Computer-assisted Surgery Research Articles

No difference in surgical time and total theatre time between robotically assisted and computer assisted total knee arthroplasty

IntroductionA number of studies have demonstrated a significant reduction of surgical time for robotically assisted surgery (RAS) total knee arthroplasty (TKA) after the learning curve between 6 and 43 cases. It is unknown if the logistics of RAS produce a longer total theatre time since published literature only reflects the surgical time. It is also unknown how RAS surgical and total theatre times compare with computer assisted surgery (CAS) TKA.MethodsThis is a prospective study of 524 consecutive patients undergoing a CAS or a RAS TKA using the same cementless implant. We recorded age, sex, body mass index (BMI), incision time of the first case, total surgical time, total theatre time, length of stay and 90-day complication and readmission rate.ResultsDuring the study period, 205 CAS and 199 RAS TKA were performed. There was no difference at baseline in age (p = 0.546), sex (p = 0.920) or BMI (p = 0.791). Surgical time for CAS was 78.3 (± 22.2) min and for RAS was 80.1 (± 25.7) min, p = 0.451. Total theatre time for CAS was 117.4 (± 27.8) min and 119.3 (± 30.7) min for RAS, p = 0.515. There was no difference in length of stay (p = 0.674), 90-day complication (p = 0.530) or readmission rate (p = 0.930). There was a difference in skin-incision average time for the first case (p = 0.022).ConclusionsAlthough theatre set-up for the first case is 5 min longer, RAS-TKA does not prolong the surgical time or total theatre time when compared with CAS-TKA. There was no reduction in case volume since the introduction of robotics.Level of evidenceIII.

A Novel Method of Correcting Lower Facial Asymmetry: Computer-Assisted Surgery with Contralateral Mandibular Outer Cortex Sandwich Grafting.

Lower facial asymmetry often results in an esthetically unpleasing appearance. The purpose of this study was to develop a novel method for correcting lower facial asymmetry using mandibular augmentation with sandwich bone grafts from the contralateral mandibular outer cortex (MOC), and to evaluate the efficacy of this method using computer-assisted techniques. The medical records of 16 patients with lower facial asymmetry who underwent mandibular augmentation with sandwich bone grafts from the contralateral MOC between January 2016 and December 2019 were retrospectively reviewed. Preoperative computer-aided design (CAD) was performed based on CBCT data, MOC grafts were harvested from the donor side using a 3D printed osteotomy guide template and grafted to the recipient side in sandwich manner to augment the contralateral mandible. Effectiveness was evaluated through pre- and postoperative CBCT data and FACE-Q questionnaire scores. Neurosensory recovery of the inferior alveolar nerve was assessed using the functional sensory recovery (FSR) scale. All procedure were successfully completed, and the asymmetry was effectively corrected three-dimensionally with no serious complications. The patients' FACE-Q scores for satisfaction with the lower facial area significantly increased from 52.19±7.51 to 86.69±7.50. No significant differences were observed in the pre- and postoperative lengths of mandibular ramus or body on either side. The donor site volume increased by 559.38±335.12 mm3 at 6 months postoperatively. The recipient site volume increased by 4415.94±1017.21 mm3 on the 7th day postoperatively and decreased by 202.63±300.85 mm3 at 6 months, reflecting a bone resorption rate of 5.67 ± 8.12%. The median FSR time for the chin and lower lip was 90 days. Mandibular augmentation with contralateral MOC sandwich grafts effectively increases mandibular width and volume witha low resorption rate. This method allows for three-dimensional restoration of facial symmetry in cases of mild to moderate lower facial asymmetry, achieving a harmonious and symmetric appearance. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. www.springer.com/00266.

REVIEW OF MODERN METHODS OF REDUCING THE COMPUTATIONAL COMPLEXITY OF IMAGE RECOGNITION IN COMPUTER-ASSISTED SURGERY

Abstract. The article is devoted to the review of modern methods of reducing the computational complexity of image recognition in computer-assisted surgery. The problem of computational complexity can adversely affect the image recognition process, slowing it down and reducing its accuracy. Given the relevance of existing image recognition technologies in surgery, a number of methods for reducing computational complexity are considered, based on existing scientific research. Calculations are presented, examples of the use of the proposed methods are considered. The research is the basis for further study of optimised methods and their integration into surgical practice.

Are Sleeves Necessary in Static Computer-Assisted Implant Surgery? A Comparative InVitro Analysis.

This study aims to examine differences in trueness and precision between surgical guides with (S) and without sleeves (SL). A secondary aim was to assess the impact of the sleeve-to-bone distance. Mandible replicas (n = 120) were printed from an STL file obtained from a clinical CBCT. The mandibles were divided into sleeved (S, n = 60) and sleeveless (SL, n = 60) groups, each further divided into three categories (n = 20 each) with different heights from the guide to the implant platform: 2 mm (H2), 4 mm (H4), or 6 mm (H6). Digital planning and surgical guide design were done for a 4.1 × 10 mm implant for site #30. Post-op positions were captured using a scan body and lab scanner. Angular deviation was the primary outcome, with 3D and 2D deviations as secondary parameters. Statistical analysis included two-sample t-tests, and one-way and two-way ANOVA. Group S (2.41 ± 1.41°) had significantly greater angular deviation than Group SL (1.65 ± 0.93°; p = 0.0001). Angular deviation increased with sleeve-to-bone distance. H2 deviations were 1.48 ± 0.80° (S) vs. 1.02 ± 0.45° (SL; p < 0.05), H4: 2.36 ± 1.04° (S) vs. 1.48 ± 0.79° (SL; p < 0.05), H6: 3.37 ± 0.67° (S) vs. 2.46 ± 0.89° (SL; p < 0.05). 3D deviation at the implant platform was 0.36 ± 0.17 mm (S) vs. 0.30 ± 0.15 mm (SL; p < 0.05) and at the apex 0.74 ± 0.34 mm (S) vs. 0.53 ± 0.31 mm (SL; p < 0.01). Group SL at H2 had the smallest inter-implant distance (0.53 ± 0.37°), while Group S at H4 had the largest (1.20 ± 0.84°; p < 0.05). Sleeveless guides are more accurate than sleeved guides, and angular deviation is influenced by the distance from the guide to the implant platform.

Enhancing accuracy of surgical stylus-tip tracking: A comparative calibration study

Accurate determination of the position of surgical stylus-tip is crucial for informed decision-making in computer-assisted surgery. This study assesses the accuracy of various calibration methods for stylus-tip tracking. A novel template-based calibration method is proposed, offering a practical protocol for assessing surgical stylus-tip accuracy. Relative position and orientation errors are measured using two custom-made phantoms and compared with those from existing techniques. Experimental results shows that our proposed method achieves greater positional accuracy (mean: 1.73 mm; range: 0.53-3.42 mm) compared to the geometry-based method (mean: 3.78 mm; range: 2.52-5.05 mm) and the algebraic-based method (mean: 2.47 mm; range: 1.52-3.52 mm). In terms of orientation accuracy, our method also performs slightly better (mean: 0.95 deg; range: 0-3.41 deg) than the geometry-based method (mean: 1.03 deg; range: 0-3.36 deg) and the algebraic-based method (mean: 1.01 deg; range: 0-3.22 deg). The advantages of our method are highlighted, demonstrating its potential for application in the operating room.

Accelerometer-based portable navigation system shows no superior accuracy over pelvic alignment guide for acetabular cup placement in total hip arthroplasty in lateral decubitus position.

Total hip arthroplasty (THA) using a portable navigation system (PNS) incurs costs per procedure. However, it does not require a large console. This study aimed to compare the accuracy of acetabular cup placement using a pelvic alignment guide (PAG) attached to the pelvis and an accelerometer-based PNS in THA performed in the lateral decubitus position. We retrospectively analyzed 100 hips that underwent primary THA in the lateral decubitus position between July 2018 and January 2021. The PAG was used in 50 hips, whereas the PNS was used in the other 50. Cup placement accuracy was measured using postoperative computed tomography scans, comparing errors in inclination and anteversion angles. The surgical time, blood loss, and complications were recorded. The follow-up period was at least 2 years in all cases. The mean absolute error of the inclination angle was similar between the groups (the PAG group: 3.7° ± 2.3° [range, 0.0-9.0]; the PNS group: 3.7° ± 2.3° [range, 0.2-10.5], p = 0.705). The mean absolute error of the anteversion angle was significantly smaller in the PAG group than in the PNS group (3.0° ± 2.4° [range, 0.0-9.7] vs. 6.5° ± 4.8° [range, 0.3-17.3], p < 0.001). The PAG group had a higher proportion of hips within 5° and 10° of the target angle (64 vs. 42%, P = 0.028, and 100 vs. 74%, p < 0.001, respectively). The PNS group had six hips with anteversion errors of 15° or more. Surgical time and blood loss were lower in the PAG group. The PNS group had one dislocation, whereas the PAG group did not. The accelerometer-based PNS did not demonstrate superior cup alignment accuracy compared to the PAG in THA performed in the lateral decubitus position. This finding informs surgeons that computer-assisted surgery is not necessarily superior to conventional THA using a PAG.

MA-VoxelMorph: Multi-scale attention-based VoxelMorph for nonrigid registration of thoracoabdominal CT images

This paper aims to develop a nonrigid registration method of preoperative and intraoperative thoracoabdominal CT images in computer-assisted interventional surgeries for accurate tumor localization and tissue visualization enhancement. However, fine structure registration of complex thoracoabdominal organs and large deformation registration caused by respiratory motion is challenging. To deal with this problem, we propose a 3D multi-scale attention VoxelMorph (MA-VoxelMorph) registration network. To alleviate the large deformation problem, a multi-scale axial attention mechanism is utilized by using a residual dilated pyramid pooling for multi-scale feature extraction, and position-aware axial attention for long-distance dependencies between pixels capture. To further improve the large deformation and fine structure registration results, a multi-scale context channel attention mechanism is employed utilizing content information via adjacent encoding layers. Our method was evaluated on four public lung datasets (DIR-Lab dataset, Creatis dataset, Learn2Reg dataset, OASIS dataset) and a local dataset. Results proved that the proposed method achieved better registration performance than current state-of-the-art methods, especially in handling the registration of large deformations and fine structures. It also proved to be fast in 3D image registration, using about 1.5 s, and faster than most methods. Qualitative and quantitative assessments proved that the proposed MA-VoxelMorph has the potential to realize precise and fast tumor localization in clinical interventional surgeries.

The Accuracy of Dental Implant Placement With Different Methods of Computer-Assisted Implant Surgery: A Network Meta-Analysis of Clinical Studies.

Computer-assisted implant surgery (CAIS) has been introduced as a tool to aid in reaching a more accurate implant position. The aim of this network meta-analysis was to compare all the available CAIS techniques and obtain collective evidence on the method that offers the highest accuracy compared to freehand implant placement. Database search was done in PubMed, Scopus, and Cochrane library in addition to extensive search in the gray literature and related systematic reviews, aiming to find clinical studies that compared any CAIS technique with another, or with freehand implant placement. The outcomes evaluated were angle, platform, and apex deviation. The search process ended on March 18, 2024. Thirty-three studies were included. All CAIS techniques (static with partial or full guidance, dynamic with partial or full guidance, the combination of static and dynamic CAIS) showed significantly less deviation than freehand implant placement, except for the static CAIS with guidance for the pilot drill only. The combination of static and dynamic CAIS ranked best among all other methods. Based on the GRADE system, the certainty of evidence in the outcomes of the meta-analysis was judged as low or moderate. The current study demonstrates that computer-assisted implant surgery provides significantly higher accuracy in implant placement, with the combination of static and dynamic CAIS being the most precise. Nevertheless, future studies are needed, considering the different types, locations, and extents of edentulism in the analyzed investigations, as well as the necessity of obtaining stronger evidence. PROSPERIO number: CRD42023482030.

Reduction Cranioplasty in Cases of Hydrocephalic Macrocephaly: Pearls and Pitfalls of Computer-Assisted Surgery.

Reduction cranioplasty may be indicated to address functional or cosmetic sequelae of hydrocephalic macrocephaly. With the advent of CAD/CAM digital workflow, surgeons can design and fabricate craniotomy guides, templates, and models that allow for precise cranial reconstruction. Although there are several advantages of virtual planning, pre-determined surgical plans may limit intraoperative flexibility, requiring surgeons to troubleshoot errors in pre-operative planning or model design. The purpose of this report is to present a series of cases demonstrating our institution's technique for single-stage reduction cranioplasty using a CAD/CAM workflow. This report will highlight the benefits and challenges associated with a contemporary digital workflow for reduction cranioplasty.

Impact of innovations in surgical techniques and advanced imaging on postoperative recovery and reduction of complications in patients with long bone fractures: a systematic review

Long bones fracture is one of the most complicated surgeries in orthopedics and the progress in the techniques as well as technologies used has recorded a steady progression in the last few years. Minimally invasive surgery (MIS), computer-assisted surgery and improved imaging techniques can all be cited as impacting on emerging practices. Conversely, the success of such techniques and their influences on the performance results should continue to be assessed in order to adjust the treatment approaches and patients’ conditions. This paper aimed at reviewing and researching current journals and literature on the topic of managing long bone fractures with specific emphasis on the new developments in surgery, imaging, and after care. Included articles were randomized control trials, cohort studies, meta-analysis, from reputable orthopedic journals and evaluated both effectiveness, and adverse outcomes of these advancements. In light of the study, it emerges that less invasive procedures in thoracic surgery lead to fewer postoperative complications and quicker convalescence time among the patients; and magnetic resonance imaging (MRI) and intraoperative fluoroscopy improves diagnostic accuracy and also surgical localization. Computer assisted surgery and augmented reality have been recognized as useful adjuncts in both the preoperative planning and intra operative navigation through the surgical field but they are still not widely used due to the costs associated with the purchase of equipment and initial technical difficulties. In particular, the use of these technologies successfully advanced the clinical efficiency in the treatment of long bone fractures.

Undifferentiated embryonal sarcoma of the liver in children: our experience in four difficult cases and three-dimensional practical exploration

AimsTo explore rare and difficult cases of undifferentiated embryonal sarcoma of the liver (UESL) in children in a single centre, summarize the diagnosis and treatment experience and analyse the role of a computer-assisted surgery system (Hisense CAS), thus providing a new global vision and three-dimensional perspective.MethodsWe retrospectively collected the clinical data including the diagnoses and treatment processes, of children with UESL confirmed by histopathological examination in our hospital from January 2009 to December 2020. The relationship between the tumour volume and important blood vessels and between the liver volume and tumour volume, as well as other three-dimensional characteristics in the reconstructed three-dimensional model were analysed using Hisense CAS. The findings from this analysis can be used to aid in surgical decision-making and preoperative planning.ResultsFour children—3 girls and 1 boy—with UESL were included in the study. The age at onset ranged from 6 to 8 years. All four children presented with symptoms of abdominal discomfort, and abdominal masses were detected during physical examination. Owing to the wishes of their parents and the possibility that the disease was benign, all four children underwent one-stage radical surgery. For patient 1, a three-dimensional reconstruction was created during the initial diagnosis, which made accurate evaluation and planning of the preoperative procedure challenging. In patient 2, the tumour was located in the middle lobe of the liver and involved the first and second hepatic hilum. For patient 3, the pathological diagnosis of the tumour after surgery was challenging, but eventually, the diagnosis was confirmed through histochemistry and consultation with higher-level hospitals. Patient 4 had a giant tumour, which had a preoperative simulated future liver remnant volume (FLV) that was 21.0% of the total volume of the liver and tumour (TLTV). According to the standard liver volume (SLV) for children, the FLV was 77.0% of the SLV, making surgery feasible. All four children underwent complete resection, and only patient 4 experienced recurrence below the diaphragm 19 months after surgery. Currently, the 3-year overall survival rate is 100%, and the 3-year event-free survival rate is 75%.ConclusionUESL in children is rare, and the key to diagnosis and treatment is complete surgical resection. Through individualized three-dimensional surgical planning, accurate and complete resection of difficult and complex UESL in children can be achieved, leading to a favourable prognosis.

Comparative study on three-dimensional versus two-dimensional imaging using a computer-assisted surgery system for preoperative planning in pediatric middle hepatic tumors

BackgroudThe study objective was to compare three-dimensional and two-dimensional imaging using computer-assisted systems (CASs) in clinical guidance for preoperative surgical planning for middle hepatic tumors in children.MethodsA retrospective analysis was performed on 23 children who underwent surgery for middle hepatic tumors in our hospital from January 2016 to June 2022. The surgical resection plan was formulated by the operator team using two-dimensional CT images before the operation. Then, the same qualified surgeons conducted an in-depth analysis and formulated the surgical resection scheme for the same pediatric patient using three-dimensional imaging of the middle hepatic tumor. The feasibility of the two schemes was compared and analyzed.ResultAll the tumors were successfully removed according to the preoperative method developed using three-dimensional imaging. The postoperative short-term follow-up revealed that all patients were doing well. Preoperative plans were revised in 9 cases after evaluating the three-dimensional images due to the disparity between the original plans and the three-dimensional relationship between the tumor and blood vessels, vascular variation, and the volume of remnant liver.ConclusionsThree-dimensional imaging with a computer-assisted surgery system is superior to two-dimensional imaging in the preoperative planning of pediatric hepatoblastoma.

Comparative study of computer-assisted and robot-assisted atlantoaxial pedicle screw implantation for reversible atlantoaxial dislocation

To investigate the effectiveness of computer-assisted and robot-assisted atlantoaxial pedicle screw implantation for the treatment of reversible atlantoaxial dislocation (AAD). The clinical data of 42 patients with reversible AAD admitted between January 2020 and June 2023 and met the selection criteria were retrospectively analyzed, of whom 23 patients were treated with computer-assisted surgery (computer group) and 19 patients were treated with Mazor X spinal robot-assisted surgery (robot group). There was no significant difference in gender, age, T value of bone mineral density, body mass index, etiology, and preoperative Japanese Orthopaedic Association (JOA) score, Neck Dysfunction Index (NDI) between the two groups ( P>0.05). The operation time, screw implantation time, intraoperative blood loss, hand and wrist radiation exposure, and complications were recorded and compared between the two groups. Gertzbein classification was used to evaluate the accuracy of screw implantation. JOA score and NDI were used to evaluate the function before operation, at 3 days after operation, and at last follow-up. At last follow-up, the status of screws and bone fusion were observed by neck three-dimensional CT. The operation time and hand and wrist radiation exposure of the computer group were significantly longer than those of the robot group ( P<0.05), and there was no significant difference in the screw implantation time and intraoperative blood loss between the two groups ( P>0.05). All patients were followed up 11-24 months, with an average of 19.6 months. There was no significant difference in the follow-up time between the two groups ( P>0.05). There was no significant difference in the accuracy of screw implantation between the two groups ( P>0.05). Except for 1 case of incision infection in the computer group, which improved after antibiotic treatment, there was no complication such as nerve and vertebral artery injury, screw loosening, or breakage in the two groups. The JOA score and NDI significantly improved in both groups at 3 days after operation and at last follow-up ( P<0.05) compared to those before operation, but there was no significant difference between the two groups ( P>0.05). At last follow-up, 21 patients (91.3%) in the computer group and 18 patients (94.7%) in the robot group achieved satisfactory atlantoaxial fusion, and there was no significant difference in the fusion rate between the two groups ( P>0.05). Computer-assisted or robot-assisted atlantoaxial pedicle screw implantation is safe and effective, and robotic navigation shortens operation time and reduces radiation exposure.

The Impact of Navigation in Lumbar Spine Surgery: A Study of Historical Aspects, Current Techniques and Future Directions.

Background/Objectives: We sought to improve accuracy while minimizing radiation hazards, improving surgical outcomes, and preventing potential complications. Despite the increasing popularity of these systems, a limited number of papers have been published addressing the historical evolution, detailing the areas of use, and discussing the advantages and disadvantages, of this increasingly popular system in lumbar spine surgery. Our objective was to offer readers a concise overview of navigation system history in lumbar spine surgeries, the techniques involved, the advantages and disadvantages, and suggestions for future enhancements to the system. Methods: A comprehensive review of the literature was conducted, focusing on the development and implementation of navigation systems in lumbar spine surgeries. Our sources include PubMed-indexed peer-reviewed journals, clinical trial data, and case studies involving technologies such as computer-assisted surgery (CAS), image-guided surgery (IGS), and robotic-assisted systems. Results: To develop more practical, effective, and accurate navigation techniques for spine surgery, consistent advancements have been made over the past four decades. This technological progress began in the late 20th century and has since encompassed image-guided surgery, intraoperative imaging, advanced navigation combined with robotic assistance, and artificial intelligence. These technological advancements have significantly improved the accuracy of implant placement, reducing the risk of misplacement and related complications. Navigation has also been found to be particularly useful in tumor resection and minimally invasive surgery (MIS), where conventional anatomic landmarks are lacking or, in the case of MIS, not visible. Additionally, these innovations have led to shorter operative times, decreased radiation exposure for patients and surgical teams, and lower rates of reoperation. As navigation technology continues to evolve, future innovations are anticipated to further enhance the capabilities and accessibility of these systems, ultimately leading to improved patient outcomes in lumbar spine surgery. Conclusions: The initial limited utilization of navigation system in spine surgery has further expanded to encompass almost all fields of lumbar spine surgeries. As the cost-effectiveness and number of trained surgeons improve, a wider use of the system will be ensured so that the navigation system will be an indispensable tool in lumbar spine surgery. However, continued research and development, along with training programs for surgeons, are essential to fully realize the potential of these technologies in clinical practice.

A Review of 3D Modalities Used for the Diagnosis of Scoliosis.

Spine radiographs in the standing position are the recommended standard for diagnosing idiopathic scoliosis. Though the deformity exists in 3D, its diagnosis is currently carried out with the help of 2D radiographs due to the unavailability of an efficient, low-cost 3D alternative. Computed tomography (CT) and magnetic resonance imaging (MRI) are not suitable in this case, as they are obtained in the supine position. Research on 3D modelling of scoliotic spine began with multiplanar radiographs and later moved on to biplanar radiographs and finally a single radiograph. Nonetheless, modern advances in diagnostic imaging have the potential to preserve image quality and decrease radiation exposure. They include the DIERS formetric scanner system, the EOS imaging system, and ultrasonography. This review article briefly explains the technology behind each of these methods. They are compared with the standard imaging techniques. The DIERS system and ultrasonography are radiation free but have limitations with respect to the quality of the 3D model obtained. There is a need for 3D imaging technology with less or zero radiation exposure and that can produce a quality 3D model for diseases like adolescent idiopathic scoliosis. Accurate 3D models are crucial in clinical practice for diagnosis, planning surgery, patient follow-up examinations, biomechanical applications, and computer-assisted surgery.

Methods for three-dimensional characterization of the acetabulum prior to pelvic reorientation osteotomy: a scoping review.

Periacetabular osteotomy is the gold standard treatment for acetabular dysplasia. The great variability of acetabular dysplasia requires a personalized preoperative planning improved by 3D reconstruction and computer-assisted surgery. To plan the displacement of the acetabular fragment by a pelvic osteotomy, it is necessary to define a reference plane and a method to characterize 3D acetabular orientation. A scoping review was performed on PubMed to search for articles with a method to characterize the acetabulum of native hips in a 3D reference frame. Ninety-eight articles out of 3815 reports were included. Three reproducible reference planes were identified: the anterior pelvic plane, the Standardization and Terminology Committee plane used in gait analysis, and the sacral base plane. The different methods for 3D analysis of the acetabulum were divided in four groups: global orientation, triplanar measurements, segmentation, and surface coverage of the femoral head. Two methods were found appropriate for reorientation osteotomies: the global orientation by a vector method and the triplanar method. The global orientation method relies on the creation of a vector from the acetabular rim, from the acetabular surface or from successive planes. Normalization of the global acetabular vector would correct acetabular dysplasia by a single alignment maneuver on an ideal vector. The triplanar method, based on angle measurements at the center of the femoral head, would involve correction of anomalies by considering axial, frontal, and sagittal planes. Although not directly fit for reorientation, the two others would help to candidate patients and verify both planning and postoperative result.

GHMM: Learning Generative Hybrid Mixture Models for Generalized Point Set Registration in Computer-Assisted Orthopedic Surgery

GHMM: Learning Generative Hybrid Mixture Models for Generalized Point Set Registration in Computer-Assisted Orthopedic Surgery

Computer-Assisted Hip Arthroscopic Surgery for Secondary Femoroacetabular Impingement After Rotational Acetabular Osteotomy Using Capsular Takedown Techniques

Secondary femoroacetabular impingement (FAI) is a severe complication observed after acetabular osteotomy; however, the diagnostic and treatment strategies of FAI have not been well established, especially with respect to arthroscopic techniques. We here describe hip arthroscopic osteochondroplasty for secondary FAI using computer-assisted techniques. The main features and tips of our technique are preoperative computed tomography (CT)-based surgical planning and the intraoperative capsule takedown method. Computer modeling produces a patient-specific 3-dimensional CT bone model. Subsequently, we identify the impingement point between the acetabulum and the femoral neck using dynamic simulation. The excess bony bumps are resected through computer surgical simulation, and pre- and postoperative 3-dimensional CT bone models are combined to identify the appropriate resection area. For the surgical technique, it is important to detach the capsule to visualize the acetabulum bony excess. Once the resection area has been sufficiently visualized, the bone resection is performed. Finally, the capsule is reattached to the excavated acetabulum, and the delaminated labrum is sewn up with the capsule in a round bale shape.

One year "ADAPT system" use for proximal femoral fracture osteosynthesis with intramedullary nail . A case control study.

Proximal femoral fractures (PFF) are a significant health concern among the elderly, often leading to complications and high mortality rates. Intramedullary nailing is widely considered the most effective treatment for lateral proximal femoral fractures (LPFF), with the Tip Apex Distance (TAD) being a crucial predictor of surgical success. This study aimed to compare outcomes between patients treated with and without the ADAPT (ADAptive Positioning Technology) system, which aids in the precise placement of the cephalic screw. A retrospective analysis was conducted on 97 patients with intertrochanteric fractures treated in 2022. Patients were divided into two groups: those treated with the ADAPT system (group I, n=34) and those treated without it (group II, n=63). Fractures were classified according to AO/OTA classification. The primary outcomes measured were operative time, cephalic screw angle, TAD, and incidence of lag screw cut-out. Statistical analyses included chi-square tests and t-tests, with significance set at P < 0.05. The ADAPT system did not significantly reduce TAD (18.21 mm in the ADAPT group vs.19.94 mm in the control group, p=0.149). Operative times were similar between the groups. The incidence of lag screw cut-out was low in both groups, with no significant differences. The study confirmed a strong correlation between higher TAD and increased risk of screw cut-out, underscoring the importance of precise screw placement. Computer-assisted surgery, such as the ADAPT system, aims to enhance the accuracy of cephalic screw placement. In this study, the ADAPT system didn't demonstrate a statistically significant advantage in reducing TAD or preventing screw cut-out. Nevertheless, the critical role of TAD in preventing fixation failure was reaffirmed, emphasising the need for precise surgical techniques. While the ADAPT system did not show a significant advantage in reducing TAD or preventing screw cut-out in this study, the importance of achieving optimal TAD in cephalomedullary nailing was reinforced. Future research should continue to explore the role of computer-assisted systems in enhancing surgical accuracy and improving outcomes for patients with LPFF.

Computer-assisted revision total knee arthroplasty does not improve postoperative knee prosthesis alignment compared to the conventional technique.

Computer-assisted surgery (CAS) during primary total knee arthroplasty (TKA) prosthesis alignment. However, literature on its use during revision TKA (rTKA) is scarce. Moreover, the effect of CAS during rTKA on rotational alignment of the prosthesis has not been described yet. The purpose of this study was to assess the effect of CAS during rTKA, focusing on the number of outliers and coronal, sagittaland rotational prosthetic alignment compared to conventional rTKA. A prospective cohort study comparing CAS-rTKA with a historical control group (CON-rTKA). The CAS-rTKA group (54 patients/62 knees) underwent rTKA using imageless CAS between 2012 and 2017. The CON-rTKA group (13 patients/23 knees) was operated using the conventional technique between 2002 and 2012. Postoperative alignment was measured using the EOS-2D/3D system (coronal and sagittal planes) and computed tomographyscan (rotation). No significant differences between the CAS-rTKA and CON-rTKA groups were found for coronal and sagittal alignment regarding the mechanical angle of the leg (p = 0.08), mechanical lateral distal femoral angle (p = 0.87), mechanical medial proximal tibial angle (p = 0.40), anatomical proximal posterior tibial angle (p = 0.43) nor femoral (p = 0.80) and tibial rotation (p = 0.15). For the proportions of coronal, sagittaland rotational outliers, no significant differences were found either. This study showed no evidence that use of CAS during rTKA leads to improved coronal, sagittalor rotational alignment of knee prosthesesor a difference of outliers between the groups. Level III, therapeutic.