Computer-assisted orthopaedic surgery: minimally invasive hip and knee reconstruction (original) (raw)
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Navigated "small implants" in knee reconstruction
Knee Surgery Sports Traumatology Arthroscopy
Purpose At the beginning of this century, unprecedented interest in the concept of using less invasive approaches for the treatment of knee degenerative diseases was ignited. Initial interest in this approach was about navigated and non-navigated knee reconstruction using small implants and conventional total knee arthroplasty. Methods To this end, a review of the published literature relating to less invasive compartmental arthroplasty of the knee using computer-based alignment techniques and on soft tissue-dedicated small implants is presented. The authors present and compare their personal results using these techniques with those reported in the current literature. These involved the use of a shorter incision and an emphasis sparing. However, nowadays most surgeons look at compartmental knee resurfacing with the use of small implants as the new customized approach for younger and higher-demand patients. The aim of this paper is to stimulate further debate. Results Since the beginning of 2000, computer-assisted surgery has been applied to total knee arthroplasty (TKA) and later to compartmental knee arthroplasty. Recent studies in the literature have reported better implant survivorship for younger patients using navigation in TKAat longer-term follow-up. Only one published report was identified showing superior clinical outcomes at short-term follow-up using computer-assisted technology compared with conventional alignment techniques in small implant surgery. No studies were found in the literature that demonstrated similar clinical advantages with navigated small implants at long-term follow-up. Two published metaanalyses were identified reporting better implant and limb alignment and no increase in complications using a navigated unicompartmental knee arthroplasty. However, neither meta-analysis showed superior clinical outcomes or survivorship with the navigated techniques. Conclusion In conclusion, we can assert that replacing just the damaged compartment and preserving the normal biomechanics will require not only new implant designs but also new technologies allowing the surgeon to make extremely precise adjustments to implant alignment and providing continuous feedback during surgery.
Acta Biomedica
Introduction: Total knee replacement (TKR) is one of the most frequent orthopaedic procedures performed every year. At the same time 20% of patients who underwent TKR are not satisfied with the outcome. The reasons are unknown; we think that a mechanical alignment beyond 3° of varus-valgus can represent the most important cause of failure of TKR and consequently patient dissatisfaction. Materials and Methods: Neutral mechanical alignment is the main goal in every TKR: this can be achieved through different tools, such as extramedullary and intramedullary guides, patient-specific instrumentation (PSI) and computer assisted surgery (CAS). The aim of this review is to compare the different alignment techniques in TKR, to describe CAS procedure and CAS results in recent literature. Results: Regarding the intramedullary guide, there is an increased risk of fatty embolism; there are great limitations on its use, or even impossibility, in cases of bone deformity and sequelae of trauma. Regarding the extramedullary guide, it becomes more difficult to use in cases of great obesity or increased soft-tissue volume around the tibia. PSI for TKR has been introduced to improve alignment, reduce outliers, operation time and the risk of fatty embolism by avoidance of intramedullary canal violation. Recent randomized controlled trials and meta-analysis proved no advantage of PSI in improving mechanical axis and implant survivorship. Discussion: CAS has provided to be a useful tool in assisting the surgeon to achieve more accurate post-operative mechanical axis through precise and reproducible bone cuts and ligament balancing. Two meta-analyses definitively proved that CAS technique improves mechanical axis and implant survivorship and one recent meta-analysis demonstrated that CAS provides better mechanical alignment and higher functional scores at short-term follow-up. (www.actabiomedica.it)
The Journal of arthroplasty, 2003
This is a retrospective radiographic analysis of implant position in minimally invasive unicompartmental knee arthroplasty (UKA), open UKA, and total knee arthroplasty (TKA). Implant position and limb alignment were recorded in the AP and lateral planes. Of the 3 groups evaluated, the total knee group had the least variation and greatest accuracy of implant placement and limb alignment. UKA groups had small but significant differences in postoperative alignment and AP tibial position. Using contemporary instrumentation, UKA is less accurate than TKA in implant placement and limb alignment. Minimally invasive UKA was not as accurate as open UKA in AP tibial placement or postoperative limb alignment.
Journal of Research in Orthopedic Science, 2022
Background: Total hip arthroplasty (THA) is a highly successful orthopedic procedure, recognized as the gold standard for addressing advanced osteoarthritis, with a projected global increase in performed cases. Objectives: This study investigated the accuracy of cup positioning in patients undergoing THA using the anterolateral (AL) approach. Methods: This cross-sectional study included patients undergoing ALTHA at Shafa Yahyaiyan Hospital in Tehran, affiliated with the Iran University of Medical Sciences, from 2018 to 2023. Post-operative radiological evaluations were conducted, and anteversion and inclination were assessed using established protocols. A safe zone for cup orientation was defined with an inclination angle of 40±10° and anteversion angle of 15±10°. Results: Among 91 patients, the mean age was 51.14 years and 48 cases (52.7%) were male. Considering the safe zone for cup orientation, 69 patients (75.8%) fell within the inclination angle safe zone and 46(50.5%) were within the anteversion angle safe zone. However, no significant associations were found between age, gender, side of operation and the safe zones for anteversion and inclination. Conclusion: The results indicated that the AL approach, as performed by experienced surgeons, achieved favorable cup positioning in the majority of patients, regardless of age and gender.