Background. Achieving optimal prosthesis alignment during total knee arthroplasty (TKA) is essential. Imageless computer-assisted surgery (CAS) is developed to improve knee prosthesis alignment and with CAS it is possible to perform intraoperative alignment measurements. Lower limb alignment measurements are also performed for preoperative planning and postoperative evaluation. A new stereoradiography system, called EOS, can be used to perform these measurements in 3D and thus measurement errors due to malpositioning can be eliminated. Since both CAS and EOS are based on 3D modeling, measurements should theoretically correlate well. Therefore, objective was to compare intraoperative CAS-TKA measurements with pre- and postoperative EOS 3D measurements. Methods. In a prospective study 56 CAS-TKAs were performed and alignment measurements were recorded two times: before bone cuts were made and after implantation of the prosthesis. Pre- and postoperative coronal alignment measurements were performed using EOS 3D. CAS measurements were compared with EOS 3D reconstructions. Measured angles were: varus/valgus (VV), mechanical lateral distal-femoral (mLDFA) and medial proximal tibial angle (mMPTA). Results. Significantly different VV angles were measured pre- and postoperatively with CAS compared to EOS. For preoperative measurements, mLDFA did not differ significantly, but a significantly larger mMPTA in valgus was measured with CAS. Conclusions. EOS 3D measurements overestimate VV angle in lower limbs with substantial mechanical axis deviation. For lower limbs with minor mechanical axis deviation as well as for mMPTA measurements, CAS measures more valgus compared to EOS. Results of this study indicate that differences in alignment measurements between CAS measurements and pre- and postoperative EOS 3D are mainly due to the difference between weight bearing and non-weight bearing position and potential errors in validity and reliability of the CAS system. Surgeons should be aware of these measurement differences and the pitfalls of both measurement techniques. Level of evidence. IIb. Disclosures. The department of Orthopaedics, University of Groningen, University Medical Center Groningen receives research institutional support from InSpine (Schiedam, NL) and Stryker (Kalamazoo, Mich. USA). One of the authors (ALB) will be and has been paid as a consultant by Zimmer (Warsaw, IN, USA) for purposes of education and training in knee arthroplasty

Adult Spine Deformity (ASD) is a degenerative condition of the adult spine leading to altered spine curvatures and mechanical balance. Computational approaches, like Finite Element (FE) Models have been proposed to explore the etiology or the treatment of ASD, through biomechanical simulations. However, while the personalization of the models is a cornerstone, personalized FE models are cumbersome to generate. To cover this need, we share a virtual cohort of 16807 thoracolumbar spine FE models with different spine morphologies, presented in an online user-interface platform (SpineView). To generate these models, EOS images are used, and 3D surface spine models are reconstructed. Then, a Statistical Shape Model (SSM), is built, to further adapt a FE structured mesh template for both the bone and the soft tissues of the spine, through mesh morphing. Eventually, the SSM deformation fields allow the personalization of the mean structured FE model, leading to generate FE meshes of thoracolumbar spines with different morphologies. Models can be selectively viewed and downloaded through SpineView, according to personalized user requests of specific morphologies characterized by the geometrical parameters: Pelvic Incidence; Pelvic Tilt; Sacral Slope; Lumbar Lordosis; Global Tilt; Cobb Angle; and GAP score. Data quality is assessed using visual aids, correlation analyses, heatmaps, network graphs, Anova and t-tests, and kernel density plots to compare spinopelvic parameter distributions and identify similarities and differences. Mesh quality and ranges of motion have been assessed to evaluate the quality of the FE models. This functional repository is unique to generate virtual patient cohorts in ASD. Acknowledgements: European Commission (MSCA-TN-ETN-2020-Disc4All-955735, ERC-2021-CoG-O-Health-101044828)

Decreasing the bulk weight without losing the biomechanical properties of commercial pure titanium (Cp-Ti) medical implants is now possible by using Laser Powder Bed Fusion (L-PBF) technology. Gyroid lattice structures that have precious mechanical and biological advantages because of similarity to trabecular bone. The aim of the study was to design and develop L-PBF process parameter optimization for manufacturing gyroid lattice Cp-Ti structures. The cleaning process was then optimized to remove the non-melted powder from the gyroid surface without mechanical loss. Gyroid cubic designs were created with various relative densities by nTopology. L-PBF process parameter optimization was progressed using with Cp-Ti (EOS TiCP Grade2) powder in the EOS M290 machine to achieve parts that have almost full dense and dimensional accuracy. The metallography method was made for density. Dimensional accuracy at gyroid wall thicknesses was investigated between designed and manufactured via stereomicroscope, also mechanical tests were applied with real time experiment and numerical analysis (ANSYS). Mass loss and strut thickness loss were investigated for chemical etching cleaning process. Gyroid parts had 99,5% density. High dimensional accuracy was achieved during L-PBF process parameters optimization. Final L-PBF parameters gave the highest 19% elongation and 427 MPa yield strength values at tensile test. Mechanical properties of gyroid were controlled with changing relative density. A minute chemical etching provided to remove non-melted powders. Compression test results of gyroids at numerical and real-time analysis gave unrelated while deformation behaviors were compatible with each other. Gyroid Cp-Ti osteosynthesis mini plates will be produced with final L-PBF process parameters. MTT cytotoxicity test will be characterized for cell viability. Acknowledgements This project is granted by TUBITAK (120N943). Feza Korkusuz MD is a member of the Turkish Academy of Sciences (TÜBA)

Summary. The EOS stereography system has been developed for the evaluation of prosthetic alignment. This new low-dose device provides reliable 2D/3D measurements of knee prosthesis alignment. Introduction. Achieving optimal prosthetic alignment during Total Knee Arthroplasty (TKA) is an essential part of the surgical procedure since malpositioning can lead to early loosening of the prosthesis and eventually revision surgery. Conventional weight-bearing radiographs are part of the usual clinical follow-up after both primary TKA and revision TKA (rTKA), to assess alignment in the coronal and sagittal planes. However, proportions and angles may not be correct on radiographs since divergence exists in the vertical and horizontal planes. Furthermore estimating the exact planes by looking at the position of the patella depends on rotation in the hip joint and this may be misinterpreted by the investigator. A computed tomography (CT) scanogram can also be used. However, due to high levels of radiation and costs it is not routinely used. To this end, a new device, the EOS stereography system, has been developed. With this biplanar low-dose X-ray technique, orthogonally made 2D images and 3D reconstructions can be obtained. Advantages of EOS are that images of the leg are obtained on a 1:1 scale with an amount of radiation 800–1000 times lower than CT-scans and 10 times lower than conventional radiographs. Another advantage is that the 3D reconstructions lead to determination of the real coronal and sagittal planes. However, the software for creating 3D reconstructions is developed for the lower limbs without knee prosthesis material. Consequently a reliability study concerning the generation of 2D images and 3D reconstructions of a leg containing a knee prosthesis has not been performed yet. Therefore objective of this study was to investigate interobserver and intraobserver reliability of knee prosthetic alignment measurements after rTKA using EOS. Patients and Methods. Forty anteroposterior and lateral images of 37 rTKA patients were included. Two observers independently performed measurements on these images twice. Measured angles were varus/valgus angle in 2D (VV2D) and 3D (VV3D). Intraclass correlation coefficients (ICCs) were used to determine relative reliability and the Bland and Altman method was used to determine absolute reliability. T-tests were used to test potential differences between the two observers, first and second measurement sessions and 2D and 3D measurements. Results. Relative interobserver reliability was excellent for both VV2D and VV3D with ICCs > 0.95, and no significant differences between the two observers. For the absolute reliability of VV2D, a bias of −0.16° (95%CI: −0.31–0.01) existed between both observers. Absolute reliability of VV3D was good. Relative intraobserver reliability was excellent for both VV2D and VV3D with ICCs > 0.97. No significant difference and no bias between the first and second measurements were found. A significant difference existed between the angles measured in 2D and 3D (p=0.01). Discussion / Conclusion. The EOS low-dose stereography system provides reliable varus/valgus measurements in 2D and 3D for the alignment of the knee joint with a knee prosthesis. However, significant differences exist between the varus/valgus measurements in 2D and in 3D. Therefore, a validation study is suggested to investigate the difference between the 2D measurements and 3D reconstructions and to find a possible explanation for this difference

INTRODUCTION. Growth-guidance constructs are an alternative to growing rods for the surgical treatment of early onset scoliosis (EOS). In growth-guidance systems, free-sliding anchors preserve longitudinal spinal growth, thereby eliminating the need for surgical lengthening procedures. Non-segmental constructs containing ultra-high molecular weight polyethylene (UHMWPE) sublaminar wires have been proposed as an improvement to the traditional Luque trolley. In such a construct, UHMWPE sublaminar wires, secured by means of a knot, serve as sliding anchors at the proximal and distal ends of a construct, while pedicle screws at the apex prevent rod migration and enable curve derotation. Ideally, a construct with the optimal UHMWPE sublaminar wire density, offering the best balance between providing adequate spinal fixation and minimizing surgical exposure, is designed preoperatively for each individual patient. In a previous study, we developed a parametric finite element (FE) model that potentially enables preoperative patient-specific planning of this type of spinal surgery. The objective of this study is to investigate if this model can capture the decrease in range of motion (ROM) after spinal fixation as measured in an experimental study. MATERIALS AND METHODS. In a previous in vitro study, the ROM of an 8-segment porcine spine was measured before and after instrumentation, using different instrumentation constructs with a sequentally decreasing number of wire fixation points. In the current study, the parametric FE model of the thoracolumbar spine was first validated relative to ROM values reported in the literature. The rods, screws, and sublaminar wires were implemented, and the model was subsequently used to replicate the in vitro tests. The experimental and simulated ROM”s for the different instrumentation conditions were compared. RESULTS. Good agreement between in vitro biomechanical tests and FE simulations was observed in terms of the decrease in ROM for the complete construct with wires at each level. The stepwise increase in total ROM with decreasing number of wires at the construct ends was less prominent in silico in comparison to in vitro. CONCLUSION. Important first steps in the implementation and validation of a growth-guidance construct for EOS patients in a patient-specific FE model of the spine have been made in this study. The parametric nature of the FE model allows for rapid personalization. Although further improvements to the model will be necessary to better distinguish between different spinal instrumentation constructs, we conclude that the model can well capture essential aspects of spinal motion and the overall effect of instrumentation

Introduction. The equine SDFT tendon is a complex hierarchal structure that transmits force from muscle to bone and stores energy through its stretching and recoiling action. It is a common site of pathology in athletic horses. Our aim was to describe the ultrastructural anatomy of the SDFT as part of a larger programme to understand the structure-functional relationship of this tendon. Materials and Methods. Fifteen SDFT from different aged horses, sectioned transversely (2–3 mm thickness) and then photographed using Canon EOS 5D Mark III (100 mm focal length). Images processed through ImageJ and IMOD software for 3D reconstruction. Samples were also taken from the proximal, middle and distal part of the SDFT from a foetal, one and nine years old horse, processed for H&E staining and sectioned longitudinally in series into 20 sections (5µm), additionally the mid metacarpal region of one year old was fully sectioned into 250 sections. The entire cut surface on the slide was imaged and transformed to one collated image using Inkscape. Using IMOD collated photos transformed to mrc file (Z-stack) and in order to reconstruct 3D forms. Results. A tertiary fascicle was defined as a bundle of collagen fibres surrounded by a well-defined interfascicular matrix IFM (width 34.56 µm +/− 16.43 (St.Dev)). Secondary fascicles were defined as subdivisions of the tertiary fascicles (IFM width 11.1 µm +/− 4.01 (St.Dev)) (n=2). Using this classification we found that the numbers of the secondary and tertiary fascicles were not continuous through the tendon in a proximal to distal regions of the tendon. The histological 3D anatomy manifests similar fascicular structure in all ages, but their fascicular contours were less irregular in aged and in the mid-metacarpal region. The 3D anatomy of the mid-metacarpal tendon demonstrated heterogeneous fascicles, which had helical arrangement in their longitudinal axis. Discussion. Secondary and tertiary fascicles are heterogeneous in numbers, shapes and interconnections with each other in different regions. Fascicles appear to branch from proximal to distal through the tendon and are not always continuous through the tendon length. Some fascicles intercommunicating with each other and have helical configuration. Understanding the 3D anatomy will facilitate understanding of tendon structure-function relationships and injury predisposition

Objectives

The Attune total knee arthroplasty (TKA) has been used in over 600 000 patients worldwide. Registry data show good clinical outcome; however, concerns over the cement-tibial interface have been reported. We used retrieval analysis to give further insight into this controversial topic.