bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usability and Accuracy assessment of an innovative low dose C-arm with 2D fluoroscopy, 3D imaging and real-time navigation in a single platform for spine surgery – a cadaveric experimentation
Authors: Sledge John , Lavallee Stephane , Genna Sophie , Chabanas Laurence 
Published: October 2019

IntroductionClinical benefits of intra-operative 3D imaging and surgical navigation are widely described in the literature. However, existing guidance systems are often reported as complex and time consuming1,2,4. The Surgivisio / eCential system is an innovative intra-operative C-arm combining 2D fluoroscopy, 3D imaging and real time navigation capabilities within unified an all-in-one platform3.The aim of this cadaveric experimentation is to evaluate the usability of the system, and to assess pedicle screw placement using this novel device.Material and methodsSurgivisio / eCential device offers an all-in-one solution with a unique workflow and user interface. The embodiment used here is dedicated to any spinal procedures requiring insertion of a trocar inside a pedicle.The usability of the system is assessed by measuring the ability of the user to navigate the trocar and place k-wires percutaneously inside a group of pedicles.The accuracy of screw placement is evaluated using post-operative 3D image of the implanted screw exported on an internally developed image visualization tool. The screw placement is assessed according to Gertzbein grading scale by the operator and two other evaluators.ResultsUsabilityFor each vertebrae group, fixation of the patient reference to the end of 3D reconstruction was done in less than 10 minutes. The percutaneous navigation and placement of 6 k-wires in a vertebrae group could be performed in 28 minutes for the first 2 groups and in 22 minutes for the third group.Pedicle screw implantation100% of screws was graded 0 on Gertzbein scale by all evaluators.
Improved Patient Satisfaction Following TKA Using Intraoperative Computer Technology to Obtain Accurate Gap Balancing
Authors: Smith Austin , Eccles Christian , Bhimani Samrath , Denehy Kevin , Bhimani Rohat , Smith Langan , Malkani Arthur 
Published: October 2019

Aims:Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA). Purpose of this study was to determine if patient satisfaction could be improved following TKA using computer technology to obtain the target alignment and precisely balanced gaps.Patients &amp; Methods:75 consecutive patients undergoing primary robotic-arm assisted TKA (RA-TKA) with real-time intraoperative alignment and gap balancing information were compared with a prospective cohort of 75 consecutive patients undergoing primary TKA with manual jig-based instruments during the same time period. There were no differences between groups with age, gender, BMI, and ASA scores. TKA’s were performed by a single surgeon using same implant design, anesthesia and surgical protocols. Patient satisfaction survey using Knee Society (KSS) and Likert scoring system was obtained at 1-year follow-up.Results:Likert scoring system demonstrated 95% of patients in the computer technology group were either very satisfied or satisfied versus 75% in the manual instruments TKA group (p=0.005) at 1-year follow-up. Second question of the KSS which deals with pain at rest was significantly better in RA-TKA group (p=0.04). Fifth question which deals with recreational activities was also significantly improved in the RA-TKA group, p=0.02. RA-TKA group had a better average overall satisfaction score of 7.1 versus 6.4 in the manual instrument group, p=0.03.Conclusion:Using intraoperative computer technology to achieve the target alignment with flexion/extension gap balancing to within 1mm, a significant improvement in patient satisfaction was demonstrated compared to TKA using conventional manual jig-based instruments.
Total Hip Arthroplasty in Patients Younger than 35 Is Effective Regardless of Surgical Approach
Authors: Luthringer Tyler , Novikov David , Gabor Jonathan , Rudy Hayeem , Cizmic Zlatan , Mahure Siddharth , Schwarzkopf Ran , Davidovitch Roy , Vigdorchik Jonathan 
Published: October 2019

PURPOSE: Indications for total hip arthroplasty (THA) are expanding to include increasingly younger patients, yet limited outcomes research has focused on this population. This study compares outcomes between the anterior and posterior approach, as well as between conventional and technology-assisted THA in patients under 35-years of age.METHODS: Retrospective analysis of 139 primary THAs in 125 patients younger than 35-years old was conducted. Patients were divided into two cohorts: (1) anterior-THA and (2) posterior-THA. A posterior-THA sub-group analysis was performed to compare: (1) technology-assisted THA (tech-THA) versus (2) conventional-THA (con-THA). Demographics, perioperative data, radiographic and clinical outcomes were analyzed using Chi squared and unpaired student t-tests for categorical and continuous variables, respectively.RESULTS: Of the 139 cases performed, 40 were anterior-THA and 99 were posterior-THA. The anterior-THA cohort had shorter mean surgical time (95.0±25.7 vs. 118.3±43.3 minutes; p&lt;0.01), shorter hospital admissions (1.9±1.4 vs. 2.7±1.2 days; p&lt;0.01), and lower estimated blood loss (343.4±164.1 vs. 438.0±272.8 mL; p&lt;0.01) compared to the posterior-THA cohort. There were no significant differences in component positioning, limb length discrepancy, clinical outcomes or postoperative complications between cohorts. In the sub-group analysis, cup placement within Lewinnek’s Safe Zone was achieved in 78% of tech-THA versus 49% of con-THA (p&lt;0.01). Need for revision THA was significantly higher among the con-THA group (9.4% vs. 0%; p&lt;0.01).CONCLUSION: There is no significant difference in outcomes between anterior- and posterior-THA among patients under 35-years of age, however, the anterior approach may promote earlier hospital discharge. Technological-assistance can improve component positioning and may reduce the rate of revision for posterior-THA in patients under 35-years old.
Comparison effect of Anatomical and Conventional tibial cut in post-operative radiographic parameter and clinical outcome of ankle joint in Computer assisted TKA.
Authors: Sriphirom Pornpavit , Chompoosaeng Thakrit , Boonton Bordin 
Published: October 2019

In Total knee arthroplasty (TKA), not only knee joint affect when we restored limb alignment, but also other joints involved. Ankle joint is one of them. By changing in talar tilt, many studies shown this will lead to increase pain and disturb function of ankle. Patients may end up with unsatisfied result of TKA. Anatomical cut of tibia is use in order to avoid this problem.To compare between pre- and post-operative talar tilt angle (TTA) and ankle clinical assessment by foot function index (FFI) and ankle-hindfoot index (AHI) after anatomical tibial cut (varus 3° with anatomical axis) and conventional tibial cut (perpendicular with anatomical axis) in computer-assisted total knee arthroplastyThis study was retrospective study. We collected data of 70 knees from 54 patients. 32 knees were done by anatomical cut. The rest were conventional cut. We evaluated at pre- and post-operative for TTA. At 12-month follow-up for TTA &amp; ankle clinical assessment.In conventional group, TTA was changed 2.33°(p&lt;0.001) then 0.920(p=0.02) at follow up. In anatomical group, TTA was changed 2°(p=0.037) then 1.38°(p=1.56). Changing of TTA was not significantly different at post-operatively (p=0.76) and follow-up (p=0.98) between 2 groups. FFI&amp; AHI were not significantly different between both groups.
Computer Navigation for Revision Total Hip Arthroplasty Reduces Dislocation Rates
Authors: Cizmic Zlatan , Carroll Kaitlin , Jerabek Seth , Paprosky Wayne , Sculco Peter , Della Valle Alejandro Gonzalez , Meere Patrick , McLawhorn Alexander , Schwarzkopf Ran , Boettner Friedrich , Mayman David , Vigdorchik Jonathan 
Published: October 2019

INTRODUCTION: Computer-assisted hip navigation offers more accurate placement of hip components, potentially avoiding impingement, edge-loading, and dislocation; major causes of failure leading to revision THA. As such, the use of computer navigation may be particularly beneficial in the revision THA population. The purpose of this study was to determine if the use of computer-assisted hip navigation reduced the rate of dislocation in patients undergoing revision THA.METHODS: A retrospective review of 72 patients undergoing computer-navigated revision THA between February 2016 and May 2017 was performed. Demographics, indications for revision, type of procedure performed, and postoperative complications were collected for all patients. Clinical follow-up was recorded at 3-months, 1-year and 2-years.RESULTS: All 72 patients (48% female; 52% male) were included in the final analysis. Mean age of patients was 70.4 ± 11.2 years. Mean BMI was 26.4 ± 5.2 kg/m2. The most common indications for revision THA were instability (31%), aseptic loosening (29%), osteolysis/eccentric wear (18%), infection (11%), and miscellaneous (11%). At 3-months, 1-year, and 2-years there were no dislocations in any patients (0%). Compared to preoperative dislocation values, there was a significant reduction in the rate of dislocation with the use of computer-assisted hip navigation (31% vs. 0%; p&lt;0.05).DISCUSSION: Our study demonstrates a significant reduction in the rate of dislocation following revision THA with the use of computer navigation. Although the cause of postoperative dislocation is often multifactorial, the use of computer-assisted surgery may help to curtail femoral and acetabular malalignment in revision THA.
Integrating a Tracking Camera in the OR Using the IEEE 11073-SDC Communication Standard
Authors: Vossel Manuel , de La Fuente Matías , Wieschebrock Dario , Yilmaz Okan , Radermacher Klaus , Janß Armin 
Published: October 2019

With the increasing spread of computer assisted surgery, more and more modern operating rooms are equipped with navigation systems, each coming with its own tracking camera. Since those cameras are part of the closed monolithic navigation system, they can’t be used for other applications than the one intended by the supplier. With the novel service oriented device connectivity standard (IEEE 11073-SDC), introduced by the OR.NET initiative (www.ornet.org), needless double procurements could be avoided and multiple systems could use the same camera that – similar to OR lights – could be installed as a standard equipment in each OR. This would decrease the cost-to-benefit ratio also of new applications that would currently as such not justify to acquire a proprietary tracking camera.While the integration of a tracking camera to an open medical device IT network can open up for new applications, it should on the other hand not impair the usability and the safety of the navigation system. Therefore, a low latency must be guaranteed between tracking camera and navigational display.This paper evaluates the integration of an atracsys fusionTrack 500 tracking camera into the OR.NETwork. The response time from a change in the real world to the reception of the corresponding data package is measured to determine the feasibility of an integra- tion without impairing current navigational tasks.The results show that, as long as the underlying network infrastructure is not at its capacity limit, latencies below 60 ms are achieved. Therefore, the integration of a tracking camera for navigational tasks is feasible.
Accuracy, Inter- and Intra-Observer Reliability of a CT Alignment Measurement Protocol for Robotic-Arm Assisted Total Knee Arthroplasty
Authors: Zhang Jingwei , Persohn Scott , Bhowmik-Stoker Manoshi , Otto Jason , Paramasivam Meenakshisundaram , Wahdan Ahmad , Choplin Robert H. , Territo Paul 
Published: October 2019

Component position and overall limb alignment following Total Knee Arthroplasty (TKA) have been shown to influence device survivorships and clinical outcomes. However, these parameters are often assessed through 2D radiographs after surgery, which can be prone to inaccuracy. The purpose of this paper is to develop a new method for 3D CT based overall limb alignment and component position measurements. The technique utilizes a new mathematical model to calculate prosthesis alignment from the coordinates of anatomical landmarks used in RATKA. The hypothesis is that the proposed technique demonstrated good accuracy, as well as low intra and inter-observer variability.Two groups of patients (n=120 per group) underwent RATKA and conventional TKA at 4 imaging locations between October 2016 and August 2018, where they were recruited and consented for this prospective, non-randomized, multicenter study. CTs were collected 6 weeks post-operatively and analyzed using RATKA landmarks and the proposed technique. Measurements of 30 randomly selected cases were compared to the surgeons’ operative plan and component target positions for accuracy analysis. Two surgeons performed the same measurements separately for inter-observer variability analysis. One of the two surgeons repeated the measurements 30 days later to assess intra-observer variability.Average measurement error of overall limb alignment, femoral and tibial component positions were less than 1 degree. Bland Altman plots analysis showed great reproducibility between observers. Correlation analysis showed low variability within observer, with slopes between 0.8 to 1.0 and R-squared &gt; 0.8.The proposed method demonstrated great accuracy to plan and low intra and inter-observer variability. This can be a great tool for RATKA studies where component accuracy is assessed using post-operative CTs.
No changes in bone mineral density following total knee arthroplasty using an all polyethylene tibial component
Authors: Ewen Alistair , Rae Jill , Jeldi Artaban , Picard Frederic 
Published: October 2019

Polyethylene particles produced in metal backed tibias (MBT) are understood to contribute to bone loss and component loosening. This, and better surgical techniques (including computer navigation) and increasing costs have renewed interest in all poly tibias (APT). We investigated peri-APT bone mineral density (BMD) in patients; expecting to find no differences between two post-operative values.Patients over 65 years, with BMI ≤ 37.5 and no previous joint replacements were recruited to have TKA using the Columbus APT with computer navigation (OrthoPilot). The study cohort (n=26) had a mean age of 71.9 (sd 4.35), a BMI of 31.2 (sd 3.8). The BMD examinations were performed six weeks and 18 months post-operatively. Six regions-of-interest (ROI) were identified on anterior/posterior and lateral scans. For each ROI at each time point, relative BMD differences (RDs) were determined between limbs and RDs at the two time points were compared.No differences were found between the two RDs for any ROI. No revisions or complications were reported. At 18 months post-operatively, 78.3% of the cohort were “very satisfied” with the outcome of their surgery and Oxford Knee Scores improved significantly compared to pre-operatively (p&lt;0.005). Mean knee range of motion was 102° (sd 10.7◦) and mean leg alignment was 2.0° valgus (1°varus-6°valgus).Results from BMD suggest that implants were well fixated. Patients reported excellent satisfaction and function. We believe that using APTs and computer navigation is a viable and cheaper option to MBT for patients who are less active, have lower BMI and good bone quality.
Pelvic Tilt Cannot Be Accurately Predicted Using Anteroposterior Radiographs
Authors: Cizmic Zlatan , Gabor Jonathan , Eftekhary Nima , Rudy Hayeem , O'Sullivan Michael , Schwarzkopf Ran , Buckland Aaron , Vigdorchik Jonathan 
Published: October 2019

INTRODUCTION: Pelvic positioning during total hip arthroplasty (THA) can affect the functional position of the acetabular component. A comprehensive understanding of pelvic orientation prior to THA is necessary to allow for proper cup positioning and mitigate the risks of complications associated with component malpositioning. Measurements using anteroposterior (AP) radiographs have been described as an effective means of accurately predicting pelvic functional orientation. The purpose of our study was to describe the accuracy of assessing pelvic tilt using AP radiographs alone.METHODS: An online survey was created and sent to a cohort of fellowship-trained adult reconstruction surgeons. The survey consisted of 65 standing AP pelvis radiographs. Participants were asked to score each radiograph as 1) anterior pelvic tilt &gt; 10 degrees, 2) posterior pelvic tilt &gt; 10 degrees, or 3) neutral. Responses were then compared to measurements of pelvic tilt made on lateral standing pelvic radiographs. Categorical and continuous variables were compared using chi-squared, unpaired, two-tailed student’s T tests, and ANOVA.RESULTS: 135 surgeons completed the survey. The average correct predictive value of pelvic tilt between all surgeons was 53.2%. 51.2% of responding surgeons performed greater than 100 cases per year. 50% of surgeons reported that they were “not so familiar” or “somewhat familiar” with the principles of spinopelvic mobility. 43.5% of surgeons reported that they did not routinely use spinopelvic mobility principles in THA planning.DISCUSSION: The standing AP pelvis radiograph is poorly predictive of pelvic tilt. Pre-operative evaluation of spinopelvic parameters requires AP and lateral pelvic views for detailed assessment and accurate pre-operative planning.
One and Two Year Postoperative Patient Reported Outcomes of Robotic-Assisted Total Knee Arthroplasty
Authors: Blum Christopher , Plaskos Christopher , Hussein Adil , Koenig Jan A 
Published: October 2019

Total knee arthroplasty is a successful procedure. However, there is still area for improvement as up to 15-20% of patients remain unsatisfied. Robotic-assisted surgery (RAS) may improve patient outcomes by providing a reproducible way of obtaining neutral mechanical alignment of the limb, which has been shown to reduce early revisions and correlate with patient reported outcomes after surgery.We prospectively enrolled 106 patients undergoing robotic-assisted TKA by a single surgeon performing a measured-resection femur-first technique using the OMNIBotic system. Patients completed a KOOS and New Knee Society Score (KSS) pre-operatively and at 3, 6, 12, and 24 months (M) postoperatively. Changes in the five KOOS sub-scales were compared to available literature data from the FORCE – TJR cohort, as well as to individual studies reporting on conventional and computer-assisted TKA.When compared to FORCE-TJR 6-month (M) and 2-year (Y) data, the RAS cohort had significantly higher improvements at 6M for pain (40.5 vs. 31.1, p&lt;.001) and at 2Y for all five KOOS sub-scores. The larger improvement was due to the RAS cohort having lower baseline KOOS scores than the FORCE-TJR cohort, except for the Sports-Recreation sub-score, which was similar pre- operatively but significantly higher post-operatively for the robotic cohort. Rates of dissatisfaction with knee pain level and function using the KSS after RAS were 3.0%, 1.0%, and 2.7% at 6, 12, and 24M postoperatively, respectively.Despite having poorer joint function and higher pain pre-operatively, robotic-assisted TKA patients achieved excellent self-reported outcomes, with significantly higher levels of improvement through two years post-surgery when compared with large national cohort studies. Further controlled clinical studies are warranted to determine if these results translate to other groups of surgeons, centers and patients.
Long term Patient Outcomes following Navigated Knee Replacement:A Retrospective analysis
Authors: Jeldi Artaban , Holloway Nicholas , Ewen Alistair , Picard Frederic 
Published: October 2019

Total knee replacements (TKR) are often deemed successful when patients recover and maintain their functionality both in the short and long term. The other main indicator for success is the revision rate following TKR. This study analyses the long term results of navigated TKR based on patient related outcomes in terms of patient satisfaction, Oxford Knee Score (OKS) and also knee revision rates.The retrospective data of all patients who underwent navigated Columbus TKR from the author’s institution from 2005 to 2011 was analysed and compared to the national database. The overall cohort size was 1679 with a mean age of 68.81yrs (sd 8.46). The OKS, satisfaction scores, complication and revision rates were compiled and evaluated up to ten years post-operatively. Patient reported outcomes were recorded six weeks, one, two, five and ten years post-operatively.The results from the OKS and satisfaction scores demonstrated marked improvement throughout recovery to the ten year time point. The OKS had a mean improvement of 16.6 from the pre-operative score at the 10 year time point and the satisfaction scores improved at each follow-up and remained high at the 10 year time point. A total of 61 complications and 36 revisions recorded, with infection being the major cause for revisions.This survey has identified and established that the majority of patients undergoing knee arthoplasty using the Columbus total knee system and computer navigation function reasonably well in the long term and the revision and complication rates in this hospital are compare well with national levels..
Relationship of the tibial tuberosity (TT) position, tibial tuberositytrochlear groove (TT-TG) distance, and internal and external rotation of the knee under weight-bearing conditions
Authors: Asseln Malte , Meere Patrick , Walker Peter , Radermacher Klaus 
Published: October 2019

An important factor which influences the clinical outcome of total knee arthroplasty (TKA) is the internal/external rotational alignment of the femoral and tibial components. A rotational error of few degrees has been found to be clinically important and linked to anterior knee pain [1] and patellofemoral problems [2]. A commonly used reference to align the tibial component rotationally is the tibial tuberosity (TT). However, Howell et al. [3] showed that the medial/lateral TT position varies strongly between patients and represents an unreliable landmark during (passive) kinematic component alignment. Thereby, passive kinematics differs from active kinematics [4,5]. For example, under weight-bearing conditions the magnitude of internal/external rotation is greater and occurs earlier [6]. In the active situation, a relative internal rotation of the tibial component increases the Q-angle with a change in the force vector of the extensor mechanism.An established radiographic measure to quantify the relative rotational alignment of the femur and tibia in extension is the tibial tuberosity-trochlear groove (TT-TG) distance. It has been measured recently at different flexion angles under non-weight-bearing conditions [7]. However, Izadpanah et al. [8] reported that it also depends on weight-bearing. Hence, the complex function of the extensor mechanism in terms of the relationship between TT position, TT-TG distance, and internal/external rotation under weight-bearing conditions is still unknown and accordingly component rotational alignment targets.The aim of the study was to investigate the relationship between TT position, TT-TG distance, and internal/external rotation of the knee in the active (weight-bearing) situation.