Computer-assisted Surgery Research Articles

Hip Capsular Repair Affect on Joint Laxity in Total Hip Arthroplasty

Purpose: Loss of tissue tension around the hip is a cause of hip dislocation. The shuck test is a simple intraoperative test for soft tissue tension. This study evaluated the soft tissue tightness around the hip joint after capsule repair and compared the joint tension resulting from different capsule repair approaches. Methods: Fifty-three patients underwent a non-cemented total hip replacement using image-free computer-assisted surgery. The patients were divided into the posterior and the anterolateral approach groups. After the hip was reduce, a computer navigation plan was devise to restore proper leg length. The shuck test was applied to determine the soft tissue tension before and after capsule repair. The leg length was recorded after hip reduction and the shuck test. Data from the computer navigation were collected for analysis. Results The results of this study showed that after the shuck test, the leg length increased by up to 5.98±1.75 mm. (6.73±1.64 mm. and 5.26±1.56 mm for the posterior and anterolateral approach, respectively). After capsule repaire, the leg was shortened by 4.78±1.31 mm. (5.42±1.10 mm. and 4.15±1.20 mm for posterior and anterolateral approach, respectively). The study found that the leg shortening from the posterior approach was significantly higher than the anterolateral approach (p-value <0.001). There were no hip dislocations in this series. Conclusions: Hip capsule repair improves the soft tissue tension around the hip joint. This helps reduce the risk of hip dislocation. Hip capsule repair using a posterior approach has a better outcome.

Can Hisense computer-assisted surgery system (Hisense CAS) improve anatomy teaching in pediatric liver surgery?

This study aimed to investigate the effectiveness of the Hisense computer-assisted surgery system (CAS) in teaching pediatric liver surgical anatomy. The research subjects were residents who underwent standardized training at the Department of Pediatric Surgery at Yijishan Hospital of Wannan Medical College from May 2022 to May 2023. The study recruited a total of 62 students, with 31 students assigned to the Hisense CAS group (12 males and 19 females) and the remaining 31 students serving as controls (Control group, 15 males and 16 females). There were no significant differences in baseline characteristics observed between the two groups. This study found that the average scores of the Hisense CAS teaching group in the liver surgery evaluations were higher than those of the control group. Specifically, the Hisense CAS group had an average score of 84.25 ± 5.70 points in the liver surgery knowledge test, 77.10 ± 8.12 points in the image reading test, and 70.58 ± 8.79 points in the surgical simulation test, while the traditional teaching group had average scores of 73.45 ± 6.12 points, 69.81 ± 6.05 points, and 66.42 ± 6.61 points, respectively; the differences between the two groups were statistically significant (P < 0.05). Furthermore, this study also found that the Hisense CAS teaching model resulted in significantly better teaching satisfaction on the part of the residents in terms of standardized teaching for physicians in pediatric liver surgical anatomy. In conclusion, this study demonstrated greater satisfaction of the residents with the use of 3D reconstruction added to traditional teaching sessions and better performance during the posttraining evaluation.

Robotic-Assisted and Computer-Assisted Navigation Surgery in the Cervical Spine: Current Experiences, Techniques, and Accuracy

Background: In recent years, the role of robotic-assisted and computer-assisted navigation (RA-CAN) systems has significantly expanded in spine surgery, particularly those performed in the thoracic, lumbar and sacral spine showing higher accuracy in pedicle screw placement and improved surgical efficiency. However, there are few reports on these techniques in the cervical spine. The anatomy of the cervical spine possesses additional challenges such as the close proximity to critical neurovascular structures. Purpose: In this article, we present the existing clinical experience of RA-CAN in the cervical spine and evaluate technical considerations. Cervical spine screw fixation and decompression using RA-CAN are reviewed. Results: This analysis covers various aspects such as techniques, accuracy, and the types of procedures reported in the literature. Recent reports include surgical procedures such as anterior cervical diskectomy and fusion’s, odontoid fracture fixation, C1 lateral mass, C2 pedicle, translaminar, subaxial spine lateral mass, and mid-cervical spine pedicle screw fixation. There is potential for enormous clinical benefit to navigated decompression in cervical CAN procedures also. Future opportunities include further improvements in imaging co-localization, pre-surgical planning software, and mechanization of surgical procedures for instrumentation and decompression. Conclusion: The growth of RA-CAN in spinal surgery has shown significant potential in its application in the cervical spine for fusion procedures as well as decompression. By understanding the potential limitations and techniques reported from early experiences, previous techniques can be improved and provide further benefits for accuracy and less invasive surgery.

Clinical and Radiological Outcomes of Computer-Assisted Navigation in Primary Total Knee Arthroplasty for Patients with Extra-articular Deformity: Systematic Review and Meta-Analysis.

Computer-assisted navigation surgery (CAS) during primary total knee arthroplasty (TKA) may help improve outcomes for patients with extra-articular deformity (EAD); however, this has not been extensively studied. Therefore, we aimed to investigate the clinical and radiological outcomes following primary TKA using CAS in patients with EAD. We searched Medline, Embase, and the Cochrane Library up to March 3, 2023 for studies investigating surgical outcomes of using the navigation system for TKA to treat patients with EAD. From 14 studies, 539 knees with EAD that underwent navigation TKA were enrolled. We investigated the knee range of motion (ROM), outcome scores at final follow-up (Knee Society Score [KSS] and Knee Functional Score [KFS]), and pre- and postoperative mechanical hip-knee-ankle (mHKA) angle using lower extremity scanogram. The meta-analysis was based on the single-arm method, and all data were pooled using a random-effects model. Following our meta-analyses, the mean knee ROM changed from 87.0° (95% confidence interval [CI], 75.9°-98.1°) preoperatively to 109.4° (95% CI, 97.9°-120.8°) postoperatively. The adjusted KSS was 93.45 points (95% CI, 88.36-98.54 points), and the adjusted KFS was 91.57 points (95% CI, 86.80-96.33 points) in knees with EAD that underwent CAS-TKA. As a radiological outcome, the mHKA angle changed from 169.53° (95% CI, 166.90°-172.16°) preoperatively to 178.81° (95% CI, 178.31°-179.30°) postoperatively. CAS-TKA yielded positive clinical results and demonstrated a satisfactory alignment of the lower limb's mechanical axis. CAS-TKA showed promise for primary TKA procedures, demonstrating favorable clinical and radiological outcomes even in complex cases involving EAD.

Artificial intelligence- and computer-assisted navigation for shoulder surgery.

Background: Over the last few decades, shoulder surgery has undergone rapid advancements, with ongoing exploration and the development of innovative technological approaches. In the coming years, technologies such as robot-assisted surgeries, virtual reality, artificial intelligence, patient-specific instrumentation, and different innovative perioperative and preoperative planning tools will continue to fuel a revolution in the medical field, thereby pushing it toward new frontiers and unprecedented advancements. In relation to this, shoulder surgery will experience significant breakthroughs. Main body: Recent advancements and technological innovations in the field were comprehensively analyzed. We aimed to provide a detailed overview of the current landscape, emphasizing the roles of technologies. Computer-assisted surgery utilizing robotic- or image-guided technologies is widely adopted in various orthopedic specialties. The most advanced components of computer-assisted surgery are navigation and robotic systems, with functions and applications that are continuously expanding. Surgical navigation requires a visual system that presents real-time positional data on surgical instruments or implants in relation to the target bone, displayed on a computer monitor. There are three primary categories of surgical planning that utilize navigation systems. The initial category involves volumetric images, such as ultrasound echogram, computed tomography, and magnetic resonance images. The second type is based on intraoperative fluoroscopic images, and the third type incorporates kinetic information about joints or morphometric data about the target bones acquired intraoperatively. Conclusion: The rapid integration of artificial intelligence and deep learning into the medical domain has a significant and transformative influence. Numerous studies utilizing deep learning-based diagnostics in orthopedics have remarkable achievements and performance.

Instrument-Tissue Interaction Detection Framework for Surgical Video Understanding.

Instrument-tissue interaction detection task, which helps understand surgical activities, is vital for constructing computer-assisted surgery systems but with many challenges. Firstly, most models represent instrument-tissue interaction in a coarse-grained way which only focuses on classification and lacks the ability to automatically detect instruments and tissues. Secondly, existing works do not fully consider relations between intra- and inter-frame of instruments and tissues. In the paper, we propose to represent instrument-tissue interaction as 〈 instrument class, instrument bounding box, tissue class, tissue bounding box, action class 〉 quintuple and present an Instrument-Tissue Interaction Detection Network (ITIDNet) to detect the quintuple for surgery videos understanding. Specifically, we propose a Snippet Consecutive Feature (SCF) Layer to enhance features by modeling relationships of proposals in the current frame using global context information in the video snippet. We also propose a Spatial Corresponding Attention (SCA) Layer to incorporate features of proposals between adjacent frames through spatial encoding. To reason relationships between instruments and tissues, a Temporal Graph (TG) Layer is proposed with intra-frame connections to exploit relationships between instruments and tissues in the same frame and inter-frame connections to model the temporal information for the same instance. For evaluation, we build a cataract surgery video (PhacoQ) dataset and a cholecystectomy surgery video (CholecQ) dataset. Experimental results demonstrate the promising performance of our model, which outperforms other state-of-the-art models on both datasets.

Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review.

This systematic review summarizes existing evidence and outlines the benefits of artificial intelligence-assisted spine surgery. The popularity of artificial intelligence has grown significantly, demonstrating its benefits in computer-assisted surgery and advancements in spinal treatment. This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a set of reporting guidelines specifically designed for systematic reviews and meta-analyses. The search strategy used Medical Subject Headings (MeSH) terms, including "MeSH (Artificial intelligence)," "Spine" AND "Spinal" filters, in the last 10 years, and English- from January 1, 2013, to October 31, 2023. In total, 442 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 220 that matched the criteria, of which 11 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. In total, 11 studies met the eligibility criteria. Analysis of these studies revealed the types of artificial intelligence-assisted spine surgery. No evidence suggests the superiority of assisted spine surgery with or without artificial intelligence in terms of outcomes. In terms of feasibility, accuracy, safety, and facilitating lower patient radiation exposure compared with standard fluoroscopic guidance, artificial intelligence-assisted spine surgery produced satisfactory and superior outcomes. The incorporation of artificial intelligence with augmented and virtual reality appears promising, with the potential to enhance surgeon proficiency and overall surgical safety.

Dual-correlate optimized coarse-fine strategy for monocular laparoscopic videos feature matching via multilevel sequential coupling feature descriptor

Feature matching of monocular laparoscopic videos is crucial for visualization enhancement in computer-assisted surgery, and the keys to conducting high-quality matches are accurate homography estimation, relative pose estimation, as well as sufficient matches and fast calculation. However, limited by various monocular laparoscopic imaging characteristics such as highlight noises, motion blur, texture interference and illumination variation, most exiting feature matching methods face the challenges of producing high-quality matches efficiently and sufficiently. To overcome these limitations, this paper presents a novel sequential coupling feature descriptor to extract and express multilevel feature maps efficiently, and a dual-correlate optimized coarse-fine strategy to establish dense matches in coarse level and adjust pixel-wise matches in fine level. Firstly, a novel sequential coupling swin transformer layer is designed in feature descriptor to learn and extract multilevel feature representations richly without increasing complexity. Then, a dual-correlate optimized coarse-fine strategy is proposed to match coarse feature sequences under low resolution, and the correlated fine feature sequences is optimized to refine pixel-wise matches based on coarse matching priors. Finally, the sequential coupling feature descriptor and dual-correlate optimization are merged into the Sequential Coupling Dual-Correlate Network (SeCo DC-Net) to produce high-quality matches. The evaluation is conducted on two public laparoscopic datasets: Scared and EndoSLAM, and the experimental results show the proposed network outperforms state-of-the-art methods in homography estimation, relative pose estimation, reprojection error, matching pairs number and inference runtime. The source code is publicly available at https://github.com/Iheckzza/FeatureMatching.

Surgical accuracy of coronal and sagittal alignment in conventional closed-wedge high tibial osteotomy after computer-assisted surgery experience

BackgroundAlthough intraoperative navigation can improve the surgeon’s proficiency, no studies have analyzed postoperative outcomes of high tibial osteotomy (HTO) after computer-assisted surgery (CAS) experience. The present study compared the clinical and radiographic results between conventional and CAS closed-wedge (CW) HTOs after CAS experience.MethodsEach of the 50 conventional and CAS CW HTOs performed by single surgeon between 2015 and 2017 were included. The surgeon had experience of 140 cases of CAS CW HTOs before the study period. The groups were not different in terms of demographics. Clinically, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were investigated. Radiographically, the mechanical axis (MA), change in posterior tibial slope angle (PTS), and parallel angle were evaluated. The proportions of inlier groups for the postoperative MA (within valgus 2° ± 3°), change in the PTS (within ± 3°), and parallel angle (< 3°) were compared.ResultsThere were no significant differences in postoperative clinical results between the conventional and CAS groups. The MA was appropriately corrected in both groups (2.4° versus 2.9°, p = 0.317). The amount of change in PTS was significantly greater in the conventional group (−2.2° versus −0.8°, p = 0.018). The parallel angle was 5.3° in the conventional groups and 3.1° in the CAS group (p = 0.003). The proportion of inlier group was not significantly different in the postoperative MA (72% versus 78%) and change in the PTS (52% versus 66%). The proportion of inlier for the parallel angle was significantly lower in the conventional group (36% versus 60%, p = 0.027).ConclusionsThe surgical proficiency after CAS experience could cover the advantages of an intraoperative navigation in coronal adjustment, not in the sagittal adjustments in CW HTOs. A larger cohort with multiple surgeons in multiple centers would be required to identify the general trend.Study designLevel of evidence III.

Accuracy Comparison between Robot-Assisted Dental Implant Placement and Static/Dynamic Computer-Assisted Implant Surgery: A Systematic Review and Meta-Analysis of In Vitro Studies.

Background and Objectives: The present systematic review and meta-analysis undertake a comparison of studies that examine the accuracy of robot-assisted dental implant placement in relation to static computer-assisted implant surgery (SCAIS), dynamic computer-assisted implant surgery (DCAIS), and freehand procedures. This study aims to provide a comprehensive understanding of the precision of robot-assisted dental implant placement and its comparative efficacy in relation to other placement techniques. Methods: The guidelines recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to organize and compose this review. Four electronic databases (PubMed, Web of Science, Scopus, and Cochrane) were systematically searched for pertinent articles. Articles were selected following the inclusion and exclusion criteria. Qualitative and quantitative analyses of the selected articles were performed. Results: The initial electronic search resulted in 1087 hits. Based on the inclusion and exclusion criteria, five articles were selected for qualitative analysis, out of which three were considered for quantitative analysis. Three parameters were considered for accuracy evaluation (angular, coronal, and apical deviation). The mean angular deviation was -1.22 degrees (95% CI, -1.06--1.39), the mean coronal deviation was -0.15 mm (95% CI, -0.24--0.07), and the mean apical deviation was -0.19 mm (95% CI, -0.27--0.10). Conclusions: The robotic implant system was found to have significantly lower angular deviations and insignificantly lower coronal and apical deviations compared to DCAIS. Within the limitations of this review, it can be concluded that robot-assisted implant placement in resin models permits higher accuracy compared to DCAIS and SCAIS systems. However, due to the limited number of comparative studies with high heterogeneity, the findings of this review should be interpreted with caution. Further research is necessary to confirm the clinical application of robotics in implant surgery.

The true pelvic volume change with various corrective osteotomy techniques for exstrophy-epispadias complex spectrum: the value of computer-assisted virtual surgery.

Pelvic osteotomies are essential to approximate widened symphysis pubis in the exstrophy-epispadias complex, yet it is unknown which osteotomy type has the greatest effect on pelvic volume. We therefore used virtual surgery to study pelvic volume change with anterior, oblique, and posterior iliac osteotomies. Preoperative CT scans of two cloacal and one classic bladder exstrophy patients were used. Simulations were free-hand or constrained to keep minimal strain in the sacrospinous SSL and sacrotuberous STL ligaments. Changes in inter-pubic distance, pelvic volume, SSL and STL strains were measured. Mean pelvic volume decreased by 10% with free hand compared to 23% with constrained simulations ( P = 0.171) and decreased by 7% with posterior, 17% with diagonal and 26% with horizontal osteotomies ( P = 0.193). SSL and STL were strained by 20% and 26%, respectively, with free-hand simulations. A statistically significant moderate positive correlation was found between the decrease in inter-pubic distance and reduction in pelvic volume (r = 0.6, P = 0.004). Mean pelvic volume decreased 0.05, 0.37 and 0.62% for each mm of pubic symphysis approximation with posterior, diagonal and horizontal osteotomies, respectively. Differences in effect on pelvic volume were identified between the osteotomies using virtual surgery which predicted residual diastasis in actual cloacal exstrophy surgical reconstructions. Oblique osteotomies are a compromise, avoiding difficulties with posterior osteotomies and excessive pelvic volume reduction with horizontal osteotomies. Understanding how osteotomy type affects pelvic morphology with virtual surgery may be an effective adjunct to pre-operative planning in exstrophy spectrum.

Status Quo of Surgical Navigation

Surgical navigation, also referred to as computer-assisted or image-guided surgery, is a technique that employs a variety of methods - such as 3D imaging, tracking systems, specialised software, and robotics to support surgeons during surgical interventions. These emerging technologies aim not only to enhance the accuracy and precision of surgical procedures, but also to enable less invasive approaches, with the objective of reducing complications and improving operative outcomes for patients. By harnessing the integration of emerging digital technologies, surgical navigation holds the promise of assisting complex procedures across various medical disciplines. In recent years, the field of surgical navigation has witnessed significant advances. Abdominal surgical navigation, particularly endoscopy, laparoscopic, and robot-assisted surgery, is currently undergoing a phase of rapid evolution. Emphases include image-guided navigation, instrument tracking, and the potential integration of augmented and mixed reality (AR, MR). This article will comprehensively delve into the latest developments in surgical navigation, spanning state-of-the-art intraoperative technologies like hyperspectral and fluorescent imaging, to the integration of preoperative radiological imaging within the intraoperative setting.

Computer-Assisted Intramedullary Nailing of Intertrochanteric Fractures Did Not Prevent Tip–Apex Distance Outliers

Intertrochanteric femoral fractures are commonly treated with intramedullary nails (IMNs). A tip–apex distance (TAD) of more than 20–25 mm is associated with an increased risk of cut-out. The Stryker Adaptive Positioning System (ADAPT) is a computer-assisted navigation system designed to reduce TADs. We aim to assess if the ADAPT reduces the number of outliers with a TAD &gt; 20 mm. All patients with intertrochanteric fractures treated with an IMN between 1 September 2020 and 12 March 2022 were included. Patients were included in three periods: a pre-ADAPT period (55 patients); an ADAPT period (50 patients), where it was compulsory to use the system; and a post-ADAPT period after the discontinuation of the system (59 patients). The TADs and lag screw protrusions beyond the lateral cortex were measured. The median TADs in the three periods were 17.0 mm (8–31 mm), 15.5 mm (9–30 mm), and 18.0 mm (11–32 mm), respectively. The absolute number of outliers with a TAD &gt; 20 mm decreased from 15/55 patients in the pre-ADAPT period to 11/50 patients during the ADAPT period. This observation was not statistically significant, but this is likely due to the lack of power of the present study to show changes of this magnitude. However, our expectation that the ADAPT would diminish outliers markedly or close to zero outliers was not met, as we observed 11/50 = 22% outliers with a TAD &gt; 20 mm when using computer-assisted surgery, i.e., ADAPT and Gamma3 for intertrochanteric fractures. Based on these findings, the use of the ADAPT was discontinued at our level 1 trauma center.

An Automatic and Robust Visual SLAM Method for Intra-Abdominal Environment Reconstruction

Three-dimensional (3D) surface reconstruction is used to solve the problem of the narrow field of view in laparoscopy. It can provide surgeons or computer-assisted surgery systems with real-time complete internal abdominal anatomy. However, rapid changes in image depth, less texture, and specular reflection pose a challenge for the reconstruction. It is difficult to stably complete the reconstruction process using feature-based simultaneous localization and mapping (SLAM) method. This paper proposes a robust laparoscopic 3D surface reconstruction method using SLAM, which can automatically select appropriate parameters for stereo matching and robustly find matching point pairs for laparoscope motion estimation. The changing trend of disparity maps is used to predict stereo matching parameters to improve the quality of the disparity map. Feature patch extraction and tracking are selected to replace feature point extraction and matching in motion estimation, which reduces its failure and interruption in feature-based SLAM. The proposed feature patch matching method is suitable for parallel computing, which can improve its computing speed. Evaluation results on public in vivo and ex vivo porcine abdominal video data show the efficiency and robustness of our 3D surface reconstruction approach.

Accuracy and Precision of Mandible Segmentation and Its Clinical Implications: Virtual Reality, Desktop Screen and Artificial Intelligence

Objective3D modeling is a major challenge in computer-assisted surgery (CAS). Manual segmentation, as the gold standard, is tedious, time consuming, and particularly challenging for the mandible, while artificial intelligence (AI)-based segmentation is a promising and time-saving alternative. However, little is known about the clinical implications of various segmentation methods. MethodIn this cross-over study, ten mandibles were segmented in virtual reality (VR), on a desktop screen (DS) by five experts and via five AI models. The exported mandible models were evaluated using metrics, a public reference (PUBDS), and blinded assessments by two radiologists. ResultsAverage segmentation-to-volume accuracy (1 = poor, 5 = perfect) was comparable for human segmentation (VR: 4.56; DS: 4.33; PUBDS: 4.55) and significant better than AI-based segmentation (AI: 3.80), while the average segmentation-to-segmentation accuracy revealed that DS (91.4 %/0.37 mm [Dice coefficient/average Hausdorff distance]) was more comparable to PUBDS than to VR (90.1 %/0.44 mm). The precision of VR (96.8 %/0.14 mm) and DS (96.6 %/0.15 mm) was superior to PUBDS (94.1 %/0.21 mm) and the AI method (89.2 %/0.60 mm). While VR was significantly faster than DS and PUBDS for the manual segmentation methods (p = 0.007/< 0.001), in contrast, the AI method is not time sensitive due to its possible hardware scalability. ConclusionAccuracy and precision of mandible segmentation depends primarily on CT quality and anatomical site, which should be considered in clinical applications and the generation of AI training data and could negatively impact CAS. Although current AI models have perfect intra-model reliability, they demonstrate higher inter-model variability and are accompanied by invalid outliers making human review still necessary. In summary, the use of VR in manual segmentation showed high accuracy and precision overall while saving time, making it the preferred method over DS due to its good usability.

The degree of C-reactive protein elevation after total knee arthroplasty is related to bone and medullary injury rather than soft tissue.

First, we want to find out whether computer-assisted surgery (CAS) for total knee arthroplasty (TKA), which does not require opening the femoral medullary canal, results in a lesser C-reactive protein (CRP) level increase postoperatively compared to manual TKA. Second, they seek to examine whether the CRP reduction in CAS TKA and manual TKA follows a similar pattern within the first 2 weeks after surgery. Third, the study aims to compare and analyze the CRP levels in 3 different groups: CRP levels in CAS TKA with surgeons who started TKA surgery by CAS, CRP levels in manual TKA by surgeons with little experience, and CRP levels in skillful manual TKA performed after conducting over 200 cases. The 3 patient groups were as follows. Group 1: Patients who underwent non expertized surgeon CAS TKA (N = 63). Group 2: Patients who underwent manual TKA after surgeon CAS TKA experience (N = 108). Group 3: Patients who underwent manual TKA after surgeon 200 cases or more of either CAS TKA or manual TKA experience (more skillful manual TKA) (N = 66). CRP levels were analyzed using electronic medical records for 3 time points: within 3 months before surgery, 5 days after surgery, and 11 days after surgery. There were no statistically significant differences in pre operative CRP values among the 3 groups. At 5 days after surgery, the CRP level were 48.59 ± 32.75 for CAS TKA, 69.82 ± 42.76 for early manual TKA, and 67.73 ± 44.00 for skillful manual TKA, indicating a statistically significant lower CRP level in the CAS TKA group compared to the manual TKA groups (P = .01). At 11 days after surgery, there were no statistically significant differences in CRP level among the 3 groups, with was 12.12 ± 9.74 for CAS TKA, 14.07 ± 13.18 for early manual TKA, and 11.43 ± 11.45 for skillful manual TKA. The degree of CRP elevation after TKA is related to bone and medullary injury rather than soft tissue.

Increased Femoral Component Flexion and No Difference in Slope in Robotic- versus Computer-Assisted Total Knee Arthroplasty When Targeting Mechanical Alignment.

Robotic-assisted surgery (RAS) in total knee arthroplasty (TKA) is becoming popular due to better precision, when compared with other instrumentation. Although RAS has been validated in comparison with computer-assisted surgery (CAS), data from clinical settings comparing these two techniques are lacking. This is especially the case for sagittal alignment. Whereas pure mechanical alignment (MA) aims for 0 to 3 degrees of flexion of the femoral component and 3° of posterior slope for the tibial component, adjusted MA (aMA) mostly used with RAS allows for flexing of the femoral component for downsizing and increase of slope for an increase of the flexion gap. In the present study, we compared sagittal alignment after TKA using RAS with aMA and CAS targeting MA, which has been the standard in the center for more than 10 years. We analyzed a prospectively collected database of patients undergoing TKA in a single center. Femoral component flexion and tibial slope were compared for both techniques. In 140 patients, 68 CAS and 72 RAS, we found no difference in tibial slope (p = 0.661), 1° median femoral component flexion (p = 0.023), and no difference in outliers (femur, p = 0.276, tibia, p = 0.289). RAS slightly increases femoral component flexion, but has no influence on tibial slope, when compared with CAS in TKA. If MA is the target, RAS provides no benefit over CAS for achieving the targeted sagittal alignment. LEVEL OF EVIDENCE: Level III retrospective study.

No Benefit of Robotic-Assisted over Computer-Assisted Surgery for Achieving Neutral Coronal Alignment in Total Knee Arthroplasty.

The use of robotic-assisted surgery (RAS) in total knee arthroplasty (TKA) is becoming increasingly popular due to better precision, potentially superior outcomes and the ability to achieve alternative alignment strategies. The most commonly used alignment strategy with RAS is a modification of mechanical alignment (MA), labeled adjusted MA (aMA). This strategy allows slight joint line obliquity of the tibial component to achieve superior balancing. In the present study, we compared coronal alignment after TKA using RAS with aMA and computer-assisted surgery (CAS) with MA that has been the standard in the center for more than 10 years. We analyzed a prospectively collected database of patients undergoing TKA in a single center. Lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were compared for both techniques. In 140 patients, 68 CASs and 72 RASs, we observed no difference in postoperative measurements (median 90 degrees for all, LDFA p = 0.676, MPTA p = 0.947) and no difference in outliers <2 degrees (LDFA p = 0.540, MPTA p = 0.250). The present study demonstrates no benefit in eliminating outliers or achieving neutral alignment of both the femoral and the tibial components in robotic-assisted versus computer-assisted TKA if MA is the target. To utilize the precision of RAS, it is recommended to aim for more personalized alignment strategies. The level of evidence is level III retrospective study.

Precision of the ultrasonography-integrated tibial extramedullary guide for total knee arthroplasty.

Precise determination of the tibial mechanical axis in total knee arthroplasty (TKA) requires intraoperative identification of the talus center. We present the ultrasonography-integrated tibial extramedullary guide (USG) that enables real-time visualization of the talus. This study assesses the precision of USG compared to computer-assisted surgery (CAS) and validates the efficacy of USG. We evaluated 58 patients (62 knees) who underwent primary TKA retrospectively, categorizing them into USG and CAS groups (31 each). We statistically analyzed demographic data, the preoperative alignment of the tibial plateau to the mechanical axis, the postoperative alignment of the tibial component to planned alignment on 3D-CT, pain visual analog scale, and WOMAC scores. Additionally, the frequency of postoperative outlier from planned alignment over 2° was statistically compared. No significant differences were observed in the preoperative data between the groups. The accuracy (mean deviation from the planned alignment) in both groups was not statistically different. However, in terms of the precision of coronal alignment, the USG group exhibited lower variance than the CAS group in the F-test (F value = 2.76, p = 0.023). Moreover, there were no postoperative deviations beyond 2 degrees in the USG group, in contrast to a 20% outlier frequency in the CAS group (p = 0.024). Concerning the precision of sagittal alignment (variance and deviations over 2°), no statistical differences were identified. The USG demonstrated higher precision in the tibial coronal plane than CAS in coronal alignment. Direct identification of the individual talus may enhance precision.

Pediatrics, Craniofacial and Orthognathic Surgery Track: How Accurate is Computer-Assisted Surgery in Fronto-Orbital Advancement for Craniosynostosis?

Pediatrics, Craniofacial and Orthognathic Surgery Track: How Accurate is Computer-Assisted Surgery in Fronto-Orbital Advancement for Craniosynostosis?