J. Lebleu, Charles-Eric Winandy, A. Pauwels, G. Kordás, Wouter Van Lysebettens, P. Van Overschelde
There is controversy regarding the effect of different approaches on recovery after THR. Collecting detailed relevant data with satisfactory compliance is difficult.Our retrospective observational multi-center study aimed to find out if the data collected via a remote coaching app can be used to monitor the speed of recovery after THR using the anterolateral (ALA), posterior (PA) and the direct anterior approach (DAA).771 patients undergoing THR from 13 centers using the moveUP platform were identified. 239 had ALA, 345 DAA and 42 PA. There was no significant difference between the groups in the sex of patients or in preoperative HOOS Scores. There was however a significantly lower age in the DAA (64,1y) compared to ALA (66,9y), and a significantly lower Oxford Hip Score in the DAA (23,9) compared to PA (27,7). Step count measured by an activity tracker, pain killer and NSAID use was monitored via the app. We recorded when patients started driving following surgery, stopped using crutches, and their HOOS and Oxford hip scores at 6 weeks.Overall compliance with data request was 80%. Patients achieved their preoperative activity level after 25.8, 17,7 and 23.3 days, started driving a car after 33.6, 30.3 and 31.7 days, stopped painkillers after 27.5, 20.2 and 22.5 days, NSAID after 30.3, 25.7, and 24.7 days for ALA, DAA and PA respectively. Painkillers were stopped and preoperative activity levels were achieved significantly earlier favoring DAA over ALA. Similarly, crutches were abandoned significantly earlier (39.9, 29.7 and 24.4 days for ALA, DAA and PA respectively) favoring DAA and PA over ALA. HOOS scores and Oxford Hip scores improved significantly in all 3 groups at 6 weeks, without any statistically significant difference between groups in either Oxford Hip or HOOS subscores.No final conclusion can be drawn as to the superiority of either approach in this study but the remote coaching platform allowed the collection of detailed data which can be used to advise patients individually, manage expectations, improve outcomes and identify areas for further research.
{"title":"Does your approach matter ?","authors":"J. Lebleu, Charles-Eric Winandy, A. Pauwels, G. Kordás, Wouter Van Lysebettens, P. Van Overschelde","doi":"10.29007/f3mx","DOIUrl":"https://doi.org/10.29007/f3mx","url":null,"abstract":"There is controversy regarding the effect of different approaches on recovery after THR. Collecting detailed relevant data with satisfactory compliance is difficult.Our retrospective observational multi-center study aimed to find out if the data collected via a remote coaching app can be used to monitor the speed of recovery after THR using the anterolateral (ALA), posterior (PA) and the direct anterior approach (DAA).771 patients undergoing THR from 13 centers using the moveUP platform were identified. 239 had ALA, 345 DAA and 42 PA. There was no significant difference between the groups in the sex of patients or in preoperative HOOS Scores. There was however a significantly lower age in the DAA (64,1y) compared to ALA (66,9y), and a significantly lower Oxford Hip Score in the DAA (23,9) compared to PA (27,7). Step count measured by an activity tracker, pain killer and NSAID use was monitored via the app. We recorded when patients started driving following surgery, stopped using crutches, and their HOOS and Oxford hip scores at 6 weeks.Overall compliance with data request was 80%. Patients achieved their preoperative activity level after 25.8, 17,7 and 23.3 days, started driving a car after 33.6, 30.3 and 31.7 days, stopped painkillers after 27.5, 20.2 and 22.5 days, NSAID after 30.3, 25.7, and 24.7 days for ALA, DAA and PA respectively. Painkillers were stopped and preoperative activity levels were achieved significantly earlier favoring DAA over ALA. Similarly, crutches were abandoned significantly earlier (39.9, 29.7 and 24.4 days for ALA, DAA and PA respectively) favoring DAA and PA over ALA. HOOS scores and Oxford Hip scores improved significantly in all 3 groups at 6 weeks, without any statistically significant difference between groups in either Oxford Hip or HOOS subscores.No final conclusion can be drawn as to the superiority of either approach in this study but the remote coaching platform allowed the collection of detailed data which can be used to advise patients individually, manage expectations, improve outcomes and identify areas for further research.","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130104280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manuel Vossel, Lukas Theisgen, K. Radermacher, M. de la Fuente
The accuracy of image-based computer assisted orthopedic surgery highly depends on the accuracy of the registration step as well as image acquisition, planning and tool calibration. In this paper the accuracy of those steps is evaluated exemplarily for a robotic laminectomy.A high-resolution test bench was designed to compare the actual location of an object and the position to which the robotic system guides the surgical tool according to the image-based plan.Depending on the distance between the patient reference array and the tool array, average accuracies from 0.14 mm ± 0.17 mm to 0.42 mm ± 0.15 mm with a maximum error of 0.59 mm were measured.This very high accuracy is in the range of the thickness of the spinal dura mater.
{"title":"Accuracy Evaluation of Image-Based Virtual Fixtures in Robotic Laminectomy","authors":"Manuel Vossel, Lukas Theisgen, K. Radermacher, M. de la Fuente","doi":"10.29007/cr5c","DOIUrl":"https://doi.org/10.29007/cr5c","url":null,"abstract":"The accuracy of image-based computer assisted orthopedic surgery highly depends on the accuracy of the registration step as well as image acquisition, planning and tool calibration. In this paper the accuracy of those steps is evaluated exemplarily for a robotic laminectomy.A high-resolution test bench was designed to compare the actual location of an object and the position to which the robotic system guides the surgical tool according to the image-based plan.Depending on the distance between the patient reference array and the tool array, average accuracies from 0.14 mm ± 0.17 mm to 0.42 mm ± 0.15 mm with a maximum error of 0.59 mm were measured.This very high accuracy is in the range of the thickness of the spinal dura mater.","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114920535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Baptiste Dehaine, Marion Decrouez, Nicolas Loy Rodas
Progress in machine learning and artificial intelligence (AI) opens the way to the devel- opment of smart clinical-assistance systems and decision-support tools for the operating room (OR). Yet, before deploying these algorithms in the OR, assessment of their perfor- mances in real clinical conditions is necessary. Gathering intraoperative data for training and testing is hard, and robustness to the challenging conditions of the OR is not always demonstrated. In this paper we introduce a unique multi-patient dataset of images cap- tured during Total Knee Arthroplasty (TKA) surgery. We use this dataset to compare five deep learning-based image segmentation approaches and provide quantitative and qualita- tive results. We hope that this work will help bringing light on the performances of AI in a real surgical environment.
{"title":"A benchmark for Deep Learning-based approaches for In-vivo segmentation of 2D images in Total Knee Arthroplasty","authors":"Baptiste Dehaine, Marion Decrouez, Nicolas Loy Rodas","doi":"10.29007/bcs4","DOIUrl":"https://doi.org/10.29007/bcs4","url":null,"abstract":"Progress in machine learning and artificial intelligence (AI) opens the way to the devel- opment of smart clinical-assistance systems and decision-support tools for the operating room (OR). Yet, before deploying these algorithms in the OR, assessment of their perfor- mances in real clinical conditions is necessary. Gathering intraoperative data for training and testing is hard, and robustness to the challenging conditions of the OR is not always demonstrated. In this paper we introduce a unique multi-patient dataset of images cap- tured during Total Knee Arthroplasty (TKA) surgery. We use this dataset to compare five deep learning-based image segmentation approaches and provide quantitative and qualita- tive results. We hope that this work will help bringing light on the performances of AI in a real surgical environment.","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117037439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Greene, Clément Daviller, S. Polakovic, Noah Davis, C. Roche
Preoperative anatomic measurements in total shoulder arthroplasty (TSA) influence a surgeon’s decision-making process in deciding treatment options for a given patient. Glenoid retroversion is one of the most significant measurements and can be highly subject to intra- and inter-observer variability in measurement technique. This study compares surgeon measured retroversion values to semi-automated software measured retroversion values on the same 1862 computed tomography scans, showing consistent measurements with an average absolute mean error between the two techniques of 3.1 ± 3.6°
{"title":"Surgeon vs. semi-automated software measured assessment of glenoid retroversion","authors":"A. Greene, Clément Daviller, S. Polakovic, Noah Davis, C. Roche","doi":"10.29007/x2v4","DOIUrl":"https://doi.org/10.29007/x2v4","url":null,"abstract":"Preoperative anatomic measurements in total shoulder arthroplasty (TSA) influence a surgeon’s decision-making process in deciding treatment options for a given patient. Glenoid retroversion is one of the most significant measurements and can be highly subject to intra- and inter-observer variability in measurement technique. This study compares surgeon measured retroversion values to semi-automated software measured retroversion values on the same 1862 computed tomography scans, showing consistent measurements with an average absolute mean error between the two techniques of 3.1 ± 3.6°","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114769976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Schwarzkopf, B. Culp, M. Bradley, Emily I McIntosh
Despite the success of total knee arthroplasty (TKA), malalignment continues to be a problem which often leads to post-operative complications. The aim of this study was to investigate the accuracy of a novel, imageless, optical surgical navigation tool to assist with the alignment of femoral and tibial cuts performed during total knee arthroplasty. Six board-certified orthopedic surgeons performed TKA procedures on 9 cadavers (17 knees total), using a novel, imageless navigation system (Intellijoint KNEE, Intellijoint Surgical). Varus/valgus, femoral flexion, tibial slope, and rotation measurements from the device were compared with angular measurements calculated from post-operative computed tomography (CT) images. Navigation measurements were highly correlated with those obtained from CT scan in all three axes. For the femoral cuts, the absolute mean difference in varus/valgus was 0.83° (SD 0.46°, r = 0.76), in flexion was 1.91° (SD 1.16°, r = 0.85), and in rotation was 1.29° (SD 1.01°, r = 0.88) relative to Whiteside’s line and 0.97° (SD 0.56°, r = 0.81) relative to the posterior condylar axis. For the tibia, the absolute mean difference in varus/valgus was 1.08° (SD 0.64°, r = 0.85), anterior/posterior slope was 2.78° (SD 1.40°, r = 0.60), and rotation was 2.98° (SD 2.54°, r = 0.79). Intraoperative monitoring with the imageless navigation tool accurately measures femoral and tibial cuts in TKA and may help to increase component alignment.
{"title":"A cadaveric investigation of the accuracy of a new, computer-assisted navigation system for total knee arthroplasty: A comparison with computed tomography imaging","authors":"R. Schwarzkopf, B. Culp, M. Bradley, Emily I McIntosh","doi":"10.29007/qmj5","DOIUrl":"https://doi.org/10.29007/qmj5","url":null,"abstract":"Despite the success of total knee arthroplasty (TKA), malalignment continues to be a problem which often leads to post-operative complications. The aim of this study was to investigate the accuracy of a novel, imageless, optical surgical navigation tool to assist with the alignment of femoral and tibial cuts performed during total knee arthroplasty. Six board-certified orthopedic surgeons performed TKA procedures on 9 cadavers (17 knees total), using a novel, imageless navigation system (Intellijoint KNEE, Intellijoint Surgical). Varus/valgus, femoral flexion, tibial slope, and rotation measurements from the device were compared with angular measurements calculated from post-operative computed tomography (CT) images. Navigation measurements were highly correlated with those obtained from CT scan in all three axes. For the femoral cuts, the absolute mean difference in varus/valgus was 0.83° (SD 0.46°, r = 0.76), in flexion was 1.91° (SD 1.16°, r = 0.85), and in rotation was 1.29° (SD 1.01°, r = 0.88) relative to Whiteside’s line and 0.97° (SD 0.56°, r = 0.81) relative to the posterior condylar axis. For the tibia, the absolute mean difference in varus/valgus was 1.08° (SD 0.64°, r = 0.85), anterior/posterior slope was 2.78° (SD 1.40°, r = 0.60), and rotation was 2.98° (SD 2.54°, r = 0.79). Intraoperative monitoring with the imageless navigation tool accurately measures femoral and tibial cuts in TKA and may help to increase component alignment.","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126310606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
William Xiang, E. Windsor, Shei-Shen Wang, A. Inglis, P. Sculco
Background: Restoration of the hip-knee-ankle (HKA) angle to within 3 of the neutral mechanical axis is considered a well-aligned total knee arthroplasty (TKA), with outliers associated with higher failure rates. Thus, efforts to improve intraoperative surgical accuracy are of strong clinical interest. This study evaluated the accuracy and safety of a novel, imageless, computer-assisted navigation system (CAS) for TKA.Methods: 112 consecutive patients who underwent primary TKA between January-December 2020 with 2 board-certified, high-volume orthopedic surgeons using the same imageless CAS were retrospectively reviewed. Patient age, BMI, sex, postoperative complications, and reoperations were collected. Two trained reviewers independently assessed tibial and femoral component mechanical alignment measurements in a standardized manner on postoperative full-leg AP and lateral radiographs. The primary outcome was mean absolute degrees of difference for each measurement compared to intraoperative CAS measurements. Outcomes were reported as means standard deviation.Results: 38%(N=43/112) of patients were male. Mean age was 698 years and mean BMI was 31.15.9. 71%(N=79/112) of patients had a well-aligned TKA (HKA within 3).The mean absolute difference was 1.51.2 for femoral coronal alignment, 1.00.8 for tibial coronal alignment, 2.21.5 for femoral flexion, and 1.81.6 for tibial slope.Two patients(1.8%) underwent reoperation; specifically, 1 patient received a 1-stage revision for periprosthetic joint infection 5 months postoperatively and the other underwent lysis of adhesions 9 months postoperatively for arthrofibrosis.Conclusions: This novel imageless CAS provides accurate readings within 2 for tibial and femoral coronal and sagittal alignment, and patients have low complication rates at early follow-up.
{"title":"Validation of an Imageless Optical Computer-assisted Navigation System for Total Knee Arthroplasty","authors":"William Xiang, E. Windsor, Shei-Shen Wang, A. Inglis, P. Sculco","doi":"10.29007/tdcj","DOIUrl":"https://doi.org/10.29007/tdcj","url":null,"abstract":"Background: Restoration of the hip-knee-ankle (HKA) angle to within 3 of the neutral mechanical axis is considered a well-aligned total knee arthroplasty (TKA), with outliers associated with higher failure rates. Thus, efforts to improve intraoperative surgical accuracy are of strong clinical interest. This study evaluated the accuracy and safety of a novel, imageless, computer-assisted navigation system (CAS) for TKA.Methods: 112 consecutive patients who underwent primary TKA between January-December 2020 with 2 board-certified, high-volume orthopedic surgeons using the same imageless CAS were retrospectively reviewed. Patient age, BMI, sex, postoperative complications, and reoperations were collected. Two trained reviewers independently assessed tibial and femoral component mechanical alignment measurements in a standardized manner on postoperative full-leg AP and lateral radiographs. The primary outcome was mean absolute degrees of difference for each measurement compared to intraoperative CAS measurements. Outcomes were reported as means standard deviation.Results: 38%(N=43/112) of patients were male. Mean age was 698 years and mean BMI was 31.15.9. 71%(N=79/112) of patients had a well-aligned TKA (HKA within 3).The mean absolute difference was 1.51.2 for femoral coronal alignment, 1.00.8 for tibial coronal alignment, 2.21.5 for femoral flexion, and 1.81.6 for tibial slope.Two patients(1.8%) underwent reoperation; specifically, 1 patient received a 1-stage revision for periprosthetic joint infection 5 months postoperatively and the other underwent lysis of adhesions 9 months postoperatively for arthrofibrosis.Conclusions: This novel imageless CAS provides accurate readings within 2 for tibial and femoral coronal and sagittal alignment, and patients have low complication rates at early follow-up.","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131002929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Spine Cobot System (eCential Robotics, France) is a new platform which unifies 2D/3D imaging, navigation and a robotic arm. The intent is to increase patient and surgeon safety without adding time or complexity to the surgical workflow. The primary endpoint of this cadaveric trial is to assess the precision and safety of pedicular screw positioning. The secondary endpoint is to confirm the system’s usability by the operative team. The Spine Cobot System is composed of a C-arm, a station which includes the software, an infrared camera and a collaborative robotic arm (cobot). Screw placement and neural safety were assessed. Precision of screw placement was determined by comparing the final 3D acquisition to the surgeon’s planned trajectory. Safety was quantified by 3 blinded surgeons using the Gertzbein-Robbins classification. Additionally, the usability of the integrated system for spine surgery was assessed. A system evaluation was performed in compliance with international standards (IEC, FDA). Three experienced surgeons placed 90 pedicular screws in 3 prone cadavers. 100% (90/90) of the screws were accurately placed according to the Gertzbein-Robbins classification. 97% (87/90) were classified as Grade 0 and 3% (3/90) as Grade 1. The average pilot hole middle point distance deviation is 1.3mm±0.88 mm. The average pilot hole angular deviation is 0.6°±0.6°. Only 2 usability errors were observed during the workflow assessment, and none was critical for patient safety. This preliminary study shows the efficiency of the system for pedicular screw placement, with precision and safety results. This confirms the functionality of a unified system for usability and effectiveness.
{"title":"Evaluation of a New Unified Robotic Platform: a Cadaver Study","authors":"N. Lonjon, G. Cavalié, J. Sledge, M. Boudissa","doi":"10.29007/v4g5","DOIUrl":"https://doi.org/10.29007/v4g5","url":null,"abstract":"The Spine Cobot System (eCential Robotics, France) is a new platform which unifies 2D/3D imaging, navigation and a robotic arm. The intent is to increase patient and surgeon safety without adding time or complexity to the surgical workflow. The primary endpoint of this cadaveric trial is to assess the precision and safety of pedicular screw positioning. The secondary endpoint is to confirm the system’s usability by the operative team. The Spine Cobot System is composed of a C-arm, a station which includes the software, an infrared camera and a collaborative robotic arm (cobot). Screw placement and neural safety were assessed. Precision of screw placement was determined by comparing the final 3D acquisition to the surgeon’s planned trajectory. Safety was quantified by 3 blinded surgeons using the Gertzbein-Robbins classification. Additionally, the usability of the integrated system for spine surgery was assessed. A system evaluation was performed in compliance with international standards (IEC, FDA). Three experienced surgeons placed 90 pedicular screws in 3 prone cadavers. 100% (90/90) of the screws were accurately placed according to the Gertzbein-Robbins classification. 97% (87/90) were classified as Grade 0 and 3% (3/90) as Grade 1. The average pilot hole middle point distance deviation is 1.3mm±0.88 mm. The average pilot hole angular deviation is 0.6°±0.6°. Only 2 usability errors were observed during the workflow assessment, and none was critical for patient safety. This preliminary study shows the efficiency of the system for pedicular screw placement, with precision and safety results. This confirms the functionality of a unified system for usability and effectiveness.","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127341589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Hoeffel, L. Goldstein, K. Michnacs, J. Ruppenkamp, Manoranjith Anandan, C. Holy
Introduction: Primary robotic total knee arthroplasty (TKA) is associated with favorable outcomes. To further understand robotic TKA learning curve, we evaluated early postoperative outcomes of robotics vs. manual TKA, based on surgeon experience. Methods: Patients (> 64 years) from the Medicare database, with primary, unilateral, elective TKA (“index”) from October 2015 to December 2019 were identified and categorized based on robotic vs. manual surgery, and surgeon experience: low-count surgeons had < 40 cases in the 12-months pre-index; medium-low, medium- high and high count surgeons had 41-80, 81-120 and 121-160 cases, respectively. The low-count robotic cohort (RC) was compared to the low, medium-low, medium-high, and high count manual cohort (MC) for the length of the hospital stay (LOS), and rates of home and skilled nursing facility (SNF) discharge. Descriptive statistics (means and proportion with 95% confidence intervals) were performed. Results: 296 low-count robotic cases were compared to 209,494 low-count manual and 252,905 medium-low, medium-high and high-count manual cases. The low-count RC had an average LOS of 2.03 days (95% confidence intervals (CI): 1.86-2.20) vs. 2.20 days (95%CI: 2.20-2.21) for the low-count MC. 82.4% patients (95%CI: 78.1%-86.8%) from the low-count RC were discharged home vs. 74.2% (95%CI: 74.0%-74.4%) in the low-count MC and 83.6% (95%CI: 83.3%-84.0%) in the high-count MC. Discharge to SNF affected 15.2% (95%CI: 11.1%-19.3%) in the low-count RC vs. 21.0% (95%CI: 20.9%-21.2%) and 15.2% (95%CI: 14.9%-15.4%) in the low-count and medium-high MC, respectively. Conclusion: Patients operated with robotic surgery by surgeons with low yearly volume had a LOS and probability of home discharge similar to that of patients operated with manual surgery by high-volume surgeons. Patients in the robotic group also had a lower rate of SNF discharge compared to the patients in the manual surgery group, with surgeons of similar experience.
{"title":"Early post-operative outcomes following robotic vs. manual total knee arthroplasty in low- vs. high-volume surgeons.","authors":"D. Hoeffel, L. Goldstein, K. Michnacs, J. Ruppenkamp, Manoranjith Anandan, C. Holy","doi":"10.29007/cxql","DOIUrl":"https://doi.org/10.29007/cxql","url":null,"abstract":"Introduction: Primary robotic total knee arthroplasty (TKA) is associated with favorable outcomes. To further understand robotic TKA learning curve, we evaluated early postoperative outcomes of robotics vs. manual TKA, based on surgeon experience. Methods: Patients (> 64 years) from the Medicare database, with primary, unilateral, elective TKA (“index”) from October 2015 to December 2019 were identified and categorized based on robotic vs. manual surgery, and surgeon experience: low-count surgeons had < 40 cases in the 12-months pre-index; medium-low, medium- high and high count surgeons had 41-80, 81-120 and 121-160 cases, respectively. The low-count robotic cohort (RC) was compared to the low, medium-low, medium-high, and high count manual cohort (MC) for the length of the hospital stay (LOS), and rates of home and skilled nursing facility (SNF) discharge. Descriptive statistics (means and proportion with 95% confidence intervals) were performed. Results: 296 low-count robotic cases were compared to 209,494 low-count manual and 252,905 medium-low, medium-high and high-count manual cases. The low-count RC had an average LOS of 2.03 days (95% confidence intervals (CI): 1.86-2.20) vs. 2.20 days (95%CI: 2.20-2.21) for the low-count MC. 82.4% patients (95%CI: 78.1%-86.8%) from the low-count RC were discharged home vs. 74.2% (95%CI: 74.0%-74.4%) in the low-count MC and 83.6% (95%CI: 83.3%-84.0%) in the high-count MC. Discharge to SNF affected 15.2% (95%CI: 11.1%-19.3%) in the low-count RC vs. 21.0% (95%CI: 20.9%-21.2%) and 15.2% (95%CI: 14.9%-15.4%) in the low-count and medium-high MC, respectively. Conclusion: Patients operated with robotic surgery by surgeons with low yearly volume had a LOS and probability of home discharge similar to that of patients operated with manual surgery by high-volume surgeons. Patients in the robotic group also had a lower rate of SNF discharge compared to the patients in the manual surgery group, with surgeons of similar experience.","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130145197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mismatch between the patient’s knee morphology and the implant geometry is linked to poorer clinical outcome after total knee arthroplasty (TKA). Hence, patients whose knee morphology differs strongly from the norm may have a higher risk to be dissatisfied after surgery. Consequently, a preoperative risk assessment regarding differences between individual knee morphology and implant geometry is favorable. For adequate availability and limited radiation dose, this should be based on standard imaging in TKA, being conventional radiographs.We reviewed morphological measures of the knee to be evaluated on X-ray images. Only measures of the articulating areas, without connections to pathologies such as patellar instability or pain, were included. In addition, the accuracy of 2D-3D knee reconstruction was reviewed, in order to assess the potential use for 3D X-ray based analysis.Various parameter definitions for the evaluation on anterior-posterior and lateral X-rays exist in the literature. If given, the inter- and intraobserver reliability can be interpreted as moderate to excellent. Several authors have reported on 2D-3D reconstruction accuracies with maximum absolute errors of ~5-6 mm for in vitro studies.Mismatch between the bone morphology implant geometry can partly be assessed in 2D, using single X-rays. Methods for 2D-3D reconstruction demonstrated potential for enabling 3D X ray-based analyses. However, improvements regarding accuracy and larger in vivo validation studies are pending.A basic preoperative risk assessment using X-rays is possible. Future steps could include the automation of the parameter derivation and an enhancement of 2D-3D reconstruction for enabling a more comprehensive assessment.
{"title":"X-ray based morphological analysis of the knee - a review","authors":"Sonja Grothues, K. Radermacher","doi":"10.29007/sqcb","DOIUrl":"https://doi.org/10.29007/sqcb","url":null,"abstract":"Mismatch between the patient’s knee morphology and the implant geometry is linked to poorer clinical outcome after total knee arthroplasty (TKA). Hence, patients whose knee morphology differs strongly from the norm may have a higher risk to be dissatisfied after surgery. Consequently, a preoperative risk assessment regarding differences between individual knee morphology and implant geometry is favorable. For adequate availability and limited radiation dose, this should be based on standard imaging in TKA, being conventional radiographs.We reviewed morphological measures of the knee to be evaluated on X-ray images. Only measures of the articulating areas, without connections to pathologies such as patellar instability or pain, were included. In addition, the accuracy of 2D-3D knee reconstruction was reviewed, in order to assess the potential use for 3D X-ray based analysis.Various parameter definitions for the evaluation on anterior-posterior and lateral X-rays exist in the literature. If given, the inter- and intraobserver reliability can be interpreted as moderate to excellent. Several authors have reported on 2D-3D reconstruction accuracies with maximum absolute errors of ~5-6 mm for in vitro studies.Mismatch between the bone morphology implant geometry can partly be assessed in 2D, using single X-rays. Methods for 2D-3D reconstruction demonstrated potential for enabling 3D X ray-based analyses. However, improvements regarding accuracy and larger in vivo validation studies are pending.A basic preoperative risk assessment using X-rays is possible. Future steps could include the automation of the parameter derivation and an enhancement of 2D-3D reconstruction for enabling a more comprehensive assessment.","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131085038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Van Overschelde, P. Vansintjan, P. Byn, Cynthia Lapierre, Wouter Van Lysebettens
AIMS: The Pixee Knee+ system offers intraoperative assistance through augmented reality glasses. This allows the surgeon to see the tibial and femoral axis depicted on the surgical field, providing real-time information during surgery.METHODS: 122 patients received TKA surgery with the Pixee Knee+ system, and were matched based on gender and age to 122 patients who received conventional surgery. PROMs (Oxford knee Score, KOOS, and Forgotten Joint score) were collected preoperatively, at 6 weeks and 3 months. The difference between the scores at 6 weeks versus preoperative (Delta) was analyzed over time of surgery, in order to evaluate any possible surgeon learning curve.RESULTS: Pixee patients scored significantly lower on the symptoms sub-scale of the KOOS score at 6 weeks. Similarly, at 3 months, the Quality of life sub-score, Forgotten Joint score and Oxford Knee Score were all significantly worse for the Pixee group. When analyzing the Delta KOOS over time, a clear increase in the linear model could be established for the Pixee group, whereas the Delta KOOS outcomes in the conventional group remained at a plateau.CONCLUSION: The use of the Pixee Knee+ system results in an initial inferior clinical outcome when comparing the average of the two groups. This is likely explained by a learning curve, which shows an increase over time of the Delta KOOS at 6 weeks in the Pixee group. To what extent this increase over time will persist remains to be investigated
{"title":"Does augmented reality improve clinical outcome in TKA? A prospective observational report.","authors":"P. Van Overschelde, P. Vansintjan, P. Byn, Cynthia Lapierre, Wouter Van Lysebettens","doi":"10.29007/wt68","DOIUrl":"https://doi.org/10.29007/wt68","url":null,"abstract":"AIMS: The Pixee Knee+ system offers intraoperative assistance through augmented reality glasses. This allows the surgeon to see the tibial and femoral axis depicted on the surgical field, providing real-time information during surgery.METHODS: 122 patients received TKA surgery with the Pixee Knee+ system, and were matched based on gender and age to 122 patients who received conventional surgery. PROMs (Oxford knee Score, KOOS, and Forgotten Joint score) were collected preoperatively, at 6 weeks and 3 months. The difference between the scores at 6 weeks versus preoperative (Delta) was analyzed over time of surgery, in order to evaluate any possible surgeon learning curve.RESULTS: Pixee patients scored significantly lower on the symptoms sub-scale of the KOOS score at 6 weeks. Similarly, at 3 months, the Quality of life sub-score, Forgotten Joint score and Oxford Knee Score were all significantly worse for the Pixee group. When analyzing the Delta KOOS over time, a clear increase in the linear model could be established for the Pixee group, whereas the Delta KOOS outcomes in the conventional group remained at a plateau.CONCLUSION: The use of the Pixee Knee+ system results in an initial inferior clinical outcome when comparing the average of the two groups. This is likely explained by a learning curve, which shows an increase over time of the Delta KOOS at 6 weeks in the Pixee group. To what extent this increase over time will persist remains to be investigated","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116044251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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