparing (QS) TKR is the least invasive MIS procedure,
but it is technically demanding with higher reported rates of complications
and outliers. This study was designed to compare the early clinical
and radiological outcomes of TKR performed by an experienced surgeon
using the QS approach with or without
The purpose of this study is to evaluate accuracy of tibia cutting and tibia implantation in UKA which used
Introduction. CT-based
Introduction. While component malposition remains a major short and long term problem associated with total hip arthroplasty, enhanced technologies such as
Pre-operative knowledge. Knowledge-based total hip arthroplasty is becoming increasingly recognised for improved safety, efficiency, and accuracy. Pre-operative knowledge of native and planned femoral anteversion, the exact size of implants, neck length and offset, and head lengths can serve to safely accelerate surgery and reduce the need for intra-operative imaging. Pre-operative knowledge of the effect on change in leg length and offset effected by specific implant combinations can serve to minimise undesired changes. The use of a smart mechanical
Background. Total hip arthroplasty (THA) is one of the most successful surgical procedures ever performed. Nevertheless if procedure is performed by high or low volume surgeons; more than 50% of cups are still placed out of the safe zone, which is connected to lower survival rate of the prosthesis. The idea was to develop an imageless
Introduction. Robotic-assisted hip arthroplasty helps acetabular preparation and implantation with the assistance of a robotic arm. A computed tomography (CT)-based
Utilization of C-arm fluoroscopy during direct anterior total hip arthroplasty (THA) is disruptive and potentially increases the risks of patient infection and cumulative surgeon radiation exposure. This pilot study evaluated changes in surgeon C-arm utilization during an initial 10 cases of direct anterior THA in which an imageless computer-assisted
There is enough evidence to show that
Introduction. Computer
INTRODUCTION. Several papers have reported the efficacy of an imageless
Introduction. Two aspects are very important for knee joint replacement – restoration of biomechanical limb axis and achieving ligaments balance. Computer
A cadaver study using six pairs of lower limbs was conducted to investigate the accuracy of computer
Introduction. Total knee arthroplasty (TKA) reliably improves pain and function in patients with knee osteoarthritis (OA), though a substantial percentage of patients remain unsatisfied. Reasons include the presence of complications, persistent pain, and unmet expectations. The aim of this study was to determine whether the sequential addition of accelerometer-based
Accurate evaluation of lower limb coronal alignment is essential for effective pre-operative planning of knee arthroplasty. Weightbearing hip-knee-ankle (HKA) radiographs are considered the gold standard. Mako SmartRobotics uses CT-based
Purpose. This study aims to evaluate the two-year post-operative clinical outcomes of patients undergoing total knee arthroplasty (TKA) with computer-assisted surgery (CAS) using a pinless
INTRODUCTION. Cup orientation of total hip arthroplasty (THA) is critical for dislocation, range of motion, polyethylene wear, pelvic osteolysis, and component migration. But, substantial error under manual technique has been reported specially in revision THA due to a bone loss and poor anatomical landmark. We have used three kinds of
Bilateral sequential total knee replacement was carried out under one anaesthetic in 100 patients. One knee was replaced using a CT-free computer-assisted
Proper positioning of the acetabular cup deters dislocation after total hip arthroplasty (THA) and is therefore a key focus for orthopedic surgeons. The concept of a safe zone for acetabular component placement was first characterized by Lewinnek et al. and furthered by Callanan et al. The safe zone concept remains widely utilized and accepted in contemporary THA practice; however, components positioned in this safe zone still dislocate. This study sought to characterize current mass trends in cup position identified across a large study sample of THA procedures completed by multiple surgeons. This retrospective, observational study reviewed acetabular cup position in 1,236 patients who underwent THA using computer-assisted
Introduction. Restoration of normal hip biomechanics is vital for success of total hip arthroplasty (THA). This requires accurate placement of implants and restoration of limb length and offset. The purpose of this study was to assess the precision and accuracy of computer
Introduction. Stryker computer
The efficacy of an imageless
Introduction. Proper acetabular cup placement is very important factor for successful clinical results in total hip arthroplasty (THA). Malposition of acetabular cup has been linked to increased rates of dislocation, impingement, pelvic osteolysis, cup migration, leg length discrepancy and polyethylene wear. Recently, some authors reported usefulness of
Introduction. Acetabular revision surgery is challenging due to severe bone defects. Burch-Schneider anti-protrusion cages (BS cage: Zimmer-Biomet) is one of the options for acetabular revision, however higher dislocation rate was reported. A computed tomography (CT)-based
Background:. While more than ½ of acetabular components placed during hip arthroplasty are significantly malpositioned, traditional surgical
Introduction. Failures in total knee arthroplasty (TKA) have been associated with overall lower limb malalignment and component malposition. Although traditional computer
Background. Bone preservation is desired for future revision in any knee arthroplasty. There is no study comparing the difference in the amount of bone resection when soft tissue balance is performed with or without computer
Introduction. Computer-assisted
Over the past decades, computer-aided
Purpose of the study: Revision total knee arthroplasty (rTKA) is becoming a routine procedure. The technical problems are greater than with a first-intention implantation because of the potential malposition of the initial implants, loss of bone stock, and prior ligament injury. It could be hypothesised that as for implantation of a primary TKA,
Introduction. The KneeAlign2 (OrthAlign, Inc., Aliso Viejo, CA) is a portable accelerometer-based
Background. The literature quotes up to 20% dissatisfaction rates for total knee replacements (TKR). Swedish registry and national joint registry of England and Wales confirm this with high volumes of patients included. This dissatisfaction rate is used as a basis for improving/changing/modernising knee implant designs by major companies across the world. Aim. We aimed to compare post TKR satisfaction rates for navigated and non navigated knees. Methods. This was a retrospective analysis of prospectively collected data. All patients undergo comprehensive preoperative evaluation and comprehensive consent process and same rehabilitation protocols are followed as standard practice. Two groups were established depending on whether surgery was performed with or without computer
Introduction. Component positioning is of great importance in total hip arthroplasty (THA) and
The optimal overall lower extremity and component alignment in total knee arthroplasty (TKA) has recently been questioned, yet the majority of studies demonstrate TKA positioning to effect the rate of implant loosening, polyethylene stresses, knee kinematics, and gait. Most commonly, extramedullary tibial and intramedullary femoral alignment guides are used to set coronal alignment in TKA, but these “conventional” methods have a limited degree of accuracy. The goal of obtaining more precise and accurate component positioning has led to the development of computer-assisted surgical (CAS) techniques. Although numerous comparative studies have shown significant improvements with the use of CAS techniques, concerns over increased operative times, large capital costs, and the learning curve associated with their use have limited their widespread acceptance. Recently, handheld
The purpose of this study was to evaluate in vivo fit and fill analysis of tapered wedge-type stem in total hip arthroplasty (THA) with computed tomography (CT)-based
Computer
We have investigated the accuracy of placement of the femoral component using imageless
Introduction:. Since2007, we have used CT-based fluoroscopy-matching
Malalignment of more than three degrees in coronal plane was associated with poor outcome. Most of the alignment occurred in the tibial coronal plane alignment. Computer assisted surgery (CAS) in total knee arthroplasty (TKA) aimed to minimize malalignment. Most of the CAS-TKA results were using infrared tracking system. Electromagnetic
Nearly 99,000 total knee arthroplasties (TKAs) are performed in UK annually. Despite plenty of research, the satisfaction rate of this surgery is around 80%. One of the important intraoperative factors affecting the outcome is alignment. The relationship between joint obliquity and functional outcomes is not well understood. Therefore, a study is required to investigate and compare the effects of two types of alignment (mechanical and kinematic) on functional outcomes and range of motion. The aim of the study is to compare navigated kinematically aligned TKAs (KA TKAs) with navigated mechanically aligned TKA (MA TKA) in terms of function and ROM. We aim to recruit a total of 96 patients in the trial. The patients will be recruited from clinics of various consultants working in the trust after screening them for eligibility criteria and obtaining their informed consent to participate in this study. Randomization will be done prior to surgery by a software. The primary outcome measure will be the Knee injury and Osteoarthritis Outcome Score The secondary outcome measures include Oxford Knee Score, ROM, EuroQol five-dimension questionnaire, EuroQol visual analogue scale, 12-Item Short-Form Health Survey (SF-12), and Forgotten Joint Score. The scores will be calculated preoperatively and then at six weeks, six months, and one year after surgery. The scores will undergo a statistical analysis.Aims
Methods
Computer
Introduction: Computerised
Total knee arthroplasty (TKA) has become one of the most successful procedures in orthopedics, and its survival rates are reportedly greater than 90% after 15 years. Malpositioning of the component, however, can lead to various failures, such as aseptic loosening, instability, polyethylene wear, and patellar dislocation.
Introduction. Orientation of the acetabular component in total hip arthroplasty has been shown to influence component wear, stability, and impingement. Freehand placement of the component can lead to widely variable radiographic outcomes. Accurate abduction, in particular, can be difficult in the lateral decubitus position due to limited ability to appreciate and control positional obliquity of the pelvis. A CT-based mechanical
Introduction: Modern
Glenoid replacement is a manual bone removal procedure that can be difficult for surgeons to perform. Surgical robotics have been utilized successfully in hip and knee orthopaedic procedures but there are no systems currently available in the shoulder. These robots tend to have low adoption rates by surgeons due to high costs, disruption of surgical workflow and added complexity. As well, these systems typically use optical tracking which needs a constant line-of-sight which is not conducive to a crowded operating room. The purpose of this work was developing and testing a surgical robotic system for glenoid replacement. The new surgical system utilizes flexible components that tether a Stewart Platform robot to the patient through a patient specific 3D printed mount. As the robot moves relative to the bone, reaction loads from the flexible components bending are measured by a load cell allowing the robot to “feel” its way around. As well, a small bone burring tool was attached to the robot to facilitate the necessary bone removal. The surgical system was tested against a fellowship-trained surgeon performing standard surgical techniques. Both the robot and the surgeon performed glenoid replacement on two different scapula analogs: standard anatomy and posterior glenoid edge wear referred to as a Walch B2. Six of each scapula model was tested by the robot and the surgeon. The surgeon created a pre-operative plan for both scapula analogs as a target for both methodologies. CT scans of the post-operative cemented implants were compared to the pre-operative target and implant position and orientation errors were measured. For the standard shoulder analogs the net implant position and orientation errors were 1.47 ± 0.48 mm and 2.57 ± 2.30° for the robot and 1.61 ± 0.29 mm and 5.04 ± 1.92° for the surgeon respectively. For the B2 shoulders, the net implant position and orientation errors were 2.16 ± 0.36 mm and 2.89 ± 0.88° for the robot and 3.01 ± 0.42 mm and 4.54 ± 1.49° for the surgeon respectively. The new tracking system was shown to be able to match or outperform the surgeon in most metrics. The surgeon tended to have difficulty gauging the depth needed as well as the face rotation of the implant. This was not surprising as the reaming tool used by the surgeon obscures the view of the anatomy and the spherical cutter hinders the ability to index the tool. The robot utilized only one surgical tool, the bone burr, precluding the need for multiple instruments used by the surgeon to prepare the glenoid bone bed. The force-space