bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuromonitoring to avoid euthanasia in a quadriplegic patient
Authors: Vermeersch Geert 
Published: October 2019

Background: Under very limited circumstances euthanasia can be performed in Belgium since 2002 (Verwilghen, 2012). If a patient has medical condition with no hope on improvement, with physical and/or psychological suffering, he can ask for terminating his life. The written demand is on voluntary bases, well considered, repeated and was not induced due to external pressure from other people. Neuromonitoring has been used in spine surgery during the last four decades. (Lall, et al., 2012) (Gonzales, Jeyanandarajan, Hansen, Zada, &amp; Hsieh, 2009) With the development of new modalities, new applications were introduced in spine surgery in order to avoid neurological damage during surgical procedures.Method: A patient with a partial recovered ASIA A C7 quadriplegia suffering from wounds caused by his spinal instrumentation had intraoperative neuromonitoring. In case he became dependent for his personal care, he wanted to have euthanasia executed on him.Conclusion: So far there is no literature on the use of neuromonitoring to avoid euthanasia in cases where spinal surgery is needed, but surgery has an inherent risk of causing damage to nerval structures, which can cause loss of recovered nerve function after spinal cord injury. This potential loss of independence was an unbearable physical and psychological suffering the patient would not want to go through again. By using neuromonitoring, the key muscles were observed during the surgery. No neurological events were seen during the prodecure. He had some general weakness after the surgery but kept his autonomy, so no euthanasia was needed.
The Learning Curve and Alignment Assessment of an Image-Free Handheld Robot in TKA: The First Patient Series in Europe
Authors: Bollars Peter , Boeckxstaens Anton , Mievis Jan , Janssen Daniel 
Published: October 2019

BACKGROUND: The typical goal of TKA is to obtain a neutral mechanical axis of the leg. The NAVIO® Surgical System (Smith &amp; Nephew, Pittsburgh, PA, USA) is aimed at reducing technical errors and outliers. The aim of this study is to assess the surgeons’ learning curve and limb alignment in TKA.METHODS:The first sixty-nine patients who underwent TKA with the NAVIO system by two experienced surgeons were included in this study. Pre- and postoperative mechanical limb alignment and balancing was measured by the NAVIO system. Registration time, planning time and cutting time was monitored preoperatively by the NAVIO™ system. All data was analyzed retrospectively.RESULTS:The mean preoperative mechanical limb alignment was 3.18° varus (SD 4.28°, range 15.08° varus to 4.30° of valgus). The mean intraoperative planned angle was 0.59° varus (SD 0.97°, range 2.50° varus to 0.99° valgus). The mean postoperative alignment was 1.17° varus (SD 1.78°, range 4.52° varus to 4.33° valgus. The mean extra surgical time (EST) for registration and planning decreased from 23.4min (SD 3.7min) to 13.2min (SD 2.0) throughout the learning curve with a range of 10min05sec to 28min19sec.CONCLUSION: The NAVIO robotic system is a valuable tool in assisting total knee arthroplasty. It allows the surgeon to accurately determine optimal implant position for each patient and minimize statistical outliers in alignment.
Development and validation of image-based subject-specific skeletal models of spinal deformity patients for use in motion analysis
Authors: Overbergh Thomas , Severijns Pieter , Moke Lieven , Jonkers Ilse , Scheys Lennart 
Published: October 2019

Conventional radiographic analysis in spinal deformity only quantifies the static skeletal body structure and no conclusions can be drawn with respect to functional abilities. The aim of this work was to introduce subject-specific, skeletal full spine multi- body models in a spinal deformity population for quantifying their full dynamic function. To accomplish this, the creation of a subject-specific model as well as its use with optical motion capture was validated.As such, this work puts within reach the extension of the current state-of-the-art clinical management from static based concepts with concepts that integrate dynamic functional data.
A Retrospective Comparison of Functional Outcomes of Robotic-Assisted and Conventional Unicompartmental Knee Arthroplasty
Authors: Crizer Meredith , Battenberg Andrew , McGrath Mikayla , Kim Seong , Lonner Jess 
Published: October 2019

INTRODUCTION: Unicompartmental knee arthroplasty (UKA) is effective for alleviating symptoms of arthritis in a single knee compartment; however, errors in alignment and instability may predispose to failure. Robotic technology has improved precision, but its impact on functional recovery after UKA remains unknown. The purpose of this study was to compare early functional recovery, pain, and radiographic alignment in UKA performed with either robotic assistance or conventional methods.METHODS: All consecutive patients undergoing UKA by a single physician from January 2015 to March 2018 were retrospectively reviewed. Lower Extremity Functional Scale (LEFS), KOOS Jr, and VAS (0-10) outcomes scores were collected preoperatively, 1, 6, and 12 weeks postoperatively. Radiographic alignment was assessed at the initial postoperative visit.RESULTS: There were 161 patients, 65 conventional and 96 robotic. At baseline, there was no difference in average age, BMI, or outcomes scores between the two groups. Average preoperative pain was significantly higher in conventional patients (6.1 vs. 5.4; p=0.04). At 3 weeks post-op, conventional UKA patients still had significantly higher pain levels (3.9 vs. 3.1; p=.02). Both groups showed significant improvement in LEF (p&lt;.0001) scores over time (p&lt;.0001). Significant improvement in KOOS Jr. scores from pre-op (52.3) to 6 and 12-weeks postoperatively (67.6, 69.8; p&lt;0.001). When comparing PCS of the VR/SF-12, the robotic-assisted group had significantly higher improvement compared to the conventional group at 6-weeks (40.6 vs. 35.6; p=0.02).CONCLUSION: Robotic assisted UKA resulted in fewer radiographic outliers, and more rapid recovery with less early postoperative pain although functional differences tended to equilibrate by 3 months postoperatively.
Early Revision Analysis of Robotic-Arm Assisted and Manual Unicompartmental Knee Arthroplasty
Authors: Cool Christina , Needham Keith , Coppolecchia Andréa , Khlopas Anton , Sodhi Nipun , Ehiorobo Joseph , Mont Michael 
Published: October 2019

Background:The purpose of this study was to evaluate hospital admissions for revision surgeries associated with robotic-arm assisted unicompartmental knee arthroplasty (rUKA) vs. manual UKA (mUKA) procedures.Methods:Patients ≥18 years of age who received either a mUKA or a rUKA procedure were candidates for inclusion and were identified by the presence of appropriate billing codes. Procedures performed between March 1st, 2013 and July 31st, 2015 were used to calculate the rate of surgical revisions occurring within 24-months of the index procedure. Following propensity matching, 246 rUKA and 492 mUKA patients were included. Revision rates and the associated costs were compared between the two cohorts. The Mann-Whitney U test, was used to compare continuous variables, and fisher’s exact tests was used to analyze discrete categorical variables.Results:At 24-months following the primary UKA procedure, patients who underwent rUKA had fewer revision procedures (0.81% [2/246] vs. 5.28% [26/492]; p=0.002), shorter mean LOS (2.00 vs. 2.33 days; p&gt;0.05), and incurred lower mean costs for the index stay plus revisions ($26,001 vs. $27,915; p&gt;0.05) than mUKA patients. Length of stay at index, and index costs were also lower for rUKA patients (1.77 vs. 2.02 days; p=.0047) and ($25,786 vs. $26,307; p&gt;0.05).Conclusions:Study results demonstrate that patients who underwent rUKA had fewer revision procedures, shorter LOS, and incurred lower mean costs (although not statistically different) during the index admission and at 24-months post-operative. These results could be important for payers as the prevalence of end-stage knee OA increases alongside the demand for cost-efficient treatments.
A Method for Validation and Error-Quantification of 3D-Printed Models for Acetabulum Fracture Surgery
Authors: Andress Sebastian , Achilles Felix , Suero Eduardo M. , Becker Christopher , Linhart Christoph , Greiner Axel , Rubenbauer Bianka , Kammerlander Christian , Boecker Wolfgang , Weidert Simon 
Published: October 2019

Despite the increasing use of 3D printing in orthopedic surgery, there is no established method for the validation of a printed bone model. A printing error could potentially lead to complications, especially when the model is used for surgery planning. We aimed to validate a series of 33 acetabular fractures with a novel method by detailed analysis of model errors.After applying a surface filter on both the patients model and the 3D printed model, a two-step registration consisting of landmark-based pre-registration and ICP-registration, was slightly varied and conducted 100 times, yielding a mean surface deviation and standard deviation for each model surface point.We furthermore showed that more than 30 random ICP-registration points lead to a sufficiently good registration, and that the variation of the pre-registration is small enough to guarantee a stable ICP registration result.Deviations caused by failed registration are unveiled by a large standard deviation of the 100 registration routines. For the fracture series, the mean surface deviation error between the printed model and the patient model was less than 1 mm (median = 0.7 mm; 95% CI = 0.68-0.72 mm). The largest errors were found in areas with remaining support structure material, on printbed-facing model sides and on abrasive surface regions. By visualizing the residual registration error, it was possible to clearly detect surface deviations and to quantify them.
Interesting Cases in Robotic-Arm Assisted Total Knee Arthroplasty
Authors: Garbarino Luke , Sodhi Nipun , Ehiorobo Joseph , Gold Peter , Marchand Kevin , Marchand Robert , Hepinstall Matthew , Mont Michael 
Published: October 2019

Introduction:Robotic-arm assisted surgery allows for the execution of well-aligned knee arthroplasty regardless of pre-existing deformity. This case series is presented to show the utility of robotic-arm assisted TKA in achieving well-balanced, well-aligned results in a variety of challenging scenarios.Methods:We present seven challenging cases of robotic-arm assisted total knee arthroplasty. There were two conversion TKAs following a previous surgery. One case featured a previous tibial plateau fracture treated with a plate and screws construct while another featured a prior femoral nail with significant bony overgrowth. Five cases of severe deformity were also identified, with one tibial nonunion, two valgus knees and one patient with two varus knees due psoriatic arthritis treated with staged bilateral TKAs. Patient clinical history, physical examinations, intraoperative surgical techniques and postoperative courses were recorded.Results:All cases were able to utilize effective preoperative planning to obtain precise intraoperative bone cuts and component positioning. Each of the seven cases achieved well-balanced, well-aligned arthroplasties. There were no intraoperative or postoperative complications. At latest follow up, all patients showed significant improvements in pain and ambulation compared to preoperative exams.Discussion:Robotic-arm assisted surgery allows for the integration of preoperative CT scans to establish and execute a surgical plan with precision. Despite the complexity of these cases, excellent results were achieved without the need for revision-type components. These cases display the ability of robotic-arm assisted surgery to achieve consistent well-aligned results with minimal bone loss in challenging total knee arthroplasty cases.
Patient-specific ROM and load-based Target Zone for Total Hip Arthroplasty and its Application in a retrospective Analysis
Authors: Habor Juliana , Fischer Maximilian C. M. , Tokunaga Kunihiko , Okamoto Masashi , Radermacher Klaus 
Published: October 2019

The outcome of total hip arthroplasty (THA) depends on multiple alignment and design parameters. Unsuitable parameter settings could lead to impingement, dislocation, increased wear, and loosening. This work introduces a method for calculating a patient-specific target zone based on range of motion (ROM) related and load related criteria. Possible bone or prosthesis impingement are analyzed. The resulting hip force is calculated and compared to the pre-operative situation. The edge loading risk is analyzed. Pelvic tilt is considered for the calculation of the ROM and the load. THA parameters fulfilling all criteria are included in the target zone.The above described method has been applied to 30 cases retrospectively. All cases had been planned and navigated on the basis of CT data. From each patient, pre- and post-operative CT and EOS data and Harris Scores were acquired. The pre-operative data served as the input data for the target zone calculator. We hypothesized that cases with post-operative THA parameters inside the target zones have higher scores than other cases.The patients whose implants are within the target zones had higher scores than the remaining patients. Especially patients inside both target zones (combined target zone) had higher scores. The results also show that for 19 out of 30 patients, conventional CT-based planning and navigation does not provide optimal placement regarding the combined target zone. A further validation of the method with a larger sample size is part of our ongoing work.
Accuracy of Soft Tissue Balancing in Robotic-Assisted Measured-Resection TKA Using a Robotic Distraction Tool
Authors: Koenig Jan , Shalhoub Sami , Chen Eric , Plaskos Christopher 
Published: October 2019

Achieving proper soft tissue balance during total knee arthroplasty (TKA) can reduce post- operative instability and stiffness as well as improve patient reported outcomes. The objective of this study was to compare final intra-operative coronal balance throughout the knee range of motion in navigated robotic-assisted TKA when performed with quantifiable feedback from a robotic ligament tensioning tool versus with standard trials and navigation measurements alone.The study included a prospective cohort of 52 patients undergoing robotic-assisted TKA using a measured resection technique. The cohort was divided into two sequential groups: a non-sensor-assisted group (n=25) and a subsequent sensor-assisted group (n=27). Once bony cuts and soft tissue balancing was performed in the non-sensor cohort, the final tibiofemoral gaps were measured throughout the knee range of motion using a robotic-assisted tensioner with the surgeon blinded to the measurements. For the sensor cohort, the surgeon preformed soft-tissue releases or re-cuts in order to balance the knee using the gap measurement data from the robotic tensioner. The robotic-assisted tensioner was then used to measure the final medial and lateral gap measurements.The average mediolateral gap difference throughout the range of flexion was 1.9 ± 0.7 mm with maximum difference of 7.8 mm for the non-sensor cohort. The sensor cohort had an average mediolateral difference of 1.5 ± 0.6 mm and a maximum difference of 3.8 mm. The difference between the two groups was statistically significant from 60 to 90 degrees of flexion. 38-41% of knees were balanced to within 1 mm mediolaterally in the non-sensor group compared to 48-70% for the sensor group when measured at various flexion angles. 65-76% of knees were balanced to within 2 mm for the non-sensor group compared to 78-86% for the sensor-assisted group. The number of knees requiring subsequent soft tissue releases was similar in each group. Soft tissue balancing with the aid of a robotic tensioning tool resulted in significantly more accurate soft tissue balance than when using navigation measurements and standard trials alone in this single surgeon study.
A 90-Day Episode-of-Care Cost Analysis of Robotic-Arm Assisted Total Knee Arthroplasty
Authors: Cool Christina , Jacofsky David , Seeger Kelly , Coppolecchia Andréa , Sodhi Nipun , Ehiorobo Joseph , Mont Michael 
Published: October 2019

IntroductionOne way to potentially help contain the rising healthcare costs is the utilization of technological advances, such as robotic-assistive technology, for total knee arthroplasty (TKA). Therefore, the purpose of this study was to perform a cost analysis between robotic-arm assisted TKA and manual TKA (mTKA) techniques. Specifically, we compared: 1) 90-day EOC costs, as well as several variables within the episode, including 2) index costs; 3) index lengths-of-stay (LOS); 4) discharge disposition; and 5) readmission rates.MethodsA retrospective claims analysis was performed on Medicare FFS beneficiaries who underwent rTKA and mTKA procedures between January 1, 2016 and March 31, 2017. Patients were matched rTKA to mTKA in a 1-to-5 ratio, yielding 519 rTKAs and 2,595 mTKAs. The overall 90-day EOC costs, including the index procedures, LOS, discharge dispositions, and readmissions were compared between cohorts.ResultsOverall 90-day EOC costs ($18,568 vs. $20,960) as well as index facility costs ($12,384 vs. $13,024; p=0.0001) were found to be less than that for rTKA vs. mTKA. rTKA also accrued $1,744 fewer costs than mTKA (5,234 vs. $6,978; p=&lt;0.0001) utilized fewer days in inpatient (4 vs. 7; p&lt;0.0001) and SNF care (15 vs. 16; p=0.0642) as well as a 90-day readmission reduction of 33% (p=0.0423).DiscussionThe results from this study show rTKA to be associated with significantly lower 90-day EOC costs. These lower rTKA patient costs are likely attributable to the significantly lower index costs, increased likelihood of being discharged to home, shorter LOS, and decreased readmission rates, when compared to mTKA patient costs.
In-Hospital manufacturing of patient specific 3D-printed guides
Authors: Aguado-Maestro Ignacio , García-Cepeda Ignacio , González-Álvarez Juan José , Cebrián-Rodríguez Elisa , López-Sánchez Javier , Fernández-Díez Diego , Sierra-Matilla Leandro , García-Alonso Manuel 
Published: October 2019

IntroductionPatient specific instrumentation is a novel aid the industry has been implementing in our hospitals during the last years. However, the cost of the process and the impossibility to discuss face to face with the manufacturer the needs of the particular cases may favor the in-hospital production of these devices.We present the design and manufacturing process of three patient-specific devices to treat complex common situations in orthopaedic surgery, such as intramedular tumor resections, long bone pseudarthrosis and malunions of articular fractures.Material and MethodsCT scans of the region of interest were performed to all the patients. Horos® software was used to isolate the affected bone region, whereas Meshmixer® software was used to create the patient specific guides. An Ultimaker 2+® 3D printer was used to print the guide, in a biocompatible material (SmartFil® Medical). The printing parameters included a nozzle of 0.6 mm and a layer height of 0.1 mm.There was one case of a low-grade chondrosarcoma in which we created a guide to resect enough cortical bone to make an extended curettage of the lesion. Phenol and PMMA were used as adjuvants after the curettage. We used the same guide to obtain an exact replica of allograft which was later placed in position.We had a femur diaphyseal atrophic pseudarthrosis in a patient with achondroplasia, in which the guide permitted the resection of the affected bone with a saw and posterior osteosynthesis with an anterior LCP plate.Finally, in an intraarticular malunion of a distal radius Die-Punch fracture we used the guide to make an osteotomy of the affected articular portion and correct the articular surface. Bone autograft was added prior to the osteosynthesis with a plate.ResultsMean design time was 6.3 hours. Mean printing time was 5.2 hours. The price of the filament used for each guide was under 10 USD. The mean time from the CT-Scan and the surgery being performed was 2.7 months. In all cases the patient specific guides fitted in the bone and permitted the planned resection/osteotomy.All the surgeries fulfilled their purpose.ConclusionsPatient specific guides are easy to design in a local setting with the aid of free software. Design time still needs dedication although it permits the manufacturing of the guides following surgeon needs. The use of self-designed and printed guides is safe and accurate, with a low cost for the institutions.
Mid-term Patient Reported Outcomes and Survivorship Following Robotic Assisted Total Knee Replacement: A Cohort Study
Authors: Chen Eric , Husain Adil , Billow Nicholas , Koenig Jan , Plaskos Christopher 
Published: October 2019

Despite the advantages of real time alignment assessment and visual feedback while balancing offered by robotic assisted total knee arthroplasty, few clinical studies have reported patient outcomes. The purpose of this study is to report the midterm patient reported outcomes and survivorship of a computer-navigated TKA system with a robotic cutting guide. This patient cohort is the first IRB approved series of patients treated in the United States with this robotic knee system. This study serves as a midterm follow-up study on for this cohort, upon which learning curve, intra-operative efficiency, and deformity management were previously reportedRecipients of 152 consecutive total knee arthroplasties using a computer- navigated TKA system performed by a single surgeon between June 2010 and January 2012 were surveyed between 5-7 years post-operatively. 94 patients were reachable for outcome measures and survivorship data was obtained in 98 patients. Mean patient age at follow up was 74.6 +/- 8.6 years. Implant survivorship was 99.0% at an average of 6.5 years. Mean patient reported knee outcome scores were 62.7 (KSS-SF) and 79.5 (KOOS-JR). Overall satisfaction rate was reported as “satisfied or very satisfied” in 80.2%, “neutral” in 11.0%, and “dissatisfied or very dissatisfied” in 7.7% of patients.Robotic assisted total knee arthroplasty using a computer-navigated TKA system with a robotic cutting guide appears to provide a durable outcome with sustainable midterm patient reported outcomes and excellent survivorship. Further follow up is required to determine if there are long term outcome and survivorship benefits of robotic assisted total knee arthroplasty.