Anatomical Angle Research Articles

Pilates method program for the management of scoliosis of GADYTRA health personnel

Introduction: Scoliosis corresponds to the misalignment or deviation of the spine to the side. It can be accompanied by rotation of the vertebrae. In the adult population, 60% suffer from scoliosis, altering posture and pain. Analyzing research studies, Pilates have been selected for the management of the pathology. Objective: Implement a Pilates-based exercise program to improve scoliosis in the health personnel working in GADYTRA (Diagnostic and Therapeutic Gastroenterology of the Amazon Region). Methods: The research was carried out with a population of 28 people. It was quasi-experimental, observational, longitudinal, and quantitative approach. The results were analyzed before and after with the Nordic questionnaire, VAS, and anatomical angles. The pilates program was used in a period of 12 weeks. For the analysis and data processing, Shapiro Willk, T Student, and Wilcoxon were used. Results: Greater discomfort in the neck, upper and lower back, and hips was identified after the Pilates program and from the post-test it was obtained that there is a reduction in pain and a decrease in the angles of the shoulders and hips. It improved posture and pain in participants. Conclusions: The Pilates program works to improve pain and posture with adequate discipline in the population.

Preservation rhinoplasty: evaluating the effects of cephalic resection on nasal anatomical angles in primary open rhinoplasty

Preservation rhinoplasty: evaluating the effects of cephalic resection on nasal anatomical angles in primary open rhinoplasty

Phantom-Enhanced High Mechanical Accuracy for Frame-Based Deep Brain Stimulation.

Deep brain stimulation (DBS) is a neurosurgical procedure that depends on high-accuracy targeting of structures to implant electrodes within the brain. The positioning of these electrodes in the brain determines the long-term efficacy of treating diseases such as Parkinson's disease, essential tremor, or dystonia.Misplaced electrodes in DBS can lead to poor efficacy and stimulation-induced side effects. Widespread targeting errors and variability have been published throughout the literature. As such,improvement in targeting accuracy is needed to enhance the quality of the procedures. A stereotactic phantom was utilized to test and adjust targeting before the surgical placement in the brain for 91 sequential electrodes.The tip of the microelectrode, the first rigid point in time, was measured and compared to the planned target.The technique utilized a to-target cannulawith an XY stage that allowed x-axis and y-axis adjustments and correction for inaccuracies relative to the phantom.A calculation was developed to convert anatomical angles (sagittal and coronal) provided by commercial planning stations to spherical angles to calculate points along a trajectory.Errorcalculations included each dimensional axis, Euclidean error, and radial error. Bends in the cannula and microelectrode were observed and corrected by referencing the phantom. All 91 first-pass tracks traversed the intended target, and three electrodes required a second mapping track beyond the first penetration due to neurophysiological and intraoperative testing. The results showed overall ultra-high (0-0.5 mm) to high (>0.5-1 mm) accuracy, an average Euclidean error of 0.66±0.30 mm, and a radial error of 0.45±0.28 mm with dimensional errors of less than 0.5 mm per axis. The utilization of a stereotactic phantom is an important tool to enhance the stereotactic targeting before insertion into the brain. This phantom technique yielded ultra-high to high accuracy in error calculations.Future methods and studies shouldfocus on error minimization to enhance these DBS mechanical accuracy and correlations with clinical outcomes.

Predominant determinants for evaluation of right parasternal approach in transthoracic echocardiography in aortic stenosis: a study based on three-dimensional cardiac computed tomography analysis.

The maximum blood flow velocity through the aortic valve (AVmax) using Doppler transthoracic echocardiography (TTE) is important in assessing the severity of aortic stenosis (AS). The right parasternal (RP) approach has been reported to be more useful than the apical approach, but the anatomical rationale has not been studied. We aimed to clarify the influence of the angle formed by the ascending aorta and left ventricle on Doppler analysis by TTE (Sep-Ao angle) and three-dimensional multidetector computed tomography (3D-MDCT) in patients with AS. A total of 151 patients evaluated using the RP approach and 3D-MDCT were included in this study. The Sep-Ao angle determined using TTE was compared with that determined using 3D-MDCT analysis. In MDCT analysis, the left ventricular (LV) axis was measured in two ways and the calcification score was calculated simultaneously. The Sep-Ao angle on TTE was consistent with that measured using 3D-MDCT. In patients with an acute Sep-Ao angle, the Doppler angle in the apical approach was larger, potentially underestimating AVmax. Multivariate analysis revealed that an acute Sep-Ao angle, large Doppler angle in the apical approach, smaller Doppler angle in the RP approach, and low aortic valve calcification were independently associated with a higher AVmax in the RP approach than in the apical approach. The Sep-Ao angle measured using TTE reflected the 3D anatomical angle. In addition to measurements using the RP approach, technical adjustments to minimize the Doppler angle to avoid bulky calcification should always be noted for accurate assessment.

THE IMPORTANCE OF ANATOMICAL CHARCOT RECONSTRUCTION UTILIZING STANDARDIZED OSTEOTOMIES TO IMPROVE SURGICAL OUTCOMES

IntroductionCharcot neuroarthropathy is a debilitating condition that frequently leads to skeletal instability, and has an increased risk of ulceration leading to infection and amputation. However, surgical reconstruction may offer limb salvage and restauration of an ulcer-free, plantigrade stable foot for functional weight-bearing. We report on our case series according to a prospective protocol and analyse factors leading to a favourable outcome.MethodsWe report a prospective follow-up of 62 patients undergoing Charcot reconstruction, May 2014- Jan 2022, by two surgeons. Peripheral vascular disease was routinely assessed using Duplex scan and major arterial disease was treated before reconstruction. Utilising 3D modelling, pre-operative planning and standardised osteotomies, we performed anatomical correction with radiological evidence. Definitive fixation was undertaken with internal fixation to stabilise the hindfoot. Multivariant analysis was performed to assess risk factors for failure (P>0.05 statistical significance).Results59 feet were included, 3 patients did not progress to definitive surgery and 3 patients had bilateral surgery. 62.7% patients were male with an average age of 56, 88.13% had Type 2 diabetes, 56% were hypertensive, 14% were on dialysis. Twenty (54.1%) single stage reconstructions had pre-operative ulceration, 3 pts had ischaemic heart disease and 36 pts had evidence of peripheral arterial disease. 81% of patients achieved normalisation of the 3 out of 4 anatomical angles (P<0.05). Two patients (3.1%) required metalwork removal for infection and limb salvage, 11 (18.6%) had delayed wound healing. Survivorship was 97% at 3yrs, and 94% at 6yrs, however if pre-existing vascular disease was present, it was 94% at 3yrs 85.3% at 6yrs. All patients were mobile at a 3 years mean follow up.ConclusionCareful patient selection, multidisciplinary team and anatomic reconstruction led to predictable outcomes and functional limb salvage. Pre-operative vascular compromise led to a slight reduction in survivorship, but no major amputation.

The Naso-Orbito-Frontal (NOF) Complex In Facial Feminization Surgery

Background: With the increasing demand for facial feminization surgery, there is a growing need for reliable and reproducible techniques to enhance outcomes. Objective: This study aimed to evaluate the effectiveness of single-stage Naso-Orbito-Frontal (NOF) complex reshaping in facial feminization surgery. Effectiveness was gauged by CT scan assessments and an unvalidated patient satisfaction survey at 6 months post-operative. Methods: The study included 155 transfeminine patients undergoing surgery of the upper third of the face. Outcomes were compared in patients receiving either Orbito-Frontal (OF) surgery or combined Naso-Orbito-Frontal (NOF) surgery. A comparative analysis of pre- and postoperative standardized CT scan sections was performed, focusing on multiple anatomic angles in two dimensions. A self-administered satisfaction questionnaire based on six FACE-Q items was completed at 6 months. Results: Among the 155 patients, 65 underwent OF surgery, and 90 underwent NOF surgery. The follow-up period ranged from 6 to 36 months, with an average of 18 months. Significant changes in craniometric measurements were observed: in the OF group, average changes in nasofrontal, frontal tilt, and metopion angles were +12.3±0.2°, -8.5±2.2°, and +20.0±0.1° respectively (p<0.001); in the NOF group, same metrics were +28.5±0.3°, -9.3±2.4°, and +23.9±0.1° (p<0.001). The NOF group demonstrated higher overall satisfaction (Median: 4/5) compared to the OF group (Median: 3/5). No early complications were reported. Conclusion: The NOF complex surgery is an effective approach in gender-affirming surgery of the upper third of the face, yielding predictable results and higher patient satisfaction. Level of Evidence 3.

Application of a Navigated Drill for Cervical Pedicle Screw Insertion at C3-6.

Background Perforation of the cervical pedicle screw, especially lateral perforation, may lead to critical complications, such as vertebral artery injury. Sub-axial cervical spines (C3-6) are at risk of complications because these levels have limited area and angle. This study aimed to compare a navigated drill and a navigated probe for the insertion of cervical pedicle screws at C3-6. Methodology This retrospective study included 106 patients treated with cervical pedicle screws at C3-6. In total, 52 patients with 200 cervical pedicle screws using a navigated drill (group D) and 54 patients with 170 cervical pedicle screws using a navigated probe (group P) were compared. The perforation rate, anatomical medial angle of the pedicle, and actual angle of the screw were investigated using computed tomography. The planning error was defined as when the pedicle screw was applied for a small pedicle width of <3.5 mm. All perforations except for planning errors were defined as technical perforations. Results Grade 1 screw perforations were identified in 16 and 17 screws in groups D and P, respectively. Overall, 88% of the perforations were medial in group D, and 82% of perforations were lateral in group P. Technical perforations were found in 7/191 (3.7%, group D) and 15/168 (8.9%, group P) screws. There were no significant differences in the anatomical angle of the pedicle between the groups. The mean medial angle of the pedicle screws was 24.7° (group D) and 30.9° (group P) (p < 0.05). Conclusions The perforation rate of group D was less than half of that of group P. This was because a navigated drill was able to create a bony pilot hole at the hard medial cortical wall of the pedicle with a small medial angle, which was difficult to do with a navigated probe. A navigated drill can be useful for cervical pedicle screw insertion at C3-6 because of its easiness and safety.

Fully automatic algorithm for detecting and tracking anatomical shoulder landmarks on fluoroscopy images with artificial intelligence

ObjectivePatients with rotator cuff tears present often with glenohumeral joint instability. Assessing anatomic angles and shoulder kinematics from fluoroscopy requires labelling of specific landmarks in each image. This study aimed to develop an artificial intelligence model for automatic landmark detection from fluoroscopic images for motion tracking of the scapula and humeral head.Materials and methodsFluoroscopic images were acquired for both shoulders of 25 participants (N = 12 patients with unilateral rotator cuff tear, 6 men, mean (standard deviation) age: 63.7 ± 9.7 years; 13 asymptomatic subjects, 7 men, 58.2 ± 8.9 years) during a 30° arm abduction and adduction movement in the scapular plane with and without handheld weights of 2 and 4 kg. A 3D full-resolution convolutional neural network (nnU-Net) was trained to automatically locate five landmarks (glenohumeral joint centre, humeral shaft, inferior and superior edges of the glenoid and most lateral point of the acromion) and a calibration sphere.ResultsThe nnU-Net was trained with ground-truth data from 6021 fluoroscopic images of 40 shoulders and tested with 1925 fluoroscopic images of 10 shoulders. The automatic landmark detection algorithm achieved an accuracy above inter-rater variability and slightly below intra-rater variability. All landmarks and the calibration sphere were located within 1.5 mm, except the humeral landmark within 9.6 mm, but differences in abduction angles were within 1°.ConclusionThe proposed algorithm detects the desired landmarks on fluoroscopic images with sufficient accuracy and can therefore be applied to automatically assess shoulder motion, scapular rotation or glenohumeral translation in the scapular plane.Clinical relevance statementThis nnU-net algorithm facilitates efficient and objective identification and tracking of anatomical landmarks on fluoroscopic images necessary for measuring clinically relevant anatomical configuration (e.g. critical shoulder angle) and enables investigation of dynamic glenohumeral joint stability in pathological shoulders.Key Points• Anatomical configuration and glenohumeral joint stability are often a concern after rotator cuff tears.• Artificial intelligence applied to fluoroscopic images helps to identify and track anatomical landmarks during dynamic movements.• The developed automatic landmark detection algorithm optimised the labelling procedures and is suitable for clinical application.

Is the Pre-Shaping of an Orbital Implant on a Patient-Specific 3D-Printed Model Advantageous Compared to Conventional Free-Hand Shaping? A Systematic Review and Meta-Analysis.

This study aimed to perform a systematic review and meta-analysis to compare pre-shaped implants on a patient-specific 3D-printed (3DP) model to manual free-hand shaping (MFS) for orbital wall reconstruction. The PRISMA protocol was followed in this study, and the review was registered in the PROSPERO database (CRD42021261594). A search was conducted in MEDLINE (PubMed), Embase, Cochrane Library, Clinicaltrials.gov, Google Scholar, and the grey literature. Ten articles were included, and six outcomes were analyzed. In total, 281 patients were in the 3DP group and 283 were in the MFS group. The studies had an overall high risk of bias. 3DP models resulted in a better accuracy of fit, anatomical angle reproduction, and defect area coverage. The correction of orbital volume was also superior with statistical significance. There was a higher percentage of the correction of enophthalmos and diplopia in the 3DP group. Intraoperative bleeding and hospital stay were reduced in the 3DP group. The meta-analysis of operative time showed a reduction in the average operative time by 23.58 min (95% CI: -43.98 to -3.19), which was statistically significant (t(6) = -2.8299, p = 0.0300). The 3DP models appear advantageous for an accurate orbital wall reconstruction, with fewer complications than those for conventional free-hand-shaped implants.

Distal Femoral Valgus Resection Angle in Conventional Total Knee Arthroplasty - a CT Scanogram Study.

In conventional total knee arthroplasty (TKA), the distal femur valgus resection angle (DFVA) is decided either by measuring the specific resection angle for each patient on preoperative anteroposterior hip-knee-ankle (HKA) weight-bearing radiograph or using a fixed resection angle of five to seven degrees, when such facilities are not available. This study aims to measure the DVFA in TKA patients using preoperative HKA non-weight-bearing computerized tomography (CT) scanogram scout films and determine its relation with preoperative coronal plane lower-limb deformities. In this retrospective radiological study, various measurements were performed on bilateral, preoperative hip-knee-ankle CT scanograms of 73 knee osteoarthritis patients who had presented for total knee replacement surgery using a standard protocol. The angle between the femoral anatomical axis and femoral mechanical axis was measured as the femoral mechanical anatomical angle (FMAA), which corresponds to the surgical DFVA. The angle between the femoral and tibial mechanical axes was measured as mechanical femorotibial angle (MFTA). The correlation between FMAA and MFTA was studied. The mean FMAA for the study group was 6.45° (range 3° to 11°, SD 1.17°). The MFTA for the study group ranged from 24° varus to 14° valgus. The alignment was valgus in 14.4% (n=21), varus in 84.2% (n=123), and "0 degrees" in 1.3% (n=2). With valgus coronal alignment taken as positive and varus as negative, the Pearson's correlation coefficient for MFTA with FMAA was r = -0.5183 (p<0.001), indicating that valgus knees tended to have a smaller FMA angle and varus knees tended to have a larger FMA angle. In the non-availability of individualized measurements, in primary TKA, we recommend setting DFVA as five degrees for valgus deformities, six degrees for mild/moderate varus deformities (MFTA <15°) and seven degrees for severe varus deformities (MFTA > 15°).

Optimal anatomical angle and distance for drilling in cervical oblique corpectomy: A surgical anatomical study.

One of the difficulties of oblique corpectomy, less discussed in the literature, is the problem of how to achieve an optimum corpectomy. Therefore, this anatomico-radiological study was conducted to shed light on the use of the microscope at an appropriate angle and optimum drill distances in clinical cases undergoing cervical oblique corpectomy surgery. We examined the average distance of the diagonal line extending from the medial aspect of the ipsilateral vertebral foramen to the contralateral pedicle in cervical computed tomography -angiography axial scans in four cervical vertebrae, C3, C4, C5, and C6. We also measured the average angle between this diagonal trajectory and the horizontal line, making a total of 712 measurements in 89 patients. We found that horizontal drilling with an average length of 23-26 mm at an acute angle of about 22° -23° is optimal for adequate decompression of the spinal cord in the oblique corpectomy approach. Depending on the patient and the level of the vertebra, the distance and the angle of the horizontal drilling may range from 18 mm to 31 mm and from 15° to 33°, respectively. For an optimum cervical oblique corpectomy that provides adequate spinal cord decompression and maintains spinal stability, it is necessary to operate under a surgical microscope positioned at an acute angle and to know the horizontal drilling distance.

Anatomical Imaging Study on Uneven Settlement of the Proximal Tibia.

Uneven settlement of the proximal tibia significantly contributes to the onset and progression of medial compartment knee OA; however, the specific location and variations of proximal tibial deformity remain unclear. Therefore, this study aimed to explore the effects of the anatomic morphology of different tibial regions on proximal tibial vara and proximal tibial microstructural changes with age in both sexes to reveal the pattern of uneven settlement of the proximal tibia. In this retrospective study, we reviewed the radiographs of 414 patients (789 legs) between May and September 2021. The medial proximal tibial angle (MPTA) and four anatomic angles of the tibia (i.e., the tibial plateau-epiphyseal line [PT-EL] angle, epiphyseal line-tibial platform [EL-PF] angle, epiphyseal axis inclination angle [EAIA], and subepiphyseal axis inclination angle [SAIA]) were measured. The effect of each angle on MPTA and their changes with age in both sexes were investigated using Pearson's correlation coefficient and multiple linear regression. In females, PT-EL angle, EL-PF angle, and SAIA negatively correlated with MPTA (r=-0.325, -0.246, and -0.502; p < 0.05), and EAIA positively correlated with MPTA (r=0.099, p < 0.05). Regression analysis showed that the correlations between MPTA and PT-EL angle, EL-PF angle, and SAIA were significant (β=-1.003, -0.013, and -0.971; adjusted R2 =0.979). Furthermore, MPTA negatively correlated with age (r=-0.202, p < 0.05); PT-EL angle and EAIA positively correlated with age (r=0.237 and 0.142, p < 0.05). Regression analysis showed that only the correlation between PT-EL angle and age was significant (β=5.635, p < 0.05). In males, PT-EL angle, EL-PF angle, and SAIA negatively correlated with MPTA (r=-0.270, -0.267, and -0.533; p < 0.05), and EAIA positively correlated with MPTA (r=0.135, p < 0.05). Regression analysis showed that the correlations between MPTA and PT-EL angle, EL-PF angle, and SAIA were significant (β=-0.992, -0.017, and -0.958; adjusted R2 =0.970). However, there was no significant correlation between age and any of the measured angles (p > 0.05). Proximal tibial vara is affected by the anatomic morphology of the epiphyseal and subepiphyseal regions. In females, the uneven settlement of the epiphysis progresses with age and may be responsible for dynamic varus deformity of the proximal tibia.

An artificial intelligence based on a convolutional neural network allows a precise analysis of the alignment of the lower limb.

The objective of this study was to develop a numeric tool to automate the analysis of deformity from lower limb telemetry and assess its accuracy. Our hypothesis was that artificial intelligence (AI) algorithm would be able to determine mechanical and anatomical angles to within 1°. After institutional review board approval, 1175 anonymized patient telemetries were extracted from a database of more than ten thousand telemetries. From this selection, 31 packs of telemetries were composed and sent to 11 orthopaedic surgeons for analysis. Each surgeon had to identify on the telemetries fourteen landmarks allowing determination of the following four angles: hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and joint line convergence angle (JLCA). An algorithm based on a machine learning process was trained on our database to automatically determine angles. The reliability of the algorithm was evaluated by calculating the difference of determination precision between the surgeons and the algorithm. The analysis time for obtaining 28 points and 8 angles per image was 48 ± 12s for the algorithm. The average difference between the angles measured by the surgeons and the algorithm was around 1.9° for all the angles of interest: 1.3° for HKA, 1.6° for MPTA, 2.1° for LDFA, and 2.4° for JLCA. Intraclass correlation was greater than 95% for all angles. The algorithm showed high accuracy for automated angle measurement, allowing the estimation of limb frontal alignment to the nearest degree.

Evaluation of Distal Tibiofibular Interosseous Ligament Angle and Its Relevance in Syndesmosis Fixation

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: The interosseous ligament (IOL) of the ankle, together with the anterior and posterior inferior tibiofibular ligament (ATFL and PITFL), are important structures which stabilizes the inferior tibiofibular joint. Besides securing the fibula tightly to tibia, these ligaments prevent excessive lateral fibular displacement and external talar rotation. Thus, any injury to either bone or ligaments at this level will result in instability and abnormal joint motion. Our study aims to evaluate the anatomical angle of the ankle interosseous ligament on magnetic resonance imaging (MRI) studies to better understand the biomechanical forces that act within the distal tibiofibular joint, relevance of assimilating the anatomical angle and its relevance in syndesmosis fixations. Methods: MRIs of ankles were chosen anonymously from the global PACS system database between the months September to October 2020. A total of 34 patients' MRIs were identified. Patients who sustained bone or soft tissue injury at the level of ankle syndesmosis were excluded to avoid any ambiguity in altered position of the IOL due to trauma. The angle of interosseous ligament from the tibial plafond was measured on the coronal plane. The axial plane was used as a reference to ensure correct position of measurement. This was done in collaboration with radiologists to ensure that IOL is correctly identified, prior to start of the study. The angle was measured separately by two different investigators and the average angle was obtained for each MRI. Data was tabulated and statistical analysis was done. Results: All of the 20 ankles identified during the study period were included in the analysis. There were 10 male and 10 female patients. Nine were left ankles and 11 were right ankles. The median age was 54 years (range 14 - 83). The mean IOL angle was 65.66 degrees. The standard error of difference between the 2 investigators was 0.567 and the two-tailed P value was 0.4980. By conventional criteria, this difference is considered to be not statistically significant. Conclusion: The ligament angle formed against tibial plafond bears theoretical relevance. We propose further cadaveric studies to confirm IOL anatomical ligament angle and carrying out implant failure stress test in a lab between the implant inserted parallel to the normal angle of IOL (65 degrees) vs 90 degrees. We also propose that such studies may show that all implants to stabilize the syndesmosis may be more effective if we try to reproduce nature by replicating as close to the IOL's anatomical angle rather than using a long held dogma of fixing syndesmosis to neutralize the forces as nature intended.

Using short knee radiographs to predict the coronal alignment after TKA: Is it an accurate proxy for HKA on full-length images?

BackgroundThe postoperative clinical outcomes has been extensively demonstrated to correlate with the coronal alignment after total knee arthroplasty (TKA). However, in different studies, either the hip-knee-ankle angle (HKA) on a full-length radiograph or the femorotibial angle (FTA) on a short knee film was used to categorize the postoperative coronal alignment. Meanwhile, several different FTA ranges were regarded as neutral alignment in different studies. As a result, it is still unknown that how FTA on short knee films and HKA related to each other. The FTA may be able to become an accurate proxy of HKA to predict the coronal alignment. The purpose of this study was to explore the correlation between the FTA and the HKA after TKA and to find the most accurate FTA range.MethodsAbout 223 patients were included in this study and standard weight-bearing short knee films as well as full-length radiographs were acquired. The pre- and postoperative FTA, as well as the postoperative anatomical lateral distal femoral angle (aLDFA) and anatomical medial proximal tibial angle (aMPTA) were measured on short knee films by two orthopedic surgeons independently. On full-length films, the pre- and postoperative FTA, the pre- and postoperative HKA, as well as the postoperative mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were also recorded by two other surgeons independently. Pearson correlation analysis was performed to compare FTA and HKA, aMTPA and mMTPA, aLDFA and mLDFA, respectively.ResultsThe postoperative FTA and HKA had a good correlation (r = 0.86). The agreements were reached 82.7%, 71.0%, and 68.2% of all patients using three previously reported FTA ranges. When analyzing the independent alignment of the tibial tray and the femoral component, 84.1% and 57.9% of all patients was reached an agreement on the classification.ConclusionsOn most occasions, the consistence between the FTA and HKA in assessing the coronal limb alignment of the lower extremity and the tibial component is satisfactory. However, the postoperative full-length film is still needed to evaluate accurately the coronal alignment of the femoral component.

Computer vision for anatomical analysis of equipment in civil infrastructure projects: Theorizing the development of regression-based deep neural networks

There is high demand for heavy equipment in civil infrastructure projects and their performance is a determinant of the successful delivery of site operations. Although manufacturers provide equipment performance handbooks, additional monitoring mechanisms are required to depart from measuring performance on the sole basis of unit cost for moved materials. Vision-based tracking and pose estimation can facilitate site performance monitoring. This research develops several regression-based deep neural networks (DNNs) to monitor equipment with the aim of ensuring safety, productivity, sustainability and quality of equipment operations. Annotated image libraries are used to train and test several backbone architectures. Experimental results reveal the precision of DNNs with depthwise separable convolutions and computational efficiency of DNNs with channel shuffle. This research provides scientific utility by developing a method for equipment pose estimation with the ability to detect anatomical angles and critical keypoints. The practical utility of this study is the provision of potentials to influence current practice of articulated machinery monitoring in projects.

Comparison of Robotic and Conventional Unicompartmental Knee Arthroplasty Outcomes in Patients with Osteoarthritis: A Retrospective Cohort Study.

Robotic-arm-assisted unicompartmental knee arthroplasty (RUKA) was developed to increase the accuracy of bone alignment and implant positioning. This retrospective study explored whether RUKA has more favorable overall outcomes than conventional unicompartmental knee arthroplasty (CUKA). A total of 158 patients with medial compartment osteoarthritis were recruited, of which 85 had undergone RUKA with the Mako system and 73 had undergone CUKA. The accuracy of component positioning and bone anatomical alignment was compared using preoperative and postoperative radiograph. Clinical outcomes were evaluated using questionnaires, which the patients completed preoperatively and then postoperatively at six months, one year, and two years. In total, 52 patients from the RUKA group and 61 from the CUKA group were eligible for analysis. The preoperative health scores and Kellgren–Lawrence scores were higher in the RUKA group. RUKA exhibited higher implant positioning accuracy, thus providing a superior femoral implant angle, properly aligned implant placement, and a low rate of overhang. RUKA also achieved higher accuracy in bone anatomical alignment (tibial axis angle and anatomical axis angle) than CUKA, but surgical time was longer, and blood loss was greater. No significant differences were observed in the clinical outcomes of the two procedures.

Joint Line Obliquity Does Not Affect the Outcomes of Opening Wedge High Tibial Osteotomy at an Average 10-Year Follow-up

Background: A significant number of high tibial osteotomies (HTOs) result in an overcorrected tibia and subsequent excessive lateral joint line obliquity (JLO). The correlation between excessive JLO and poor outcomes is controversial. Purpose: To evaluate the prognostic factors (including a pathological postoperative JLO) related with the outcomes of opening wedge HTO at 10 years of follow-up. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing HTO between 2004 and 2017 for medial osteoarthritis and with a postoperative hip-knee-ankle angle between 176° and 185° were included. Clinical evaluation included Knee Society Score (KSS; knee score and function score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale for pain. Several mechanical and anatomic angles were measured pre- and postoperatively on long-leg weightbearing radiographs. Abnormal JLO was defined as a Mikulicz–joint line angle (MJL) ≥94° or a mechanical medial proximal tibial angle (mMPTA) ≥95°. Regression analysis was performed to evaluate the association between independent variables and each outcome. A Kaplan-Meier cumulative survival analysis was performed. Results: A total of 92 knees in 76 patients were included. The mean age of the patients was 53.5 years (SD, 9.7 years), and the mean follow-up was 129.4 months (SD, 44.4 months). Increased JLO was associated with a significant preoperative varus deformity (small preoperative hip-knee-ankle angle), increased mechanical lateral distal femoral angle, increased joint line congruency angle, and increased knee-ankle joint angle. Male sex was associated with better WOMAC scores (P = .0277), and increased body mass index (BMI) was associated with inferior WOMAC scores (P = .0024). A good preoperative range of motion was associated with better knee score (P = .0399) and function score (P = .0366) on the KSS. An increased BMI was associated with inferior KSS function scores (P = .0317). MJL ≥94° and mMPTA ≥95° were not associated with inferior WOMAC or KSS outcomes. With indication to total knee arthroplasty as an endpoint, Kaplan-Meier analysis showed a survival rate of 98.7% at 5 years, 95.5% at 10 years, and 92.7% at 12 years. Conclusion: Increased lateral JLO (MJL ≥94° or mMPTA ≥95°) was not correlated with the clinical outcomes of opening wedge HTO at 10 years of follow-up.

Medial patellofemoral ligament reconstruction combined with biplanar supracondylar femoral derotation osteotomy in recurrent patellar dislocation with increased femoral internal torsion and genu valgum: a retrospective pilot study

BackgroundThe purpose of this study was to evaluate the clinical and radiographic outcomes after medial patellofemoral ligament (MPFL) reconstruction combined with supracondylar biplanar femoral derotation osteotomy (FDO) in recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA) and genu valgum.MethodsBetween January 2017 to December 2020, a total of 13 consecutive patients (13 knees, 4 males and 9 females, mean age 18.7 (range, 15–29 years) with RPD with increased FAA (FAA > 25°) and genu valgum (mechanical axis deformity of ≥5°) who underwent supracondylar biplanar FDO using a Tomofix-locking plate combined with MPFL reconstruction in our institution were included. Preoperative full-leg standing radiographs, lateral views, and hip-knee-ankle computed tomography (CT) scans were used to evaluate the mechanical lateral distal femoral angle (mLDFA), anatomical femorotibial angle (aFTA), mechanical axis, patellar height, tibial tubercle-trochlear groove (TT-TG) distance, and torsional angle of the tibial and femoral in the axial plane. Patient reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS), and Tegner score preoperatively and postoperatively. Postoperative CT scans were used to evaluate the changes of FAA and TT-TG, and full-leg standing radiographs was used to evaluate the changes of mLDFA, aFTA, and mechanical axis.ResultsA total of 13 patients (13 knees) were included with an average follow-up period of 26.7 months (range 24–33). No cases developed wound infection, soft tissue irritation, and recurrent patellar dislocation during the follow-up period after surgery. Bone healing at the osteotomy site was achieved in all cases, and all patients regained full extension and flexion. Clinical outcomes (VAS, Kujala, IKDC, Lysholom, and Tegner scores) improved significantly at the final follow-up after surgery (p < 0.05). The mean mLDFA, aFTA, mechanical axis, and TT-TG distance showed statistically significant improvement following the combined surgery (p < 0.05), while the CDI did not change significantly after surgery (p>0.05).ConclusionMPFL reconstruction combined with supracondylar biplanar FDO showed satisfactory clinical outcomes and radiographic results in the short-term follow-up period.

Factors influencing knee valgus alignment in Crowe type IV hip dysplasia after total hip arthroplasty

BackgroundValgus deformity of the knee remains a complaint after total hip arthroplasty (THA) among some patients with Crowe type IV hip dysplasia. We aimed to identify the knee alignment in these patients before and after surgery, and to explore the factors contributing to postoperative knee valgus alignment.Materials and methodsWe retrospectively reviewed a series of Crowe type IV patients who received THA between February 2010 and May 2019 in our hospital. The patients’ medical data were collected from the hospital information system. On both preoperative and postoperative full limb length standing radiographs, the following parameters were measured: hip–knee–ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, anatomical tibiofemoral angle, anatomical lateral distal femoral angle, femoral neck-shaft angle, pelvic obliquity, limb length, height and lateral distance of hip center, and femoral offset. Univariate and multivariate binary logistic regression were used to identify the factors influencing postoperative knee valgus alignment.ResultsA total of 64 Crowe type IV patients (87 hips) were included in the study. Overall, HKA improved from 176.54 ± 3.52° preoperatively to 179.45 ± 4.31° at the last follow-up. Those hips were subdivided into non-valgus group (≥ 177.0°, n = 65) and valgus group (< 177.0°, n = 22) according to postoperative HKA. Only postoperative mLDFA was a significant factor in the multivariate regression model.ConclusionsThe postoperative mLDFA is a major factor related to knee valgus alignment after THA, which combines the preoperative anatomy and surgical reconstruction. Other factors previously published were found to have no significance.Level of evidenceIII.