Reconstruction Of Knee Joint Research Articles

Biological knee joint reconstruction using patella following giant cell tumor excision: a case report

A 20-year-old female patient presented to us with a large expansile swelling over right knee diagnosed clinically and confirmed histopathological and radiologically to be Giant Cell Tumor of upper end of Tibia involving both condyles with a breach in the posterior cortex. In this case report we tried to retain the joint function by biological reconstruction using the Patella after the wide excision of the tumor mass. A radical excision of the upper end of the Tibia was done. The Patella was used as an articular surface supported by ipsilateral Fibula and cortico-cancellous bone chips from the ipsilateral iliac crest as struts and complemented with synthetic bone graft pieces. Thus, the joint was reconstructed biologically. The case was followed for 1 year. The tumor was excised in toto, the knee joint was restored by the Patella and the bone graft struts. The results were discussed in detail.

Localizing the position of the Segond fracture bed under CT measurements to determine the functional tibial insertion of an anterolateral ligament.

Many studies have confirmed the existence of ligament structures in the anterolateral region of the knee that maintain rotational stability of the knee joint, namely, the anterolateral ligament (ALL). Most scholars believe that knee joint reconstruction should be considered during revision surgery and a high level of pivot displacement test (stage 2 or 3). During ALL reconstruction, the choice of ligament reconstruction sites affects the success rate and prognosis of the operation. Therefore, the choice of ligament reconstruction sites is particularly important. There is little research on the lateral ALL tibia insertion point, and most clinicians use the midpoint Gerdy's tubercle and fibular head as insertion points. However, the reconstruction effect is not ideal. This study aims to measure the position of the Segond fracture bed on CT images to determine the ALL position of the tibia. To determine the position of the Segond fracture bone bed, the CT AM Volume Share 2 system was used to manually measure the position of bone fragments in 23 Segond fracture patients. Using the highest point of Gerdy's tubercle in the CT axial slices and the outermost point of the fibular head in the CT axial slices as reference points, the direction and angle of the CT slices were adjusted to ensure that the highest point of the Gerdy tubercle, the outermost point of the fibular head, and the center of Segond fracture bed were in the same sagittal slice. A CT sagittal slice measures the vertical distance from the center of the Segond fracture bed to the Gerdy-fibular line segment (G-F line segment), which is the line connecting the highest point of the segment to the outermost point of the fibula. The distance from the vertical point at the center of the Segond fracture bed of the G-F line to the highest point of the Gerdy tubercle was measured. All measurements were performed using the same measurement standard and were expressed as a percentage of the length of the G-F line. The measured results were statistically analyzed using SPSS 25.0 descriptive statistical research methods. The average length of the G-F segment measured on CT images was 39.6 ± 2.0 mm, and the average vertical length from the center of the Segond fracture bed to the G-F segment was 13.1 ± 1.1 mm, accounting for 33.2% ± 2.1% of the length of the G-F segment. The length from the vertical point of the fracture bed on the G-F line segment to the highest point of the Gerdy tubercle was 14.7 ± 1.3 mm, accounting for 37.1% ± 2.9% of the length of the G-F segment. Through the study of the CT measurement of the Segond fracture location, we obtained the location of the functional tibial insertion of ALL, which is different from the anatomical insertion of ALL and is more inclined to the Gerdy tubercle and above, which has reference value for the treatment of recovering the function of anterolateral ligament after reconstruction.

The Evaluation of Electromyography Biofeedback on Proprioception and Balance in Healthy Young Athletes

Introduction: We evaluated the effect of electromyography biofeedback on proprioception and functional balance in healthy young athletes.
 Materials and Methods: In this clinical trial, 24 athletes were randomly divided into two study (n=12) and control (n=12) groups. The study group received rehabilitation exercises, including one-foot standing, squatted standing, and isometric contraction of quadriceps muscle at different knee angles, including 30, 45, and 90 degrees of knee flexion along with electromyography biofeedback. The control group received only rehabilitation exercises without electromyography biofeedback. Exercises were performed by both groups for a 4-week period in three sessions per week. Functional balance and proprioception before and after exercises were measured using the star excursion balance test and a system consisting of digital photography non-reflective markers, respectively. The data of the center of pressure and time of vertical ground reaction force using a force plate was also collected to evaluate static balance and dynamic balance, respectively.
 Results: The absolute error in knee joint reconstruction for 30° (P=0.005), 45° (P=0.001), and 90° (P=0.033) angles significantly decreased after the intervention in the study group compared to the control group. Star excursion balance test scores in all directions did not show any significant differences between the two groups (P>0.05), except for the anterior-lateral direction (P=0.03). Moreover, all variables related to static and dynamic balance did not show a significant difference between two the groups after the interventions (P>0.05).
 Conclusion: The electromyography biofeedback intervention can probably be used as a rehabilitation protocol in recovering and healing proprioception injuries resulting from sports injuries.

Comparison of Knee Proprioception between Athletes with Anterior Cruciate Ligament Injury and Healthy Athletes

Introduction: In addition to the instability of the knee joint, injury to the anterior cruciate ligament (ACL) leads to a functional deficit in the form of diminished proprioception of the knee joint. The purpose of this study was to compare knee proprioception in athletes with an ACL injury and healthy athletes.
 Materials and Methods: The participants in this cross-sectional study were 26 athletes with an ACL injury and 24 healthy athletes who were selected from the orthopedic clinic at Baqiyatallah Hospital in 2019, Tehran City, Iran. Cooper or non-Cooper subjects with ACL injury were identified via the knee injury and osteoarthritis outcome score (KOOS). The knee proprioception of all participants was recorded using a system consisting of digital photography, non-reflective markers, and Digimizer software.
 Results: The results showed that there was no significant difference between groups in the absolute error of knee joint reconstruction at both 45° and 90° angles.
 Conclusion: The data of the study showed that in comparison with healthy athletes, the knee joint proprioception of athletes with an ACL injury is not different and has the same function.

The Effects of Transcranial Direct Current Stimulation (tDCS) and Biofeedback on Proprioception and Functional Balance in Athletes with ACL-deficiency

Background: Following an anterior cruciate ligament (ACL) rupture, proprioceptive deficiency may be responsible for functional balance defects and joint instability. Recently, using transcranial direct current stimulation (tDCS) or biofeedback has been recommended for athletes with ACL rupture. Objectives: This study aimed to evaluate the effects of tDCS and biofeedback modalities while performing contraction exercises in athlete with an ACL rupture. Methods: Thirty-three athletes with ACL rupture were randomly divided into three groups of tDCS, biofeedback, and control, with 11 people in each group. All groups underwent a ten-session training of intermittent contractions of the lower extremity muscles in a standing position at different knee angles, including 30, 45, and 90 degrees of knee flexion during four weeks. The control group received no tDCS or biofeedback modalities except the contraction exercises. All subjects were evaluated both before and at the end of interventions. The proprioception measured as rate of absolute error in the knee joint reconstruction was assessed by the digital photography technique at knee flexion angles of 30, 45, and 90 degrees. The functional balance was assessed by the star excursion balance test in eight different directions. All measurements were carried out on the injured limb. Results: The results showed no significant difference among three groups regarding all variables related to the proprioception and functional balance (P > 0.05). Intra-group comparison (before and after intervention) indicated that biofeedback significantly improved both the functional balance in all directions and the proprioception of the injured knee at three knee flexion angles (P < 0.05). Moreover, tDCS significantly improved the functional balance in six directions, except anterior-lateral and posterior, and also improved the proprioception at all angles of knee flexion. Conclusions: Although the results did not show a large difference among groups, both tDCS and biofeedback modalities, along with intermittent isometric exercises, may have reduced knee absolute error at the knee flexion angles of 30, 45, and 90 degrees as well as improved the functional balance. Therefore, it was recommended that these modalities should be included in rehabilitation program targeting ACL-deficient knee subjects.

The role of bone mineral density and cartilage volume to predict knee cartilage degeneration.

Knee Osteoarthritis (OA) is a highly prevalent condition affecting knee joint that causes loss of physical function and pain. Clinical treatments are mainly focused on pain relief and limitation of disabilities; therefore, it is crucial to find new paradigms assessing cartilage conditions for detecting and monitoring the progression of OA. The goal of this paper is to highlight the predictive power of several features, such as cartilage density, volume and surface. These features were extracted from the 3D reconstruction of knee joint of forty-seven different patients, subdivided into two categories: degenerative and non-degenerative. The most influent parameters for the degeneration of the knee cartilage were determined using two machine learning classification algorithms (logistic regression and support vector machine); later, box plots, which depicted differences between the classes by gender, were presented to analyze several of the key features’ trend. This work is part of a strategy that aims to find a new solution to assess cartilage condition based on new-investigated features.

The effect of TRX suspension trainer and BOSU platform after reconstruction of anterior cruciate ligament of the knee joint

Background and Study Aim. The tear of the anterior cruciate ligament of the knee joint is experienced by people of all ages for a variety of reasons. The physiotherapy procedures with different equipment help recover lost functions. The aim of this research was to determine the effect of ‘TRX’ (Total body Resistance eXercise) suspension trainer and platform ‘BOSU’ (Both Sides Utilized) after anterior cruciate ligament of knee joint reconstruction.
 Material and Methods. The study included 20 patients after anterior cruciate ligament reconstruction surgery, 13 women, age (31.7 ± 3.4) and 7 men, age (31.7 ± 3.5) participated in the assessment. The strength of the calf flexors and extensors muscles was assessed by Lovett scale. The range of motion of the knee joint was assessed by goniometer. The static and dynamic body balance was assessed by Fullerton Advanced Balance Scale. The stability of the knee joint was assessed by Lachman test. The statistical data reliability was evaluated using Student's T criterion.
 Results. The data obtained showed that stabilization exercises with ‘TRX’ suspension trainer ant platform ‘BOSU’ have positive effect on knee joint after reconstruction. In the first and second group strength of the calf flexors and extensors muscles, amplitude of knee joint, static and dynamic balance significantly increased (p<0.05). Knee joint stability increased. Comparing both groups’ results, there are no statistically significant difference (p>0.05). 
 Conclusions. Physiotherapy exercises with TRX suspension trainer and platform ‘BOSU’ can help patients to return lost muscles strength, knee joint amplitude, static and dynamic balance and knee joint stability.

CT- and MRI-Based 3D Reconstruction of Knee Joint to Assess Cartilage and Bone.

For the observation of human joint cartilage, X-ray, computed tomography (CT) or magnetic resonance imaging (MRI) are the main diagnostic tools to evaluate pathologies or traumas. The current work introduces a set of novel measurements and 3D features based on MRI and CT data of the knee joint, used to reconstruct bone and cartilages and to assess cartilage condition from a new perspective. Forty-seven subjects presenting a degenerative disease, a traumatic injury or no symptoms or trauma were recruited in this study and scanned using CT and MRI. Using medical imaging software, the bone and cartilage of the knee joint were segmented and 3D reconstructed. Several features such as cartilage density, volume and surface were extracted. Moreover, an investigation was carried out on the distribution of cartilage thickness and curvature analysis to identify new markers of cartilage condition. All the extracted features were used with advanced statistics tools and machine learning to test the ability of our model to predict cartilage conditions. This work is a first step towards the development of a new gold standard of cartilage assessment based on 3D measurements.

Knee joint reconstruction using regional flaps: an aesthetic approach to extensive defects following fourth-degree contact burns

Knee joint reconstruction using regional flaps: an aesthetic approach to extensive defects following fourth-degree contact burns

Clinical Applications and Outcome of Proximally Based Medial Gastrocnemius Muscle Flap.

BACKGROUNDGastrocnemius muscle flap has been in vogue for approximately five decades. The current study was carried out to document the indications and outcome of proximally based medial gastrocnemius muscle flap in our patients.METHODSThis case series was conducted in Department of Plastic Surgery and Orthopedics, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan during 3 years. It included all patients who were managed with proximally based medial gastrocnemius muscle flap for various indications.RESULTSThere were 31 patients with 24 (77.41%) males and 7 (22.58%) females. The age ranged between 16- and 53 years (mean: 27.47±10.33 years). The indications for gastrocnemius muscle flap included traumatic defects with exposed tibia/ knee joint (n=20; 64.51%), prophylactic coverage of megaprosthesis employed for knee joint reconstruction (n=9; 29%), excisional defect of cutaneous squamous cell carcinoma with exposed tibia (n=1; 3.22%), and salvage of infected total knee arthroplasty (n=1; 3.22%). The hospital stay was 7-16 days (mean: 12.41±2.87 days). The flap survival in our series was 100%. There was partial skin graft in two patients (n=2; 6.45%). CONCLUSIONGastrocnemius muscle flap was a quick, easy and reliable coverage tool for small to moderate sized defects around the knee, the proximal third of the tibia as well as coverage of prosthesesis employed for knee arthroplasty. Inclusion of 2-4 cm tendon enhances the flap dimension without causing any additional morbidity.

Which factors are associated with the functional recovery in patients undergoing endoprosthetic knee reconstruction following bone tumour resection? \u2013 A observational study

BackgroundThe aim of the present study was to explore whether control of balance and other factors were associated with functional recovery and walking performance in the short term in a group of patients receiving modular knee endoprosthetic reconstruction following bone tumour resection in order to provide effective suggestions for a new rehabilitation protocol.MethodsA cross-sectional study was carried out in the chemotherapy ward of an Italian hospital specialized in bone cancer. All patients consecutively treated using a modular knee endoprosthetic between January 2013 and February 2014 were included in the study. One year after surgery, various measuring instruments were used to assess the functional outcome achieved: Musculoskeletal Tumor Society rating scale, Toronto Extremity Salvage Score and specific motor tests of gait, such as gait speed and resistance. Data concerning the variables involved are as follows: bone resection, knee joint range of motion, quadriceps muscle strength and posture control. Statistical tests included correlation analysis (Pearson and Spearman correlation).ResultsBalance control was significantly correlated to all the gait tests performed. Age, duration of chemotherapy and strength of the knee extensor muscles also showed a correlation. Conversely, joint range of motion and resection percentage did not show a significant correlation.ConclusionsRehabilitation in patients undergoing knee joint reconstruction due to cancer should include balance control exercises, which involve not only the treated limb but address the entire sensory and motor system. This extends beyond the concept of treatment aimed at improving individual functions such as joint range of motion and muscular strength.

Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees

Objective: Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees. Methods: From January 2015 to October 2016, 26 patients with skin and soft tissue defect on knees after severe burn or trauma were hospitalized in our unit. Among these patients, 14 patients had patellar ligament defect, and 16 patients had knee joint capsule defect. Wound debridement was operated on 1 to 3 days after admission. After debridement, the area of skin and soft tissue defect ranged from 10 cm×7 cm to 42 cm×18 cm. Vacuum sealing drainage (VSD) treatment was performed after debridement, and flap transplantation operation was performed after VSD treatment for 5 to 7 days. Defects of nine patients were treated with local rotation flaps. Seven patients with skin and soft tissue defects on knees and knee joint capsule defects of 5 cm×3 cm to 9 cm×7 cm were treated with free anterolateral femoral flaps combined with fascia lata. Ten patients with skin and soft tissue defects on knees and patellar ligament defects of 6 cm×3 cm to 12 cm×4 cm were treated with free anterolateral femoral flaps combined with iliotibial tract. The area of flaps ranged from 11 cm×9 cm to 22 cm×15 cm. After flap transplantation operation, functional reconstruction of knee joint was carried out according to early, continuous, and sequential systematic rehabilitation treatment strategy. The pain degree and function of knee joint of patients were scored by the International Knee Documentation Committee (IKDC) Knee Evaluation Form before operation and 12 months after operation. The knee joint flexion and extension degrees of patients were measured by joint protractor in 2 weeks and 12 months after operation. The color Doppler ultrasound was used to evaluate integrity of knee joint capsule and continuity of patellar ligament of patients in 6 and 12 months after operation. Results: All flaps of 26 patients survived well, and wounds healed completely after the operation. Distal parts of flaps of 2 patients treated with free anterolateral femoral flaps had local necrosis after the operation, and their wounds healed after debridement and transplantation of autologous intermediate split-thickness skin graft of thigh. The IKDC Knee Evaluation Form score of patients was (79±8) points in 12 months after operation, which was significantly higher than (64±7) points before operation (t=7.20, P<0.05). The flexion degree of knee joint of patients was (117±10)° in 12 months after operation, which was significantly larger than (35±8)° in 2 weeks after operation (t=32.65, P<0.05). The extension degree of knee joint of patients was (12±9)° in 12 months after operation, which was significantly smaller than (61±9)° in 2 weeks after operation (t=19.63, P<0.05). In 6 and 12 months after operation, 9 patients treated with local rotation flaps had good integrity of knee joint capsule and continuity of patellar ligament; 7 patients treated with free anterolateral femoral flaps and fascia lata had good integrity of knee joint capsule; 10 patients treated with free anterolateral femoral flaps and iliotibial tract had good continuity of patellar ligament. During follow-up of 12 months, all flaps survived well; knees of all patients had good appearance; knee joints functioned normally. Conclusions: Good appearance and function of knees can be achieved by repairing wound of skin and soft tissue defect on knees after severe burn or trauma with local rotation flaps or free anterolateral femoral flaps with fascia lata or iliotibial tract plus systematic rehabilitation treatment of knee joint in early stage after flap transplantation operation.

Knee joint reconstruction using liquid nitrogen recycled autograft prosthesis composite after wide resection for high-grade chondrosarcoma

Background: Chondrosarcoma is the second most common malignant primary tumor of bone. The prognosis for chondrosarcoma depends mainly on its histologic grading and location. High-grade chondrosarcoma has higher a tendency to recur and metastasize. The standard treatment for chondrosarcoma is wide resection without adjuvant therapy. Numerous reconstructive options are available, varying from endoprostheses, biological reconstruction using allografts or osteoarticular allografts, and recycling of tumor-bearing segment. Methods: We retrospectively reviewed seven patients with high-grade chondrosarcoma who underwent wide resection of the tumor mass and reconstruction using liquid nitrogen treated recycled autograft prosthesis composite. Evaluation was done for local recurrence, metastasis, graft-bone union, osteosynthesis, implant, or graft-related complications. The functional outcome was assessed by the Musculoskeletal Tumour Society scoring system. Results: The mean follow-up period was 46 mo (range 24-65 mo). The average duration for graft union was 8.2 mo (range 7-10 mo). No local recurrence was detected in any patient. None of them had any metastatic deposits. One had a superficial wound infection. One had fulminant infection that required hip disarticulation. The mean Musculoskeletal Tumour Society functional score was 67.7% (range 60-78). Conclusions: Recycled autograft prosthesis composite using liquid nitrogen is an oncologically safe and effective reconstructive option for the management of chondrosarcoma around the knee. It maintains knee function and restores the bone stock. It overcomes endoprosthesis-related problems, overcoming the obstacles of allograft in countries where it is not available or not socially or religiously acceptable.

Applications of 3D printing in TKR Pre surgical planning for Design Optimization – A Case Study

In traditional preoperative planning orthopedic surgeons utilized 2D plain X-Ray images are used to access the bone anatomy of patients, which results more surgical time, heavy intraoperative blood loss and more tissue removal under the tibia and femoral cut. Consequently the surgeon can perform satisfactory reconstruction of knee joint using the images produced through Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) image processing techniques with minimal of said losses. The 3D model of patient knee is produced by interfacing the CT scan data with 3D slicer software. 3D printer can produce solid 3D physical objects using STL file, this can be used in surgical planning to overcome many limitations of 2D imaging.

Postoperative Knee Joint Stability Following Anterior Cruciate Ligament Reconstruction Using the Ligament Advanced Reinforcement System.

One of the goals of the synthetic materials used in knee joint reconstruction of the anterior cruciate ligament (ACL) is to improve the strength and stability of the graft immediately after the reconstruction. One of the synthetic grafts is a non-absorbable synthetic ligament device made of terephthalic polyethylene polyester fibers, the Ligament Advanced Reinforcement System (LARS). The aim of the study was to assess postoperative knee joint stability in patients who had undergone ACL reconstruction using the LARS graft. The study group was comprised of 20 males who had undergone primary unilateral intraarticular ACL reconstruction using LARS. The patients were evaluated one day before the reconstruction and an average of six weeks postoperatively. Knee stability was evaluated manually using the Lachman test, anterior drawer test and pivot-shift test. Knee active range of motion (ROM) was measured. Preoperatively, the Lachman test indicated abnormal/2+ results in the vast majority of the patients. The postoperative results in most of the patients were normal/0. The anterior drawer test results were also abnormal/2+ preoperatively and normal/0 postoperatively. The pivot-shift test was positive in all of the patients before the ACL reconstruction and negative after the surgery. In general, no differences were found in the ROM between the involved and uninvolved limbs and in the between-measurement comparison. The evaluation demonstrated significant progress from the preoperative to postoperative results in reducing anterior translation and anterolateral rotational instability of the tibia in patients who had undergone ACL reconstruction using the synthetic LARS graft. In the short-term follow-up assessments, restoration of anterior and anterolateral rotational stability of the operated knee joints was observed.

The Effect of Platelet Rich Plasma (PRP) in Anterior Cruciate Ligament (ACL) Reconstruction Surgery

A torn in anterior cruciate ligament (ACL) caused by interference with the proprioceptive function of the knee joint can result in decreased function and other joint structure degradation that ultimately affect to daily activities. Platelet rich plasma (PRP) is widely used in recent studies to improve the healing of soft tissue injuries because it contains a lot of growth factor. This study was to determine the effect of platelet rich plasma in ACL reconstruction surgery. ACL reconstruction patients either with or without PRP were evaluated with Joint Position Sense (JPS) and Threshold To Detection of Passive Motion (TTDPM) measurements and the results were compared. From this study found 20 patients who had ACL reconstruction performed either with or without PRP. The test results showed statistically significant differences JPS in patients with ACL reconstruction who given PRP and not, at angle of 30˚ (p=0,037) and 45˚ (p=0,034). It also obtained a non-significant difference TTDPM in both groups (p=0,172). The conclusion obtained in this study is the addition of platelet rich plasma in patients with ACL reconstruction of knee joint can improve the function of JPS at an angle of 30˚ and 45˚, while the function of TTDPM is not increased significantly.

Biomechanical study of the tibia in knee replacement revision

The best management of severe bone defects following total knee replacement is still controversial. Metal augments, tantalum cones and porous tibial sleeves could help the surgeon to manage any type of bone loss, providing a stable and durable knee joint reconstruction. Five different types of prostheses have been analysed: one prosthesis with straight stem; two prostheses with offset stem, with and without supplement, and two prostheses with sleeves, with and without stem. The purpose of this study is to report a finite element study of revision knee tibial implants. The main objective was to analyse the tibial bone density changes and Von Misses tension changes following different tibial implant designs. In all cases, the bone density decreases in the proximal epiphysis and medullary channels, with a bone density increase also being predicted in the diaphysis and at the bone around the stems tips. The highest value of Von Misses stress has been obtained for the straight tibial stem, and the lowest for the stemless metaphyseal sleeves prosthesis.

Estudio biomecánico de la tibia en el recambio de una artroplastia de rodilla

The best management of severe bone defects following total knee replacement is still controversial. Metal augments, tantalum cones and porous tibial sleeves could help the surgeon to manage any type of bone loss, providing a stable and durable knee joint reconstruction. Five different types of prostheses have been analysed: one prosthesis with straight stem; two prostheses with offset stem, with and without supplement, and two prostheses with sleeves, with and without stem. The purpose of this study is to report a finite element study of revision knee tibial implants. The main objective was to analyse the tibial bone density changes and Von Misses tension changes following different tibial implant designs. In all cases, the bone density decreases in the proximal epiphysis and medullary channels, with a bone density increase also being predicted in the diaphysis and at the bone around the stems tips. The highest value of Von Misses stress has been obtained for the straight tibial stem, and the lowest for the stemless metaphyseal sleeves prosthesis.

Bone loss following knee arthroplasty: potential treatment options

The management of bone loss is a crucial aspect of the revision knee arthroplasty. Bone loss can hinder the correct positioning and alignment of the prosthetic components, and can prevent the achievement of a stable bone-implant interface. There is still controversy regarding the optimal management of knee periprosthetic bone loss, especially in large defects for which structural grafts, metal or tantalum augments, tantalum cones, porous metaphyseal sleeves, and special prostheses have been advocated. The aim of this review was to analyze all possible causes of bone loss and the most advanced strategies for managing bony deficiency within the knee joint reconstruction. Most significant and recent papers about the management of bone defects during revision knee arthroplasty were carefully analyzed and reviewed to report the most common causes of bone loss and the most effective strategies to manage them. Modular metal and tantalum augmentation showed to provide more stable and durable knee revisions compared to allografts, limited by complications such as graft failure, fracture and resorption. Moreover, modular augmentation may considerably shorten operative times with a potential decrease of complications, above all infection which has been frequently associated to the use of allografts. Modular augmentation may significantly reduce the need for allografting, whose complications appear to limit the long-term success of knee revisions.

Computed tomographic image analysis based on FEM performance comparison of segmentation on knee joint reconstruction.

The demand for an accurate and accessible image segmentation to generate 3D models from CT scan data has been increasing as such models are required in many areas of orthopedics. In this paper, to find the optimal image segmentation to create a 3D model of the knee CT data, we compared and validated segmentation algorithms based on both objective comparisons and finite element (FE) analysis. For comparison purposes, we used 1 model reconstructed in accordance with the instructions of a clinical professional and 3 models reconstructed using image processing algorithms (Sobel operator, Laplacian of Gaussian operator, and Canny edge detection). Comparison was performed by inspecting intermodel morphological deviations with the iterative closest point (ICP) algorithm, and FE analysis was performed to examine the effects of the segmentation algorithm on the results of the knee joint movement analysis.