Pub Date : 2016-01-01DOI: 10.1080/24699322.2016.1249959
S. Khuangsirikul, Kreangsak Lekkreusuwan, T. Chotanaphuti
Abstract Background: Both minimally invasive surgery (MIS) and computer-assisted surgery (CAS) in total knee arthroplasty have been scientifically linked with surgical benefits. However, the long-term results of these techniques are still controversial. Most surgeons assessed the surgical outcomes with regard to knee alignment and range of motion, but these factors may not reflect subjective variables, namely patient satisfaction. Purpose: To compare satisfaction and functional outcomes between two technical procedures in MIS total knee arthroplasty, namely computer-assisted MIS and conventional MIS procedure, operated on a sample group of patients after 10 years. Methods: Seventy cases of posterior-stabilized total knee prostheses were implanted using a computer-assisted system and were compared to 74 cases of matched total knee prostheses of the same implant using conventional technique. Both groups underwent arthrotomy by 2 cm limited quadriceps exposure minimally invasive surgery (2 cm Quad MIS). At an average of 10 years after surgery, self-administered patient satisfaction and WOMAC scales were administered and analyzed. Results: Demographic data of both groups including sex, age, preoperative WOMAC and post-operative duration were not statistically different. Post-operative WOMAC for the computer-assisted group was 38.94 ± 5.68, while the conventional one stood at 37.89 ± 6.22. The median of self-administered patient satisfaction scales of the computer-assisted group was 100 (min37.5–max100), while the conventional one was 100 (min25–max100). p Value was 0.889. There was one re-operative case in the conventional MIS group due to peri-prosthetic infection which was treated with debridement, polyethylene exchanged and intravenous antibiotics. Conclusions: The 10-year outcomes of computer-assisted MIS total knee arthroplasty are not superior to that of the conventional MIS technique in function and patient satisfaction. 10 years may not be enough to show the difference between these two techniques.
背景:在全膝关节置换术中，微创手术(MIS)和计算机辅助手术(CAS)都与手术益处有科学联系。然而，这些技术的长期结果仍然存在争议。大多数外科医生评估手术结果时都考虑到膝关节对齐和活动范围，但这些因素可能不能反映主观变量，即患者满意度。目的:比较计算机辅助MIS和传统MIS两种MIS全膝关节置换术的满意度和功能结果。方法:采用计算机辅助系统植入70例后稳定型全膝关节假体，并与74例相同假体采用常规技术匹配的全膝关节假体进行比较。两组均行2 cm有限四头肌暴露微创手术(2 cm Quad MIS)关节切开术。术后平均10年，对患者自我满意度和WOMAC量表进行分析。结果:两组性别、年龄、术前WOMAC、术后时间等人口学数据差异无统计学意义。计算机辅助组术后WOMAC为38.94±5.68，常规组为37.89±6.22。计算机辅助组自我给药患者满意度量表中位数为100 (min37.5-max100)，常规组为100 (min25-max100)。p值为0.889。常规MIS组1例因假体周围感染再手术，行清创、聚乙烯置换及静脉注射抗生素治疗。结论:计算机辅助MIS全膝关节置换术的10年结果在功能和患者满意度方面并不优于传统MIS技术。10年可能不足以显示这两种技术之间的差异。
{"title":"10-Year patient satisfaction compared between computer-assisted navigation and conventional techniques in minimally invasive surgery total knee arthroplasty","authors":"S. Khuangsirikul, Kreangsak Lekkreusuwan, T. Chotanaphuti","doi":"10.1080/24699322.2016.1249959","DOIUrl":"https://doi.org/10.1080/24699322.2016.1249959","url":null,"abstract":"Abstract Background: Both minimally invasive surgery (MIS) and computer-assisted surgery (CAS) in total knee arthroplasty have been scientifically linked with surgical benefits. However, the long-term results of these techniques are still controversial. Most surgeons assessed the surgical outcomes with regard to knee alignment and range of motion, but these factors may not reflect subjective variables, namely patient satisfaction. Purpose: To compare satisfaction and functional outcomes between two technical procedures in MIS total knee arthroplasty, namely computer-assisted MIS and conventional MIS procedure, operated on a sample group of patients after 10 years. Methods: Seventy cases of posterior-stabilized total knee prostheses were implanted using a computer-assisted system and were compared to 74 cases of matched total knee prostheses of the same implant using conventional technique. Both groups underwent arthrotomy by 2 cm limited quadriceps exposure minimally invasive surgery (2 cm Quad MIS). At an average of 10 years after surgery, self-administered patient satisfaction and WOMAC scales were administered and analyzed. Results: Demographic data of both groups including sex, age, preoperative WOMAC and post-operative duration were not statistically different. Post-operative WOMAC for the computer-assisted group was 38.94 ± 5.68, while the conventional one stood at 37.89 ± 6.22. The median of self-administered patient satisfaction scales of the computer-assisted group was 100 (min37.5–max100), while the conventional one was 100 (min25–max100). p Value was 0.889. There was one re-operative case in the conventional MIS group due to peri-prosthetic infection which was treated with debridement, polyethylene exchanged and intravenous antibiotics. Conclusions: The 10-year outcomes of computer-assisted MIS total knee arthroplasty are not superior to that of the conventional MIS technique in function and patient satisfaction. 10 years may not be enough to show the difference between these two techniques.","PeriodicalId":56051,"journal":{"name":"Computer Assisted Surgery","volume":"21 1","pages":"172 - 175"},"PeriodicalIF":2.1,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24699322.2016.1249959","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60126123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background: The use of reconstruction plates and lag screws has been recommended for fractures to the posterior wall of the acetabulum. However, little information about the rigidity of recommended forms of fracture fixation is available. This study aimed to evaluate the biomechanical difference among the fixation systems. Methods: A posterior wall fracture, which is represented by softer elements with lower elastic modulus, was created along an arc of 40–90° about the acetabular rim. Three different fixation systems: screws alone, reconstruction plate with screws, reconstruction plate with T-shaped plates were used to fix the posterior wall fractures to the acetabulum. Results: All three fixation system can be used to obtain good functional outcomes. The reconstruction plate with T-shaped plates was beneficial to increasing the effective stiffness, decreasing the stress concentration and enhancing the rigidity of fracture fixation. So this fixation system served an ideal result in the analysis. Conclusion: Theoretically, the reconstruction plate with T-shaped plates system may reduce many of the risks and limitations compared to the other fixation systems. This fixation system may result in a clinical benefit.
{"title":"Biomechanical comparison of fixation systems in posterior wall fracture of acetabular by finite element analysis","authors":"Jianyin Lei, Hai-bo Liu, Zhiqiang Li, Zhihua Wang, Ximing Liu, Longmao Zhao","doi":"10.1080/24699322.2016.1218052","DOIUrl":"https://doi.org/10.1080/24699322.2016.1218052","url":null,"abstract":"Abstract Background: The use of reconstruction plates and lag screws has been recommended for fractures to the posterior wall of the acetabulum. However, little information about the rigidity of recommended forms of fracture fixation is available. This study aimed to evaluate the biomechanical difference among the fixation systems. Methods: A posterior wall fracture, which is represented by softer elements with lower elastic modulus, was created along an arc of 40–90° about the acetabular rim. Three different fixation systems: screws alone, reconstruction plate with screws, reconstruction plate with T-shaped plates were used to fix the posterior wall fractures to the acetabulum. Results: All three fixation system can be used to obtain good functional outcomes. The reconstruction plate with T-shaped plates was beneficial to increasing the effective stiffness, decreasing the stress concentration and enhancing the rigidity of fracture fixation. So this fixation system served an ideal result in the analysis. Conclusion: Theoretically, the reconstruction plate with T-shaped plates system may reduce many of the risks and limitations compared to the other fixation systems. This fixation system may result in a clinical benefit.","PeriodicalId":56051,"journal":{"name":"Computer Assisted Surgery","volume":"21 1","pages":"117 - 126"},"PeriodicalIF":2.1,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24699322.2016.1218052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60126202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1080/24699322.2016.1199736
R. Khare, B. Jaramaz
Abstract Unicondylar Knee Replacement (UKR) is an orthopedic surgical procedure to reduce pain and improve function in the knee. Load-bearing long-standing antero-posterior (AP) radiographs are typically used postoperatively to measure the leg alignment and assess the varus/valgus implant orientation. However, implant out-of-plane rotations, user variability, and X-ray acquisition parameters introduce errors in the estimation of the implant varus/valgus estimation. Previous work has explored the accuracy of various imaging modalities in this estimation. In this work, we explored the impact of out-of-plane rotations and X-ray acquisition parameters on the estimation of implant component varus/valgus angles. For our study, we used a single CT scan and positioned femoral and tibial implants under varying orientations within the CT volume. Then, a custom software application was used to obtain digitally reconstructed radiographs from the CT scan with implants under varying orientations. Two users were then asked to manually estimate the varus/valgus angles for the implants. We found that there was significant inter-user variability (p < 0.05) in the varus/valgus estimates for the two users. However, the ‘ideal’ measurements, obtained using actual implant orientations, showed small errors due to variations in implant orientation. We also found that variation in the projection center does not have a statistically significant impact (p < 0.01) on the estimation of implant varus/valgus angles. We conclude that manual estimates of UKR implant varus/valgus orientations are unreliable.
{"title":"Accuracy of estimating Unicondylar Knee Replacement implant varus/valgus angles from antero-posterior radiographs","authors":"R. Khare, B. Jaramaz","doi":"10.1080/24699322.2016.1199736","DOIUrl":"https://doi.org/10.1080/24699322.2016.1199736","url":null,"abstract":"Abstract Unicondylar Knee Replacement (UKR) is an orthopedic surgical procedure to reduce pain and improve function in the knee. Load-bearing long-standing antero-posterior (AP) radiographs are typically used postoperatively to measure the leg alignment and assess the varus/valgus implant orientation. However, implant out-of-plane rotations, user variability, and X-ray acquisition parameters introduce errors in the estimation of the implant varus/valgus estimation. Previous work has explored the accuracy of various imaging modalities in this estimation. In this work, we explored the impact of out-of-plane rotations and X-ray acquisition parameters on the estimation of implant component varus/valgus angles. For our study, we used a single CT scan and positioned femoral and tibial implants under varying orientations within the CT volume. Then, a custom software application was used to obtain digitally reconstructed radiographs from the CT scan with implants under varying orientations. Two users were then asked to manually estimate the varus/valgus angles for the implants. We found that there was significant inter-user variability (p < 0.05) in the varus/valgus estimates for the two users. However, the ‘ideal’ measurements, obtained using actual implant orientations, showed small errors due to variations in implant orientation. We also found that variation in the projection center does not have a statistically significant impact (p < 0.01) on the estimation of implant varus/valgus angles. We conclude that manual estimates of UKR implant varus/valgus orientations are unreliable.","PeriodicalId":56051,"journal":{"name":"Computer Assisted Surgery","volume":"12 1","pages":"80 - 84"},"PeriodicalIF":2.1,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24699322.2016.1199736","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60126072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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