Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2021
ReviewContemporary knee arthroplasty: one fits all or time for diversity?
Total knee arthroplasty (TKA) has historically been the preferred solution for any type of knee osteoarthritis, independently of the number of compartments involved. In these days of patient-specific medicine, mono-compartmental disease could also be approached with a more individualized treatment, such as partial knee arthroplasty (PKA). Off-the-shelf (OTS) implants are often the compromise of averages and means of a limited series of anatomical parameters retrieved from patients and the pressure of cost control by limited inventory. Personalized medicine requires respect and interest for the individual shape and alignment of each patient. ⋯ TKA might not be the only solution for every patient with knee osteoarthritis, if personalized medicine wants to be offered. Patient-specific mono-compartmental resurfacing solutions, such as partial knee arthroplasty, can be part of the treatment options proposed by the expert surgeon. Customized implants and personalized alignment options have the potential to further improve clinical outcome by identifying the individual morphotype and respecting the diversity of the surgical population.
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Arch Orthop Trauma Surg · Dec 2021
ReviewCustom total knee: understanding the indication and process.
Patient-specific total knee arthroplasty (TKA) is a copy of the bony knee morphology based on a pre-op computer tomography (CT). The images are segmented in 3D and software is utilized through a proprietary process to generate individual total knee implants to recreate the articulating surfaces. The distal condylar valgus angle of the prosthesis is matched anatomically to the distal femur and reversely matched on the tibia with a thicker lateral insert. ⋯ The system is available with one solid or two separated medial and lateral PE inserts. There is a cruciate retaining (CR) and posterior stabilized (PS) version available, including various insert thicknesses. The system allows the addition of two different cemented stem extensions if needed at the time of surgery.
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Arch Orthop Trauma Surg · Dec 2021
ReviewA novel augmented reality-based surgical guidance system for total knee arthroplasty.
Many of the functional complications that arise after total knee arthroplasty (TKA) are caused by a non-optimal balance of the knee after surgery. Over the past 20 years, technology has been used in the Operating Room (OR) to help improve precision and balance. The results of Computer-Assisted Surgery (CAS) and robotic systems show improved accuracy regarding implant positioning but a relatively small improvement in patient-reported outcomes and implant survival compared to conventional TKA. Recently, Augmented Reality (AR) has been proposed as a technology that could improve accuracy in orthopaedic surgery, providing a more efficient and cost-effective solution. ⋯ Augmented Reality can be a valuable tool to improve accuracy in TKA. The use of smart glasses and integrated sensors improves the efficiency of the procedure, particularly when coupled with single-use instrumentation. A novel protocol for soft tissue assessment allows for a 3-dimensional evaluation of the ligaments and a better measurement of the effect of tibial rotation.
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Arch Orthop Trauma Surg · Dec 2021
ReviewCustomised, individually made total knee arthroplasty shows promising 1-year clinical and patient reported outcomes.
Customised individually made (CIM) implants for total knee arthroplasty (TKA) were introduced about 10 years ago. These implants aim to reduce the risk of prosthesis-related issues resulting from anthropometric differences between different knees. The purpose of this study was to analyse the short-term clinical outcome and patient reported outcome measures (PROMs) of a specific CIM implant, the ORIGIN® knee replacement system (Symbios, Yverdon-les-Bains, Switzerland), which was introduced in 2018. ⋯ The present study demonstrated significant improvements in the KSS and specific PROMs 1 year after CIM TKA. This study suggests that CIM TKA is a safe and suitable option, which can yield good clinical outcome and PROMs at least during short-term follow-up.
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Arch Orthop Trauma Surg · Dec 2021
ReviewComponent placement accuracy in two generations of handheld robotics-assisted knee arthroplasty.
Total knee arthroplasty (TKA) is the gold standard for treatment of end-stage osteoarthritis. Previous studies have shown that successful outcomes following TKA depend on accurate implant alignment and soft tissue balancing. Robotic-assisted TKA have demonstrated improved accuracy in component placement and have been associated with better outcomes and patient satisfaction. This study aims to report on the execution accuracy of two generations of handheld robotic-assisted surgical systems. ⋯ Robotic-assisted knee replacement using handheld image-free systems is able to maintain accuracy of component placement. Further investigation of patient reported outcomes as well as long-term implant longevity are needed.