Introduction. Restrictions placed on the working hours of doctors have led to increasing time-pressures on surgical training. Consequently, there has been growing interest in developing new techniques to teach and assess technical skills. The primary aim of this study was to determine whether a novel set of visual parameters assessing visuospatial ability, fine motor dexterity and gaze control could objectively distinguish between varying levels of arthroscopic experience. The secondary aim was to evaluate the correlations between these new parameters and previously established technical skill assessment methods. Methods. 27 subjects were divided into a “novice” group (n=7), “trainee” group (n=15) and expert group (n=5) based on previous arthroscopic experience. All subjects performed a diagnostic knee arthroscopy task on a simulator. Their performance was assessed using new simple visual parameters that included “prevalence of instrument loss,” “triangulation time” and “prevalence of look downs”. In addition, performance was also evaluated using previously validated technical skill assessment methods (a global rating scale and motion analysis). Results. A significant difference in performance between the groups was demonstrated using all three novel visual parameters, the global rating scale and motion analysis (Mann-Whitney U test, p< 0.05). There were strong and highly significant correlations (Spearman's rank correlation coefficient, p< 0.0001) between each of the novel parameters and the previously validated skill assessment methods. Conclusion. This study demonstrates the construct validity of three novel visual parameters for objectively assessing arthroscopic performance. Two of these are simple, can be used easily in the operating theatre, and are highly correlated with current validated methods of technical skill assessment. Given the paramount importance of identifying objective methods for evaluating technical skill in arthroscopic surgery, the generic nature of these simple visual parameters make them a powerful and user-friendly
Introduction. A key outcome measured by national joint registries are revision events. This informs best practice and identifies poor-performing surgical devices. Although registry data often record reasons for revision arthroplasty, interpretation is limited by lack of standardised definitions of revision reasons and
Disorders of human joints manifest during dynamic movement, yet no objective tools are widely available for clinicians to assess or diagnose abnormal joint motion during functional activity. Machine learning tools have supported advances in many applications for image interpretation and understanding and have the potential to enable clinically and economically practical methods for
Introduction/Aim. Mid-flexion instability is a well-documented, but often poorly understood cause of failure of TKA. NAVIO robotic-assisted TKA (RA-TKA) offers a novel, integrative approach as a planning, execution as well as an evaluation tool in TKA surgery. RA-TKA provides a hybrid planning technique of measured resection and gap balancing- generating a predictive soft-tissue balance model, prior to making cuts. Concurrently, the system uses a semi-active robot to facilitate both the execution and verification of the plan, as it pertains to both the static and dynamic anatomy. The goal of this study was to assess the ability of the NAVIO RA-TKA to plan, execute and deliver an individualized approach to the soft-tissue balance of the knee, specifically in the “mid-flexion” arc of motion. Materials and Methods. Between May and September 2018, 50 patients underwent NAVIO RA-TKA. Baseline demographics were collected, including age, gender, BMI, and range of motion. The NAVIO imageless technique was used to plan the procedure, including: surface-mapping of the static anatomy;
Despite the variety of implants or techniques that exist to treat displaced distal radial fractures, the majority fail to provide sufficient stability to permit early functional recovery. However, locking plates have the advantage over other implants in that locking screws add considerably to the overall stability. The aim of this study was to assess the functional outcome of patients with displaced distal radial fractures treated with a volar distal radial locking plate (Synthes). During a two year period, details of 98 patients admitted to our unit with inherently unstable dorsally displaced distal radial fractures treated with volar locking plates were collected prospectively. For the purpose of this analysis, only those patients (55) with unilateral fracture, able to attend the study clinic at 6 months post-injury were considered. Patients were immobilised in wool and crepe for a 2 week period. The group consisted of 15 males and 40 females with an average age of 54 (28 to 83). At 6 months, patients' perceived functional recovery averaged 80%.
Introduction. The efficacy of Virtual Reality (VR) as a teaching augment for arthroplasty has not been well examined for unfamiliar multistep procedures such as unicompartmental knee arthroplasty (UKA). This study sought to determine if VR improves surgical competence over traditional procedural preparation when performing a UKA. Methods. 22 Orthopaedic trainees were randomized to training sessions: 1) “VR group” with access to an immersive VR learning module that had been designed in conjunction with the manufacturer or 2) “Guide group” with access to manufacture's technique guide and surgical video. Both groups then performed a full UKA on SawBones models. Surgical competence was assessed via
Knee replacement is a proven and reproducible procedure to alleviate pain, re-establish alignment and restore function. However, the quality and completeness to which these goals are achieved is variable. The idea of restoring function by reproducing condylar anatomy and asymmetry has been gaining favor. As knee replacements have evolved, surgeons have created a set of principles for reconstruction, such as using the femoral transepicondylar axis (TEA) in order to place the joint line of the symmetric femoral component parallel to the TEA, and this has been shown to improve kinematics. However, this bony landmark is really a single plane surrogate for independent 3-dimensional medial and lateral femoral condylar geometry, and a difference has been shown to exist between the natural flexion-extension arc and the TEA. The TEA works well as a surrogate, but the idea of potentially replicating normal motion by reproducing the actual condylar geometry and its involved, individual asymmetry has great appeal. Great variability in knee anatomy can be found among various populations, sizes, and genders. Each implant company creates their specific condylar geometry, or “so called” J curves, based on a set of averages measured in a given population. These condylar geometries have traditionally been symmetric, with the individualised spatial placement of the (symmetric) curves achieved through femoral component sizing, angulation, and rotation performed at the time of surgery. There is an inherent compromise in trying to achieve accurate, individual medial and lateral condylar geometry reproduction, while also replicating size and avoiding component overhang with a set implant geometry and limited implant sizes. Even with patient-specific instrumentation using standard over-the-counter implants, the surgeon must input his/her desired endpoints for bone resection, femoral rotation, and sizing as guidelines for compromise. When all is done, and soft tissue imbalance exists, soft tissue release is the final, common compromise. The custom, individually made knee design goals include reproducible mechanical alignment, patient-specific fit and positioning, restoration of articular condylar geometry, and thereby, more normal kinematics. A CT scan allows capture of three-dimensional anatomical bony details of the knee. The individual J curves are first noted and corrected for deformity, after which they are anatomically reproduced using a Computer-Aided Design (CAD) file of the bones in order to maximally cover the bony surfaces and concomitantly avoid implant overhang. No options for modifications are offered to the surgeon, as the goal is anatomic restoration. Given these ideals, to what extent are patients improved? The concept of reproducing bony anatomy is based on the pretext that form will dictate function, such that normal-leaning anatomy will tend towards normal-leaning kinematics. Therefore, we seek to evaluate knee function based on
Introduction. Wearable sensors are promising tools for fast clinical gait evaluations in individuals with osteoarthritis (OA) of the knee and hip. However, gait assessments with wearable sensor are often limited to relatively simple straight-ahead walking paradigms. Parameters reflecting more complex and relevant aspects of gait, including dual-tasking, turning, and compensatory upper body motion are often overlooked in literature. The aim of this study was to investigate turning, dual-task performance, and upper body motion in individuals with knee or hip OA in addition to spatiotemporal gait parameters, taking shared covariance between gait parameters into account. Methods. Gait was compared between individuals with unilateral knee (n=25) or hip (n=26) OA scheduled for joint replacement, and healthy controls (n=27). For 2 minutes, subjects walked back-and-forth a 6 meter trajectory making 180 degree turns, with and without a secondary cognitive task. Gait parameters were collected using four inertial measurement units on feet, waist, and trunk. To test if turning, dual-tasking, and upper body motion had added value above common spatiotemporal parameters, a factor analysis was conducted. Standardized mean differences were computed for the comparison between knee or hip OA and healthy controls. One gait parameter was selected per gait domain based on factor loading and effect size for the comparison between OA groups and healthy controls. Results. Four independent domains of gait were obtained: speed-spatial, speed-temporal, dual task cost, and upper body motion. Turning parameters were part of the speed-temporal domain. From the gait domains that were obtained, stride length (speed-spatial) and cadence (speed-temporal) had the strongest factor loadings and effect sizes for both knee and hip OA, and lumbar sagittal range of motion (upper body motion) for hip OA only. Although dual-task cost was an independent domain, it was not sensitive to knee or hip OA. Conclusions. Stride length, cadence, and lumbar sagittal range of motion were non-redundant and sensitive gait parameters, representing (compensatory) gait adaptations in individuals with knee or hip OA. Turning or dual-task parameters had limited additional value for evaluating gait in knee and hip OA, although dual-task cost constituted a separate gait domain. These findings hold promise for
Fifteen-year survivorship studies demonstrate that total knee replacements have excellent survivorship, with reports of 85 to 97%. However, excellent survivorship does not equate to excellent patient reported outcomes. Noble et al. reported that 14% of their patients were dissatisfied with their outcome with more than half expressing problems with routine activities of daily living. There is also a difference in the patient's subjective assessment of outcome and the surgeon's
Fifteen-year survivorship studies demonstrate that total knee replacements have excellent survivorship, with reports of 85% to 97%. However, excellent survivorship does not equate to excellent patient reported outcomes. Noble et al. reported that 14% of their patients were dissatisfied with their outcome with more than half expressing problems with routine activities of daily living. There is also a difference in the patient's subjective assessment of outcome and the surgeon's
Fifteen-year survivorship studies demonstrate that total knee replacement have excellent survivorship, with reports of 85 to 97%. However, excellent survivorship does not equate to excellent patient reported outcomes. Noble et al. reported that 14% of their patients were dissatisfied with their outcome with more than half expressing problems with routine activities of daily living. There is also a difference in the patient's subjective assessment of outcome and the surgeon's
Fifteen-year survivorship studies demonstrate that total knee replacements have excellent survivorship, with reports of 85 to 97%. However, excellent survivorship does not equate to excellent patient reported outcomes. Noble et al reported that 14% of their patients were dissatisfied with their outcome with more than half expressing problems with routine activities of daily living. There is also a difference in the patient's subjective assessment of outcome and the surgeon's
Fifteen-year survivorship studies demonstrate that total knee replacements have excellent survivorship, with reports of 85% to 97%. However, excellent survivorship does not equate to excellent patient reported outcomes. Noble et al reported that 14% of their patients were dissatisfied with their outcome with more than half expressing problems with routine activities of daily living. There is also a difference in the patient's subjective assessment of outcome and the surgeon's
Knee replacement is a proven and reproducible procedure to alleviate pain, re-establish alignment and restore function. However, the quality and completeness to which these goals are achieved is variable. The idea of restoring function by reproducing condylar anatomy and asymmetry has been gaining favor As knee replacements have evolved, surgeons have created a set of principles for reconstruction, such as using the femoral transepicondylar axis (TEA) in order to place the joint line of the symmetric femoral component parallel to the TEA, and this has been shown to improve kinematics. However, this bony landmark is really a single plane surrogate for 3-dimensional medial and lateral femoral condylar geometry, and a difference has been shown to exist between the natural flexion-extension arc and the TEA. The TEA works well as a surrogate, but the idea of potentially replicating normal motion by reproducing the actual condylar geometry and its involved, individual asymmetry has great appeal. Great variability in knee anatomy can be found among various populations, sizes, and genders. Each implant company creates their specific condylar geometry, or “so called” J curves, based on a set of averages measured in a given population. These condylar geometries have traditionally been symmetric, with the individualised spatial placement of the (symmetric) curves achieved through femoral component sizing, angulation, and rotation performed at the time of surgery. There is an inherent compromise in trying to achieve accurate, individual medial and lateral condylar geometry reproduction, while also replicating size and avoiding component overhang with a set implant geometry and limited implant sizes. Even with patient-specific instrumentation using standard over-the-counter implants, the surgeon must input his/her desired endpoints for bone resection, femoral rotation, and sizing as guidelines for compromise. When all is done, and soft tissue imbalance exists, soft tissue release is the final, common compromise. The custom, individually made knee design goals include reproducible mechanical alignment, patient-specific fit and positioning, restoration of articular condylar geometry, and thereby, more normal kinematics. A CT scan allows capture of three-dimensional anatomical bony details of the knee. The individual J curves are first noted and corrected for deformity, after which they are anatomically reproduced using a Computer-Aided Design (CAD) file of the bones in order to maximally cover the bony surfaces and concomitantly avoid implant overhang. No options for modifications are offered to the surgeon, as the goal is anatomic restoration. Given these ideals, to what extent are patients improved? The concept of reproducing bony anatomy is based on the pretext that form will dictate function, such that normal-leaning anatomy will tend towards normal-leaning kinematics. Therefore, we seek to evaluate knee function based on
Knee laxity following anterior cruciate ligament (ACL) injury is a complex phenomenon influenced by various biomechanical and anatomical factors. The contribution of soft tissue injuries – such as ligaments, menisci, and capsule – has been previously defined, but less is known about the effects of bony morphology. (Tanaka et al, KSSTA 2012) The pivot shift test is frequently employed in the clinical setting to assess the combined rotational and translational laxity of the ACL deficient knee. In order to standardise the maneuver and allow for reproducible interpretation, the quantitative pivot shift test was developed. (Hoshino et al, KSSTA 2013) The aim of this study is to employ the quantitative pivot shift test to determine the effects of bone morphology as determined by magnetic resonance imaging (MRI) on rotatory laxity of the ACL deficient knee. Fifty-three ACL injured patients scheduled for surgical reconstruction (36 males and 17 females; 26±10 years) were prospectively enrolled in the study. Preoperative magnetic resonance imaging (MRI) scans were reviewed by two blinded observers and the following parameters were measured: medial and lateral tibial slope, tibial plateau width, femoral condyle width, bicondylar width, and notch width. (Musahl et al. KSSTA 2012). Preoperatively and under anaesthesia, a quantitative pivot shift test was performed on each patient by a single experienced examiner. An image analysis technique was used to quantify the lateral compartment translation during the maneuver. Subjects were classified as “high laxity” or “low laxity” based upon the median value of lateral compartment translation. (Hoshino et al. KSSTA 2012) Independent t-tests and univariate logistic regression were used to investigate the relationship between the pivot shift grade and various features of bone morphology. Statistical significance was set at p<0.05. A high inter-rater reliability was observed in all MRI measurements of bone morphology (ICC=0.72–0.88). The median lateral compartment translation during quantitative pivot shift testing was 2.8mm. Twenty-nine subjects were classified as “low laxity” (2.8mm). The lateral tibial plateau slope was significantly increased in “high laxity” patients (9.3+/−3.4mm versus 6.1+/−3.7mm; p<0.05). No other significant difference in bone morphology was observed between the groups. This study employed an
Knee replacement is a proven and reproducible procedure to alleviate pain, re-establish alignment and restore function. However, the quality and completeness to which these goals are achieved is variable. The idea of restoring function by reproducing condylar anatomy and asymmetry has been gaining favor. As knee replacements have evolved, surgeons have created a set of principles for reconstruction, such as using the femoral transepicondylar axis (TEA) in order to place the joint line of the symmetric femoral component parallel to the TEA, and this has been shown to improve kinematics. However, this bony landmark is really a single plane surrogate for 3-dimensional medial and lateral femoral condylar geometry, and a difference has been shown to exist between the natural flexion-extension arc and the TEA. The TEA works well as a surrogate, but the idea of potentially replicating normal motion by reproducing the actual condylar geometry and its involved, individual asymmetry has great appeal. Great variability in knee anatomy can be found among various populations, sizes, and genders. Each implant company creates their specific condylar geometry, or “so called” J curves, based on a set of averages measured in a given population. These condylar geometries have traditionally been symmetric, with the individualised spatial placement of the (symmetric) curves achieved through femoral component sizing, angulation, and rotation performed at the time of surgery. There is an inherent compromise in trying to achieve accurate, individual medial and lateral condylar geometry reproduction, while also replicating size and avoiding component overhang with a set implant geometry and limited implant sizes. Even with patient-specific instrumentation using standard over-the-counter implants, the surgeon must input his/her desired endpoints for bone resection, femoral rotation, and sizing as guidelines for compromise. When all is done, and soft tissue imbalance exists, soft tissue release is the final, common compromise. The custom, individually made knee design goals include reproducible mechanical alignment, patient-specific fit and positioning, restoration of articular condylar geometry, and thereby, more normal kinematics. A CT scan allows capture of three-dimensional anatomical bony details of the knee. The individual J curves are first noted and corrected for deformity, after which they are anatomically reproduced using a Computer-Aided Design (CAD) file of the bones in order to maximally cover the bony surfaces and concomitantly avoid implant overhang. No options for modifications are offered to the surgeon, as the goal is anatomic restoration. Given these ideals, to what extent are patients improved? The concept of reproducing bony anatomy is based on the pretext that form will dictate function, such that normal-leaning anatomy will tend towards normal-leaning kinematics. Therefore, we seek to evaluate knee function based on
Introduction. The objective of our study was to determine the extent to which the quality of the biomechanical reconstruction when performing hip replacement influences gait performances. We aimed to answer the following questions: 1) Does the quality of restoration of hip biomechanics after conventional THR influence gait outcomes? (question 1), and 2) Is HR more beneficial to gait outcomes when compared with THR? (question 2). Methods. we retrospectively reviewed 52 satisfied unilateral prosthetic hip patients (40 THRs and 12 HRs) who undertook
Fifteen-year survivorship studies demonstrate that total knee replacement have excellent survivorship, with reports of 85 to 97%. However, excellent survivorship does not equate to excellent patient reported outcomes. Noble et al reported that 14% of their patients were dissatisfied with their outcome with more than half expressing problems with routine activities of daily living. There is also a difference in the patient's subjective assessment of outcome and the surgeon's
Fifteen-year survivorship studies demonstrate that total knee replacement has excellent survivorship, with reports of 85 to 97%. However, excellent survivorship does not equate to excellent patient reported outcomes. Noble et al. reported that 14% of their patients were dissatisfied with their outcome with more than half expressing problems with routine activities of daily living. There is also a difference in the patient's subjective assessment of outcome and the surgeon's
Introduction. Unicompartmental knee arthroplasty is in particular promoted for knee OA patients with high demands on function and activity. This study used wearable inertial sensors to objectively assess function during specific motion tasks and to monitor activities of daily living to verify if UKA permits better function or more activity in particular with demanding tasks. Methods. In this retrospective, cross-sectional study, UKA patients (Oxford, n=26, 13m/13f, age at FU: 66.5 ±7.6yrs) were compared to TKA patients (Vanguard, n=26, 13m/13f, age: 66.0 ±6.9yrs) matched for gender, age and BMI (29.5 ±4.6) at 5 years follow-up. Subjective evaluation of pain, function, physical activity and awareness of the joint arthroplasty was performed by means of four PROMs: VAS pain, KOOS-PS, SQUASH (activity) and Forgotten Joint Score (FJS),. Objective measurement of function was performed using a 3D inertia sensor attached to the sacrum while performing gait test, sit-stand and block-step tests. To derive functional parameters such as walking cadence or sway during transfers or step-up previously validated algorithms were used (Bolink et al., 2012). Daily physical activity was objectively monitored with a 3D accelerometer attached to the lateral side of the unaffected upper leg during four consecutive days. Activity parameters (counts and times of postures, steps, stairs, transfers, etc.) were also derived using validated algorithms. Data was analysed using independent T-test, Mann-Whitney U test and Pearson's correlation. Results. PROM's did not show any significant difference between UKA and TKA especially for the routinely used VAS-Pain and KOOS-PS (p>0.57) while higher (better) mean scores were recorded for UKA using more specialist measures such as self-reported activity (SQUASH; UKA vs TKA: 5659 ±3753 vs 4245 ±2489, p=0.12) and joint awareness (FJS; UKA vs TKA: 50.7 ±24.3 vs 41.4 ±29.2, p=0.08). Sensor based measures of function showed significantly higher walking cadence for UKA (107.9 ±10.5 steps/min) than TKA (102.2 ±10.9 steps/min, p=0.049). Other functional parameters also indicated better UKA function, e.g. forward sway during sit-stand (UKA vs TKA: 38.0 ±13.2 deg vs 43.2 ±10.7 deg, p=0.06). The wearable activity monitors showed that UKA patients perform significantly more steps downwards on stairs or slopes (89.0 ±77.4) than TKA patients (46.9 ±51.3, p=0.03). Other, less demanding activity counts such as daily steps (6522 vs 6343, p=0.85) or sit-stand transfers (39.4 vs 42.3, p=0.37) were not different. Discussion and Conclusion. PROM's could not differentiate UKA from TKA although more specialist or demanding scores such SQUASH (activity) or FJS (joint awareness) seem to have more power.
