Archives of orthopaedic and trauma surgery
-
Arch Orthop Trauma Surg · Dec 2021
A ligament tensor-guided extramedullary alignment technique for distal femoral cut in total knee replacement: results at a minimum 3 years follow-up.
Femoral intramedullary canal referencing is used by most knee arthroplasty systems for distal femoral cut; to avoid the opening of the femoral canal different solutions have been presented such as navigation, patient-specific instruments (PSI) or the use of an extramedullary device. The FuZion® system is a tensor device, created to merge the two main techniques for performing a total knee arthroplasty: the ligament balancing and measured resection techniques. Our idea was to use the tensor as an extramedullary cutting guide for the distal femoral cut, based on a 90° tibial resection. ⋯ This technique for performing a ligament driven alignment in total knee arthroplasty showed encouraging clinical outcomes at mid-term follow up leaving a residual deformity on the coronal plane.
-
The concept of custom total knee arthroplasty (TKA) is explored with specific attention to current limitations. Arguments in favor of custom TKA are the anatomic and functional variability we encounter in our patients. The biggest conceptual challenge is to marry the need for correction of deformity with the ambition to stay as close as possible to original anatomy. ⋯ Custom knee implants are the next step in matching the geometric features of the prosthesis to the anatomy of the individual patient, after several iterations that added asymmetry and sizes in the existing implants. Several companies have proven that it is feasible to produce these implants in a safe way. An overview of current literature reveals the lack of strong methodological studies that prove the value of this new technology. Custom knee implants face conceptual and practical difficulties, some of which might be overcome with technological advances, such as robotics and artificial intelligence.
-
Arch Orthop Trauma Surg · Dec 2021
Immersive virtual reality enables technical skill acquisition for scrub nurses in complex revision total knee arthroplasty.
Immersive Virtual Reality (iVR) is a novel technology which can enhance surgical training in a virtual environment without supervision. However, it is untested for the training to select, assemble and deliver instrumentation in orthopaedic surgery-typically performed by scrub nurses. This study investigates the impact of an iVR curriculum on this facet of the technically demanding revision total knee arthroplasty. ⋯ For scrub nurses, unfamiliarity with complex surgical procedures or equipment is common. Immersive VR training improved their understanding, technical skills and efficiency. These iVR-learnt skills transferred into the real world.
-
Arch Orthop Trauma Surg · Dec 2021
Robotics improves alignment accuracy and reduces early revision rates for UKA in the hands of low-volume UKA surgeons.
It is known that in uni-compartmental knee arthroplasty (UKA) low-volume surgeons have a higher complication and revision rate than high-volume surgeons. Further, robotic-assisted UKA leads to lower early revision rate as well as fewer limb and joint line outliers compared to conventional UKA. The purpose of this study was to retrospectively analyze the outliers' and revision rate of low-volume UKA surgeons with different robotic systems at short-term follow-up. ⋯ Robotic-assisted UKA is a safe procedure in the hand of low-volume UKA surgeons. Robotic-assisted UKA minimizes overcorrection into valgus mal-alignment. Low revision rates are observed at short-term follow-up for robotic-assisted UKA. The choice of the different robotic systems has no impact on the outcome.
-
Arch Orthop Trauma Surg · Dec 2021
Immersive technologies for total knee arthroplasty surgical education.
The need to adapt surgical curricula to meet the demands of an increasingly restrictive training environment is rising. Modern constraints of surgical trainees including work-hour restrictions and concerns surrounding patient safety have created an opportunity to supplement traditional teaching methods with developing immersive technologies including virtual and augmented reality. Virtual reality (VR) and augmented reality (AR) have been preliminarily investigated as it relates to total joint arthroplasty. The purpose of this article is to discuss VR and AR as it applies to modern total knee replacement (TKR) surgical education.