Computer Assisted Navigation in Knee Arthroplasty

Bae, Dae Kyung; Song, Sang Jun

doi:10.4055/cios.2011.3.4.259

Cited by 116 publications

(89 citation statements)

References 35 publications

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“…Although, CAS has been shown to improve MA over CI, it is also associated with disadvantages like increased surgical time, expensive instrumentation, steep learning curve, higher number of personnel required and higher infection rates [13,14] . Patient specific blocks (PSB) were introduced as an alternative to CAS and CI, with the goal of improving postoperative alignment, implant positioning and overcoming the shortcomings associated with the CAS and CI.…”

Section: Introductionmentioning

confidence: 99%

Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

Vaishya

Vijay

Birla

et al. 2016

WJO

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AIM:To compare the postoperative mechanical alignment achieved after total knee arthroplasty (TKA) using computer tomography (CT) based patient specific blocks (PSB) to conventional instruments (CI). METHODS:Total 80 knees were included in the study, with 40 knees in both the groups operated using PSB and CI. All the knees were performed by a single surgeon using the same cruciate sacrificing implants. In our study we used CT based PSB to compare with CI. Postoperative mechanical femoro-tibial angle (MFT angle) was measured on long leg x-rays using picture archiving and communication system (PACS). We compared mechanical alignment achieved using PSB and CI in TKA using statistical analysis. RESULTS:The PSB group (group 1) included 17 females and seven males while in CI group (group 2) there were 15 females and eight males. The mean age of patients in group 1 was 60.5 years and in group 2 it was 60.2 years. The mean postoperative MFT angle measured on long-leg radiographs in group 1 was 178.23° (SD = 2.67°, range: 171.9° to 182.5°) while in group 2, the mean MFT angle was 175.73° (SD = 3.62°, range: 166.0° to 179.8°). There was significant improvement in postoperative mechanical alignment (P value = 0.001), in PSB group compared to CI. Number of outliers were also found to be less in group operated with PSB (7 Knee) compared to those operated with CI (17 Knee). Core tip: Computer tomography (CT) based patient specific blocks (PSB) can help restore the mechanical axis of the patients undergoing primary total knee replacement. In the present study, the PSB group had significantly better post-operative mechanical axis as compared to the conventional instrumentation group. CT based PSB holds promise to help in accurate restoration of the mechanical axis and might decrease the rates of revision after total knee arthroplasty.Vaishya R, Vijay V, Birla VP, Agarwal AK. Computerized tomography based "patient specific blocks" improve postoperative mechanical alignment in primary total knee arthroplasty. World J Orthop 2016; 7(7): 426-433 Available from:

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Section: Introductionmentioning

confidence: 99%

Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

Vaishya

Vijay

Birla

et al. 2016

WJO

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“…In addition, navigation allows for a more accurate and reproducible evaluation of component sizing, kinematics, and ligament balancing. 3 In the present case scenario, a numeric misinterpretation was suddenly encountered in the computer screen during the middle of the navigation surgery. Under such crucial circumstances the surgical team is subjected to heavy frustration, pressure and tend become clueless on not knowing which direction to proceed further.…”

Section: Discussionmentioning

confidence: 99%

A numerical misinterpretation in the computer screen during middle of the image free navigation assisted knee replacement-a dilemma of what to do next?

Selvanayagam¹,

Pfluger²

2017

Int J Res Med Sci

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Misinterpretation can occur during any step of navigation system. It is not only a dilemma for the orthopaedic surgeons on how to proceed further in such instances, but also a challenging situation to take a right call. We report here an unusual error encountered in image free Orthopilot navigation system during knee replacement surgery. A gross numerical measurement error occurred in the computer screen while femoral planning step in the tibia first technique, following which a dilemma persisted on how to proceed further. The system was reverted backwards, and the procedure was initiated again right from the beginning of the registration of bony landmarks, followed by completion of all other consecutive steps with the help of navigation system. The end result of the surgery was achieved at an accurate neutral mechanical axis with 5 degrees of maximum possible extension.

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“…Accordingly, the number of orthopedic surgeons using navigation techniques is also increasing. Although CAS has been found to improve surgery outcomes in patients undergoing total knee [21][22][23] or hip 24 replacements and to facilitate pedicle screw placement, 4,6-8 we are not aware of any study that evaluated the perception and effectiveness of CAS for the training of future orthopedic surgeons.…”

Section: Discussionmentioning

confidence: 99%

The use of computer-assisted surgery as an educational tool for the training of orthopedic surgery residents in pedicle screw placement: a pilot study and survey among orthopedic residents

Aoude

Alhamzah

Fortin

et al. 2016

cjs

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Background:The training of orthopedic residents in adequate pedicle screw placement is very important. We sought to investigate orthopedic residents' perspectives on the use of computer-assisted surgery (CAS) in a training trial. Methods:Orthopedic residents were randomly assigned to independently place a screw using the free-hand technique and the CAS technique on 1 of 3 cadavers (Cobb angles 5º, 15º and 67º) at randomly selected thoracolumbar vertebral levels. All residents were blinded to their colleagues' pedicle screw placements and were asked to complete a short questionnaire at the end of the session to evaluate their experience with CAS. We obtained CT images for each cadaver to assess pedicle screw placement accuracy and classified placement as A) screw completely in pedicle, B) screw < 2 mm outside pedicle, C) screw 2-4 mm outside pedicle, or D) screw > 4 mm outside pedicle.Results: Twenty-four orthopedic residents participated in this trial study. In total, 65% preferred using the free-hand technique in an educational setting even though most (60%) said that CAS is safer. The main reason for free-hand technique preference was the difficult technical aspects encountered with CAS. In addition, accuracy of pedicle screw placement in this trial showed that 5 screws were classified as A or B (safe zone) and 19 as grade C or D (unsafe zone) using the free-hand technique compared with 15 and 9, respectively, using CAS (p = 0.008). Conclusion:Orthopedic residents perceived CAS as safe and demonstrated improved accuracy in pedicle screw placement in a single setting. However, the residents preferred the free-hand technique in an educational stetting owing to the difficult technical aspects of CAS.Contexte : Il est très important d'apprendre aux médecins résidents en chirurgie orthopédique comment positionner adéquatement une vis pédiculaire. Notre objectif était d'obtenir l'opinion des médecins résidents sur le recours à la chirurgie assistée par ordinateur (CAO) dans un essai sur la formation. Méthodes :Des médecins résidents en chirurgie orthopédique répartis aléatoire-ment ont placé indépendamment une vis à l'aide d'une technique à main libre basée sur les repères topographiques et la palpation, et de la CAO dans 1 de 3 cadavres (angles de Cobb de 5°, 15° et 67°) dans une vertèbre dorsolombaire sélectionnée aléatoirement. Aucun des médecins résidents n'a pu observer le positionnement de la vis de ses collègues, et les participants ont rempli un court questionnaire à la fin de la séance pour évaluer leur expérience de la CAO. Nous avons obtenu un tomodensitogramme pour chaque cadavre afin d'évaluer la précision du positionnement de la vis pédiculaire, classée selon 4 catégories : A) vis entièrement dans le pédicule, B) vis < 2 mm hors du pédicule, C) vis de 2-4 mm hors du pédicule, ou D) vis > 4 mm hors du pédicule.Résultats : Vingt-quatre médecins résidents en chirurgie orthopédique ont participé à l'étude clinique. Au total, 65 % d'entre eux ont préféré utiliser la technique à main libre dans un contexte d...

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Computer Assisted Navigation in Knee Arthroplasty

Cited by 116 publications

References 35 publications

Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

A numerical misinterpretation in the computer screen during middle of the image free navigation assisted knee replacement-a dilemma of what to do next?

The use of computer-assisted surgery as an educational tool for the training of orthopedic surgery residents in pedicle screw placement: a pilot study and survey among orthopedic residents

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