Augmented reality-based navigation system applied to tibial bone resection in total knee arthroplasty

Tsukada, Sachiyuki; Ogawa, Hiroyuki; Nishino, Masami; Kurosaka, Kenji; Hirasawa, Naoyuki

doi:10.1186/s40634-019-0212-6

Cited by 42 publications

(51 citation statements)

References 25 publications

(29 reference statements)

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“…However, they did not evaluate any femur or tibia resection. The latter reported by Tsukada et al [ 11 ] reported a pilot study using sawbones where authors suggested that the AR may provide reliable accuracy for coronal, sagittal, and rotational alignment in tibial bone resection during total knee arthroplasty.…”

Section: Resultsmentioning

confidence: 99%

The use of augmented reality for limb and component alignment in total knee arthroplasty: systematic review of the literature and clinical pilot study

et al. 2021

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Purpose A systematic review of the literature has been carried out to assess the actual evidence of the use of augmented reality in total knee arthroplasty (TKA). We then conducted a pilot clinical study to examine the accuracy of the Knee + augmented reality navigation in performing TKA. The present augmented reality (AR) system allows the surgeon to view the tibial and femur axis superimposed on the surgical field through the smart glasses. It provides real-time information during surgery and intraoperative feedback. Methods A systematic review of the PubMed, MEDLINE, and Embase databases up to May 2021 using the keywords “augmented reality”, “knee arthroplasty”, “computer assisted surgery”, “navigation knee arthroplasty” was performed by two independent reviewers. We performed five TKAs using the Knee + system. Patients were 4 females, with mean age of 76.4 years old (range 73–79) and mean Body Max Index (BMI) of 31.9 kg/m2 (range 27–35). The axial alignment of the limb and the orientation of the components were evaluated on standardized pre and postoperative full leg length weight-bearing radiographs, anteroposterior radiographs, and lateral radiographs of the knee. The time of tourniquet was recorded. The perception of motion sickness was assessed by Virtual Reality Sickness Questionnaire (VRSQ) subjected to surgeon immediately after surgery. Results After duplicate removal, a total of 31 abstracts were found. However, only two studies concerned knee arthroplasty. Unfortunately, both were preclinical studies. Knee + system is able to perform a cutting error of less than 1° of difference about coronal alignment of femur and tibia and less than 2° about flexion/extension of femur and posterior tibial slope. The absolute differences between the values obtained during surgery and the measurement of varus femur, varus tibia, posterior slope, and femur flexion angle on post-operative radiographs were 0.6° ± 1.34°, 0.8° ± 0.84°, 0.8° ± 1.79°, and 0.4 mm ± 0.55 mm, respectively. Conclusions On light of our preliminary results, the Knee + system is accurate and effective to perform TKA. The translation from pilot study to high-level prospective studies is warranted to assess accuracy and cost-effective analysis compared to conventional techniques. Level of evidence IV

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Section: Resultsmentioning

confidence: 99%

The use of augmented reality for limb and component alignment in total knee arthroplasty: systematic review of the literature and clinical pilot study

et al. 2021

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“…We performed CT of the resected Sawbones and measured the varus/valgus angle in the coronal plane and flexion/extension angle in the sagittal plane using computer software (ZedKnee; LEXI) 9 . To measure these angles, we established a 3-D coordinate system according to the following definition: (1) the x axis refers to the line connecting the sulcus of the medial epicondyle and the most prominent point of the lateral epicondyle, (2) the y axis refers to a line perpendicular to the plane formed by the center of the femoral head and the midpoint of the mediolateral width of the resected distal part of the femur, and (3) the z axis refers to a line perpendicular to both the x and y axes.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, the AR-KNEE system does not require any preoperative imaging studies. Although the AR-KNEE system was shown to be accurate to within <1° in both coronal and sagittal planes in resection of the proximal part of the tibia 9 , there have been no studies to date assessing the accuracy of this system in distal femoral resection.…”

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confidence: 99%

Augmented Reality-Assisted Femoral Bone Resection in Total Knee Arthroplasty

et al. 2021

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Background: An augmented reality (AR)-based navigation system allows visualization of the center of the femoral head and femoral mechanical axis superimposed on the surgical field during total knee arthroplasty (TKA) and may help surgeons to improve the accuracy of distal femoral resection. Methods: First, we resected 10 femoral Sawbones specimens using the AR-based navigation system and performed computed tomography (CT) to measure the resection angle of the distal part of the femur. We calculated the absolute values of the differences between angles measured using CT images and angles displayed on the smartphone screen of the navigation system. Second, we measured coronal alignment using standing long-leg radiographs for 72 patients undergoing TKA and compared the error in the resection angle between TKA using the AR-based navigation system and that using a conventional intramedullary guide. Results: In the experimental study, the absolute values of the differences between angles measured on CT images and angles displayed using the AR-based navigation system were 0.8° ± 0.5° (range, 0.3° to 1.9°) in the coronal plane and 0.6° ± 0.5° (range, 0.0° to 1.4°) in the sagittal plane. In the clinical study, the mean absolute value of the error in coronal alignment was significantly smaller in the AR-based navigation group than the intramedullary-guide group (1.1° ± 1.0° [range, 0.0° to 3.2°] compared with 2.2° ± 1.6° [range, 0.0° to 5.5°], respectively; 95% confidence interval, 0.5° to 1.8°; p < 0.001). Conclusions: The AR-based navigation system may enable surgeons to perform distal femoral resection more accurately than with the conventional intramedullary guide during TKA. Clinical Relevance: This study validates the use of AR technology to enhance the precision of bone resection in TKA.

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“…In arthroplasty, exact implantation of the prosthetic components with respect to the patient’s anatomy is a main contributor to successful outcomes, functional recovery, and longevity [ 32 , 34 , 36 ]. Three studies performed on sawbones evaluated AR navigation of arthroplasties as more accurate than free-hand procedures in hip [ 32 , 36 ] and knee surgery [ 33 ].…”

Section: Clinical Applications Of Armentioning

confidence: 99%

“…The AR method was faster 1.8 ± 0.25 vs 3.9 ± 1.6 minute; p < .01. sawbone Tsukada et al 2019[ 33 ] Arthroplasty (knee) Navigation for tibial bone resection markers attached to bone and instruments Monitor The results presented comparable accuracy of this AR system for bone resection compared to conventional navigation systems (not specified). The study tested a proof of concept and is not recommended for clinical use at this state of the system by the authors.…”

Section: Introductionmentioning

confidence: 97%

Augmented Reality in Orthopedic Surgery Is Emerging from Proof of Concept Towards Clinical Studies: a Literature Review Explaining the Technology and Current State of the Art

Casari

Navab

Hruby

et al. 2021

Curr Rev Musculoskelet Med

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Purpose of Review Augmented reality (AR) is becoming increasingly popular in modern-day medicine. Computer-driven tools are progressively integrated into clinical and surgical procedures. The purpose of this review was to provide a comprehensive overview of the current technology and its challenges based on recent literature mainly focusing on clinical, cadaver, and innovative sawbone studies in the field of orthopedic surgery. The most relevant literature was selected according to clinical and innovational relevance and is summarized. Recent Findings Augmented reality applications in orthopedic surgery are increasingly reported. In this review, we summarize basic principles of AR including data preparation, visualization, and registration/tracking and present recently published clinical applications in the area of spine, osteotomies, arthroplasty, trauma, and orthopedic oncology. Higher accuracy in surgical execution, reduction of radiation exposure, and decreased surgery time are major findings presented in the literature. Summary In light of the tremendous progress of technological developments in modern-day medicine and emerging numbers of research groups working on the implementation of AR in routine clinical procedures, we expect the AR technology soon to be implemented as standard devices in orthopedic surgery.

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Augmented reality-based navigation system applied to tibial bone resection in total knee arthroplasty

Cited by 42 publications

References 25 publications

The use of augmented reality for limb and component alignment in total knee arthroplasty: systematic review of the literature and clinical pilot study

The use of augmented reality for limb and component alignment in total knee arthroplasty: systematic review of the literature and clinical pilot study

Augmented Reality-Assisted Femoral Bone Resection in Total Knee Arthroplasty

Augmented Reality in Orthopedic Surgery Is Emerging from Proof of Concept Towards Clinical Studies: a Literature Review Explaining the Technology and Current State of the Art

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