Patient-specific Instrumentation Research Articles

Combined Correction of Coronal and Rotational Deformities of the Femur With Distal Femoral Osteotomy Using Patient-Specific Instrumentation.

Distal femoral osteotomy (DFO) can be used to simultaneously correct coronal and rotational deformities. Patient-specific instruments (PSIs) are known to be helpful in such complex osteotomies, but data on surgical accuracy for the combined correction of coronal and rotational deformities of the femur are missing. To investigate the radiological results of DFO for simultaneous correction of coronal and rotational deformities using PSIs. Case series; Level of evidence, 3. All included patients underwent DFO (34 patients, 36 knees) using PSIs for combined correction of coronal and rotational deformities. The hip-knee-ankle angle (HKA) was measured in weightbearing long-leg radiographs, and the femoral torsion was assessed using computed tomography scans, both pre- and postoperatively. The achieved corrections of HKA and femoral torsion were determined for each knee, and surgical accuracy was calculated. HKA and femoral torsion changed significantly from preoperatively to postoperatively (from 2.4° ± 3.6° vs 0.1° ± 1.8° [P < .001] and 31.2° ± 17.2° vs 18.7° ± 7.4° [P < .001]). The difference from planned to achieved correction was statistically greater for HKA (-2.9° ± 3.8° vs -2.3° ± 3.5°; P = .018) than for femoral torsion (-12.4° ± 11.8° vs -12.3° ± 12.2°; P = .771), which did not reach significance. The accuracies of HKA and femoral torsion correction were 1.1° ± 1° and 2.4° ± 1.9°, respectively. Coronal and rotational deformities of the femur can accurately be corrected simultaneously by a DFO, utilizing PSIs. High accuracy was achieved for the correction of both coronal and rotational deformities, with absolute mean differences from planned to achieved correction of 1.1° and 2.4°, respectively.

Small changes of femoral torsion in varus or valgus distal femoral osteotomy using patient-specific instruments.

Hinge fractures show a relatively high incidence in varus and valgus distal femoral osteotomy (DFO) and can lead to delayed- or non-union. Another observed complication of a hinge fracture is an unintentional change of the postoperative femoral torsion of up to + 9.5° in conventionally performed DFO. We hypothesize that the change of femoral torsion in case of a hinge fracture is less pronounced when DFO is performed using patient-specific instruments (PSI) compared to the literature of conventionally performed DFO. All patients who underwent varus or valgus DFO using PSI from January 2014 to September 2023 were included. Radiographs and computed tomography (CT) scans were used to screen for hinge fractures. Pre- and postoperative femoral torsion was measured in CT. Thirty-five medial closing-wedge DFO (MCW-DFO), 27 lateral closing-wedge DFO (LCW-DFO), and 27 lateral opening-wedge DFO (LOW-DFO) were included, resulting in a total of 89 included osteotomies. A total of 55 hinge fractures (61.8%) were observed. The femoral torsion changed significantly from 20.5° ± 7.7° to 15.5° ± 8.1° (p < 0.001) in LOW-DFO with a hinge fracture, whereas the other two techniques showed no significant change of femoral torsion. The use of PSI in varus and valgus DFO showed only small changes of the postoperative femoral torsion, even in case of a hinge fracture. The change of femoral torsion was depending on the type of DFO and was only significant in LOW-DFO, however, not exceeding a mean change of 5°.

Glenoid Preparation in Reverse Shoulder Arthroplasty: Robotic-Arm Assisted Preparation Compared to Manual Preparation and Patient-specific Guides.

Precise and accurate glenoid preparation is important for the success of shoulder arthroplasty. Despite advancements in preoperative planning software and enabling technologies, most surgeons execute the procedure manually. Patient-specific instrumentation (PSI) facilitates accurate glenoid guide pin placement for cannulated reaming; however, few commercially available systems offer depth of reaming control. Robotic-arm assisted bone preparation has gained popularity in knee and hip arthroplasty, but at the present time there is limited information available on the use of robotics for shoulder arthroplasty. The purpose of this study was to compare glenoid preparation and final implant position using three techniques: manual, manual assisted with PSI, and robotic arm assisted bone preparation. Six shoulder surgeons participated in this study utilizing three preparation techniques: (1) manual reaming, (2) manual reaming over a pin inserted using PSI, and (3) preparation using a robotic arm assist with an end-effector burr and haptic boundaries. Each surgeon randomly conducted each technique on 2 separate Bone Matrix glenoid models, for a total of 36 glenoid models tested. To compare the techniques, the final prepared Bone Matrix models underwent a CT scan with 3D virtual model generation. The prepared 3D virtual glenoid models were then compared to the preoperatively planned models. Parameters compared included deviations in version, inclination, anterior-posterior (AP) translation, superior-inferior (SI) translation, and depth of reaming. Regarding glenoid version with values reported as mean deviations from the preoperative plan, the robotic-assisted technique (1°) was significantly better than manual (9°, p<0.001) and PSI (4°, p<0.001) techniques at executing the preoperative plan. Regarding inclination, the robotic-assisted technique (2°) was significantly better than manual (9°, p=0.003) but not significantly different than PSI (3°, p=0.211). The robotic-arm technique, with AP translation, resulted in significantly lower mean displacements (0.3mm) than the manual technique (2mm, p=0.001) and the PSI technique (2mm, p=0.002). With SI translation, the robotic-arm assisted technique (0.7mm) resulted in significantly lower mean displacements as compared to the manual (2mm, p=0.007) and PSI (1mm, p=0.011). The robotic-arm assisted technique (0.4 mm) did not result in significantly lower mean depth of reaming displacements compared to the manual technique (0.8 mm, p=0.051) but did when compared to PSI (0.8 mm, p=0.036). Glenoid preparation using a robotic arm with an end-effector burr and haptic boundaries was significantly better in its ability to execute a preoperatively planned implant position than manual preparation in 4 of 5 glenoid metrics examined and was significantly better than PSI in 4 of 5 glenoid metrics.

Laboratory validation of patient-specific templating for total knee arthroplasty

Patient-specific templating (PST), which is a sister procedure to patient-specific instrumentation (PSI) but hospital-based, is relatively less complex and less expensive than robotics and navigation. However, there are some concerns about the PST including the process of preoperative planning, 3D printing and material, positioning of PST intraoperatively, availability, and clinical value. The purpose of this study was to validate the technical accuracy and reliability of the PST technique in the lab and to report the outcomes of clinical application. To test the reliability of the PST technique, five observers positioned the PST templates five times over the distal femur and proximal tibial whilst a navigation system was used to measure the level of bone cutting, coronal and sagittal alignment, and rotation in both femur and tibia. The mean alignment error in all planes was 0.67° (maximum 2.5°). Concerning the bone (femoral and tibial) cutting, the mean error was 0.32 mm (maximum 1 mm). The qualitative and quantitative analysis showed an overall agreement between observers (p < 0.05). The laboratory part of this study showed that the positioning of the PST over the proximal tibia and distal femur during TKA is reliable. There were statistically insignificant intraobserver and interobserver variations.

Advancements and Prospects in Personalized Navigation Systems for Knee Arthroplasty: A Literature Review

Introduction. Traditional methods of knee arthroplasty are based on mechanical alignment, which ensures long-term component survival but does not always meet patients’ functional needs. Recent studies indicate that personalized alignment approaches, such as kinematic and functional alignment, can improve functional outcomes and reduce complication rates. These methods consider the natural axes of movement and the anatomy of the knee joint, contributing to the restoration of joint anatomy and function. Individualized navigation systems represent a modern approach to knee arthroplasty using three-dimensional preoperative models based on CT or MRI. This method improves the accuracy of fitting the prosthesis components, considering the patient’s individual anatomical features and biomechanical parameters. Objective. The objective of this literature review is to analyze the literature on using advanced navigation systems and evaluate their effectiveness, advantages, and prospects in personalizing knee joint arthroplasty. Material and Methods. Using PubMed, Scopus, and Web of Science databases, we reviewed 22 scientific studies on various navigation systems for knee joint arthroplasty. Studies were selected based on patient numbers, statistical significance, clear inclusion and exclusion criteria, and availability of objective treatment outcome data. This allowed for a detailed analysis and comparison of different navigation methods. Results. Total knee arthroplasty (TKA) is one of the most effective surgical treatments for knee osteoarthritis. However, the accuracy of prosthesis implantation remains a critical factor for the long-term success of the surgery. Deviations in placement can lead to increased wear of components and a higher risk of complications. Traditionally, standard tools and techniques based on anatomical landmarks are used for prosthesis placement. In recent years, individualized navigation systems (INS) based on preoperative three-dimensional modeling of the patient’s individual anatomy have been introduced. INS aim to improve the accuracy of knee joint component placement, reduce time of surgery, and lower the risk of complications. Conclusions. The use of patient-specific surgical instruments and resection tools in primary and revision knee joint arthroplasty improves surgical and rehabilitation outcomes. This development allows for a 30% improvement in implant positioning accuracy and a 10% reduction in CO2 emissions. Standardizing research methods and increasing surgeon experience may contribute to a better understanding of the long-term benefits of individualized navigation systems in knee joint arthroplasty. Despite the identified advantages of INS, further research is needed to determine the long-term clinical outcomes and cost-effectiveness of these systems. The application of INS is especially important in cases of significant deformities and bone defects.

Enhancing Surgical Efficiency and Radiological Outcomes Through Advances in Patient-Specific Instrument Design.

Background/Objectives: Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) uses preoperative three-dimensional imaging to create cutting blocks tailored to patient anatomy. However, there is debate regarding the additional benefits of PSI in terms of improved alignment or functional outcomes compared to using conventional instruments. Although PSI design has undergone continuous development, the improvements have not been incorporated. Therefore, the aim of this study was to compare the surgical time and radiological outcomes between advanced-design PSI and conventional instruments. Methods: We conducted a retrospective review of 328 patients who underwent primary TKAs using PSI for osteoarthritis and compared them with 328 matched patients who underwent TKA performed with conventional instruments during the same period (March 2023 to August 2024). We compared the surgical time and component alignment between the advanced-design PSI group and the conventional instrument group. Results: The average surgical time was significantly shorter in the advanced-design PSI group (47.6 ± 12.4 min) compared to the conventional instrument group (59.2 ± 14.2 min, p < 0.05). The advanced PSI design group had a significantly lower occurrence of outliers in hip-knee-ankle alignment (7%) compared to the conventional instrument group (36.3%). This trend was also observed in femoral coronal alignment, tibial coronal alignment, and femoral sagittal alignment. Conclusions: The use of advanced-design PSI demonstrated significantly reduced surgical time and improved alignment compared to conventional instruments. This highlights that proper design is a key factor for PSI to achieve superior biomechanical effects. Our study shows that advanced-design PSI technology has the potential to replace conventional instruments in TKA, though further research is required to determine its clinical outcomes and economic benefits.

Assessing the Impact of Patient-Specific Instrumentation and Fixation on Accuracy and Radiation Exposure in a Cadaveric Model of Medial Opening-Wedge High Tibial Osteotomy.

Traditional freehand techniques in high tibial osteotomy (HTO) have been shown to lack precision and accuracy. Patient-specific instrumentation (PSI) and fixation created from cross-sectional imaging have recently been introduced to address this problem. The purpose of the study was to compare traditional freehand techniques versus PSI in a human cadaveric model of HTO. It was hypothesized that the osteotomies performed using PSI would require less radiation exposure for operating room staff and would reduce deviation from the planned correction in the coronal, sagittal, and axial planes. Controlled laboratory study. Sixteen matched cadaveric knees underwent medial opening-wedge HTO via the freehand method (n = 8) or PSI technique (n = 8) with a predetermined planned opening-wedge size. Computed tomography was used to measure the achieved wedge size as well as alignment parameters in the coronal, sagittal, and axial planes. Radiation dose, number of fluoroscopic images taken, and total operative time were recorded. The mean deviation from the planned wedge size was smaller in the PSI group compared with the freehand group (0.505 vs 3.016 mm, respectively; P < .01). Total radiation dose to medical staff (0.85 vs 2.04 mGy; P < .01) and number of fluoroscopic images (15.5 vs 41; P < .01) were also smaller in the PSI versus the freehand group, respectively. No difference was seen in total operative time between the 2 groups (P = .62). In cadaveric specimens, the PSI technique demonstrated superior accuracy and decreased radiation exposure for medical staff compared with the traditional freehand technique without compromising operative efficiency. The use of PSI when HTO is performed can lead to more accurate operations and potentially improve outcomes.

3D printing technology is a more accurate tool than an experienced surgeon in performing femoral bone tunnels in multi‐ligament knee injuries

AbstractPurposeCurrent surgical methods for multi‐ligament knee reconstruction involve the creation of several reconstruction tunnels in the distal femur. However, the limited bone mass in the knee increases the risk of tunnel convergence. Increasing the accuracy of tunnel direction can minimize tunnel collision during anatomical reconstruction. 3D‐printed patient‐specific instrumentation (PSI) has gained prominence in orthopaedic surgery due to its precision. This study aims to compare the accuracy of PSI with that of the ‘freehand’ approach by an experienced surgeon for drilling the medial and lateral femoral tunnels while adhering to the recommended angulations for multi‐ligament knee injuries.MethodsTen cadaveric knees underwent computerized tomography (CT) scans to identify anatomical femoral attachments of the lateral collateral ligament (LCL), popliteal tendon (PT), medial collateral ligament (MCL) and posterior oblique ligament (POL). Using Materialise Mimics Medical v25.0 software, virtual planning of a bone tunnel for each ligament was performed, and a total of four tunnels per knee were obtained. Ten PSIs were designed for five knees: five for the medial side and five for the lateral side. The first five knees were operated on via PSI, and the other five knees were operated on by an experienced surgeon using freehand drilling based on preoperative plans. The angular deviation and entry point were assessed by overlaying post‐operative CT images onto preoperative CT images.ResultsIn the freehand group, the median angular deviation was 22.3°, with an interquartile range (IQR) of 17.6–25.2°. The PSI group presented a significantly greater accuracy in angular deviation for femoral tunnels of 5.7°, with an IQR of 4–8.2° (p &lt; 0.001). Compared with that in the preoperative planning group, the median entry point distance in the freehand group was 5.5 mm, with an IQR of 2.6–8.8 mm. The PSI group had a median entry point distance of 4.2 mm, with an IQR of 3.6–5.7 mm (p = n.s).ConclusionsCompared with the freehand technique performed by an experienced surgeon, PSI demonstrated significantly greater accuracy in terms of the mean angular deviation.Level of EvidenceLevel V.

Pre-operative planning with X-PSI™ compared to MRI-based patient-specific instrumentation in total knee arthroplasty

Pre-operative planning with X-PSI™ compared to MRI-based patient-specific instrumentation in total knee arthroplasty

3D-printed patient-specific instrumentation and the freehand technique in high-tibial osteotomy: A prospective cohort-comparative study in an outpatient setting.

Tibial valgus osteotomy has shown to be a successful and cost-effective procedure. The advent of image processing and three-dimensional (3D) printing is an interesting tool for achieving more accurate and reproducible results. The aim of our study was to compare the accuracy of the conventional technique and the use of customized guides in the correction of tibial deformities in tibial varus patients, the surgical and clinical benefits, and the impact of treatment in the outpatient setting. A prospective cohort of 30 patients who underwent tibial valgus osteotomy were selected and randomized into two groups (3D-printed guidewires and conventional techniques). All patients underwent a complete radiological study to plan the surgical procedure. During the surgical procedure, the surgical time and X-ray exposure were analysed. The following results were evaluated: surgical time and X-ray exposure, the correlation between the planned correction and the correction obtained at 3 post-operative months, pre- and post-operative knee injury and osteoarthritis outcome score (KOOS) value at 3 and 12 months, and differences between the two groups in terms of the correction obtained. Radiation exposure in the '3D-guide' group was significantly different (8 [±4.51], p < 0.05), whereas surgical time was not significantly different between the control and guide 3D groups (60.69 [±8.89] and 53.43 [±11.69], respectively). At the 3-month follow-up, the post-operative hip-knee-ankle and post-operative mechanical-proximal-tibial angle were not significantly different (p > 0.05). At 3- and 12-month post-surgery, the Knee Injury and Osteoarthritis Outcome Score (KOOS) did not significantly differ between the conventional technique and the 3D-guide technique (p > 0.05). The KOOS at 3 months were 87.86 (±5.64) for the control group and 88.46 (±3.53) for the 3D-guide group, while at 12 months they were 91.5 (±5.72) for the control group and 88.57 (±8.81) for the 3D-guide group. Customized 3D-printed guides do not permit better correction or functional results than the conventional technique; rather, they reduce surgical time and intraoperative radiation exposure. II.

Preoperative difference between 2D and 3D planning correlates with difference between planned and achieved surgical correction in patient-specific instrumented total knee arthroplasty.

The goals of this study were (1) to assess whether the preoperative difference between modalities and extent of deformity are associated with a higher difference between planned and achieved surgical correction and (2) if they yield a higher probability of intraoperative adjustments. Retrospective single-centre analysis of patients undergoing patient-specific instrumented (PSI) total knee arthroplasty (TKA). Preoperative radiographic parameters were analysed on weightbearing (WB) long-leg radiographs (LLR) and nonweightbearing (NWB) computed tomography (CT). The 2D/3D difference was calculated as the difference between preoperative WB-LLR (2D) hip-knee-ankle angle (HKA), and NWB CT (3D) HKA. Surgical records were screened to retrieve intraoperative adjustments to the preoperative plan. Postoperative assessment was performed on WB LLR. Two-hundred-eighty-two knees of 263 patients were analysed. The difference of postoperative achieved to planned HKA (HKADifference) was 2.2° ± 1.7°. The preoperative 2D HKA showed the highest correlation with HKADifference (r = -0.37, 95% confidence interval [CI]: -0.48 to -0.26, p < 0.001). Intraoperative adjustments were performed in 60% (n = 170) of all knees. Patients with a preoperative coronal deformity of >7.8° had 10.55 higher odds for an intraoperative coronal adjustment (95% CI: 4.60-24.20, p < 0.001). The extent of deformity is associated with residual coronal deformity following PSI-TKA. Patients with extensive coronal malalignment may benefit from an adaptation of the preoperative surgical plan to avoid unintended postoperative coronal malalignment. Despite the advancements with 3D preoperative planning, intraoperative adjustments in PSI-TKA are frequently performed, in particular in patients with a higher preoperative varus/valgus deformity. Level III.

Optimizing Reduction Guide Stability in Osteotomy Using Patient-Specific Instrumentation: A Basic Guideline.

The use of patient-specific instruments (PSIs) for osteotomies is becoming more popular in orthopaedic surgery for correcting mechanical axis and posttraumatic deformities. However, the PSI reduction guides have great potential for intraoperative deformation, which adversely affects the accuracy of the procedure. To conduct a finite element analysis (FEA) to analyze different design parameters to improve the intraoperative stability of the reduction guides. Descriptive laboratory study. A reduction guide with a rectangular cross section and four 4-mm K-wire slots was simplified, and the following parameters were modified: width, height, profile design, K-wire thickness, and positions. Bending and torsional moments were applied to the guide construct and guide deformation and equivalent stress were determined using FEA. Increasing the profile height by 25% resulted in a 44% reduction in guide deformation for bending (37% for torsion). A 25% increase in profile width led to an 18% deformation reduction for bending (22% for torsion). Transverse K-wire slots resulted in 51% less deformation in torsion compared with longitudinally oriented slots. Placing the central K-wire slots 25% closer to the osteotomy reduced guide deformation by 20% for bending and 11% for torsion. The most effective methods to increase reduction guide stability are to increase the guide height and reduce the central K-wire distance to the osteotomy. When performing opening or closing wedge osteotomies, which mainly involve bending of the guide, a high-profile guide and longitudinally oriented K-wire slots should be used. When torque is expected as in rotational osteotomies, the K-wire holes in guides should be oriented transversely to reduce intraoperative deformation.

Accuracy of Combined High Tibial Slope Correction Osteotomy Using 3-Dimensional-Planned Patient-Specific Instrumentation.

If an increased posterior tibial slope (PTS) and concomitant unicompartmental osteoarthritis are present, a simultaneous sagittal (slope) and coronal correcting high tibial osteotomy has been recommended. However, no study has investigated the accuracy of such combined high tibial slope correction osteotomies. (1) To report the accuracy of navigated high tibial slope correction osteotomies using patient-specific instruments (PSI) and (2) to analyze the influence of an open wedge osteotomy (OWO) versus a closed wedge osteotomy (CWO) and the hinge axis angle (HAA) on the accuracy of the PTS correction. Cohort study; Level of evidence, 3. All PSI PTS-reducing osteotomies performed at 1 institution between 2019 and 2022 were reviewed. Three-dimensional (3D) accuracy was defined as the mean absolute 3D angular difference between the planned and achieved surgical correction (in degrees) in 3D models of computed tomography data. The influence of OWO versus CWO and the HAA on the reported accuracy was analyzed and a cutoff defined using receiver operating characteristic curve analysis. Eighteen patients who underwent a slope-reducing CWO (n = 9) or OWO (n = 9) were included. The 3D accuracy for PTS was 2.3°± 1.1° (mean ± SD), with CWO being more accurate than OWO (1.4°± 0.9° vs 3.1°± 0.6°; P < .01). Accuracy strongly correlated with the HAA (r = 0.788; P < .01). An HAA >38.9° predicted a PTS error >2° (odds ratio, 1.12 [95% CI, 1.04-1.20; P = .004]; area under the curve, 0.95 [95% CI, 0.89-1.00; P < .001]) corresponding to a coronal/sagittal correction of 0.8:1. Slope-reducing osteotomy can accurately be achieved using PSI. CWO demonstrated an increased accuracy when compared with OWO, which strongly depended on the HAA. With an aim of combined PTS and coronal correction, CWO should be considered the primary choice for accurate slope reduction with a coronal/sagittal correction cutoff of 0.8:1 (HAA, 38.9°).

Total Elbow Replacement in Swine: Surgical Technique and Initial Clinical Experience in a Kunekune Sow.

The aim of this study was to describe the development of a total elbow replacement (TER) technique in swine and report the outcome of TER in a Kunekune sow (61 kg) with severe elbow osteoarthritis. The technique was developed by operating on three pig cadavers (Yorkshire 40-50 kg). The TATE Elbow implant fit was confirmed with modeling to the patient's computed tomography imaging. Patient-specific instrumentation was printed for attempted use. Total elbow replacement was performed using a lateral approach, including lateral epicondylar osteotomy, careful retraction of the radial nerve, and preservation of the lateral collateral ligament. Postoperative care included controlled exercise and physical therapy. A lateral approach to the pig elbow for TATE TER was successfully developed. The bulk of the lateral head of the triceps muscle precluded use of the patient-specific instrumentation; the procedure was performed using standard instrumentation. Radiographic evidence up to 9 months postoperatively showed adequate implant alignment and satisfactory osteointegration of humeral and radioulnar components. There were not any postoperative complications and the patient's comfort was improved by 6 months and sustained at 18 months. A lateral approach for TATE TER in a pig with advanced elbow osteoarthritis proved feasible and effective. With the expansion of the TATE Elbow line, it is possible that a larger range of pigs could be treated. This report suggests that a lateral approach for TATE TER in dogs could represent a suitable alternative to the medial approach currently used.

Design Rational for Total Ankle Arthroplasty: An Update.

The design of total ankle arthroplasty (TAA) systems is rapidly evolving as device companies try to keep pace with the expansion of surgical indications and a refinement of techniques for TAA. Even since the publication of the latest "update," published in 2018, three new designs and three updates on preexisting third-generation implants came onto the market. Improvements in third-generation TAA systems include minimal bone resection, retaining ligamentous support, and anatomic balancing. Fourth-generation systems use 3D printing technology, improved talus and tibia designs based on CT scans of arthritic and normal ankles, and include patient-specific instrumentation. We will then explore the short-term and mid-term outcomes of the previously discussed six TAA systems-INBONE, INFINITY, INVISION (Stryker), Salto-Talaris (Smith and Nephew), Scandinavian Total Ankle Arthroplasty (Enovis), Trabecular Metal Total Ankle (Zimmer Biomet), and VANTAGE (Exactech). As more research pours in regarding mid- to long-term outcomes of these implants, it is important to assess the design rationale and summarize current outcome data for these implants.

“In My Experience…A New Age of X-ray-based Patient Specific Instrumentation”

The author writes about his experience with modern Patient Specific Instrumentation.

Advances in Minimally Invasive Joint Replacement Techniques: Redefining Precision and Recovery

Minimally invasive joint replacement (MIJR) techniques have revolutionized orthopedic surgery by significantly reducing recovery times, hospital stays, and complication rates compared to traditional methods. Enhanced by innovations like robotics, augmented reality (AR), and patient-specific instrumentation (PSI), MIJR offers greater surgical precision with less trauma to surrounding tissues. This article explores the latest advancements in MIJR, demonstrating its impact on clinical outcomes and highlighting future trends such as AI-driven surgical planning and biologic implants. MIJR has become the gold standard in joint replacement, providing patients with faster recovery and improved long-term results. Minimally invasive joint replacement (MIJR) techniques have revolutionized orthopedic surgery by significantly reducing recovery times, hospital stays, and complication rates compared to traditional methods. Enhanced by innovations like robotics, augmented reality (AR), and patient-specific instrumentation (PSI), MIJR offers greater surgical precision with less trauma to surrounding tissues. This article explores the latest advancements in MIJR, demonstrating its impact on clinical outcomes and highlighting future trends such as AI-driven surgical planning and biologic implants. MIJR has become the gold standard in joint replacement, providing patients with faster recovery and improved long-term results.

Digital tools in primary total knee arthroplasty-Prevalence in the German-speaking region

Digital tools are being increasingly used worldwide in primary knee arthroplasty. This study aimed to analyze the utilization density of digital tools, the preferred alignment strategies, and the obstacles and benefits of implementing these technologies in German-speaking countries. An online survey with 57questions about digital tools in primary knee arthroplasty and their usage was conducted among members of the Arthroplasty Working Group (AE). The survey included questions on navigation, robotics, patient-specific instruments, individualized implants, and augmented reality. The survey revealed that 18% of hospitals use navigation and 17% use robotic systems in primary total knee arthroplasty surgery. The main reasons for not implementing supportive technologies were high acquisition and ongoing costs, as well as longer surgical duration. Patient-specific instruments and individualized implants currently play aminor role. Patient-specific alignment strategies, such as kinematic (navigation: 35%; robotics: 44%) and functional alignment (navigation: 15%; robotics: 35%), are preferred in this context. With conventional instrumentation predominantly mechanical alignment was applied (79%). The results indicate arelatively high utilization density of digital tools, which are mainly used to perform personalized alignment strategies in primary knee arthroplasty in German-speaking countries. This was particularly evident in high-volume hospitals. Economic aspects were the main reasons for not using these technologies. Future developments should aim to simplify the systems and thus achieve improved cost efficiency.

Comparison of Implant Placement Accuracy Between Manual, Robot-Assisted, Computer-Navigated, Augmented Reality Navigated, Patient-Specific Instrumentation, and Accelerometer Navigated Total Hip Arthroplasty: A Systematic Review and Network Meta-Analysis.

Malpositioning of the acetabular cup during total hip arthroplasty (THA) can lead to complications. Robotic surgery and navigation techniques aim to address this issue, but there is limited evidence regarding which method can achieve better clinical outcomes. Therefore, this network meta-analysis (NMA) aimed to compare the efficacy of various navigation methods. This NMA of prospective randomized controlled trials compared robot-assisted systems (RAS), computer-assisted navigation systems (CAS), augmented reality-based portable navigation (AR), patient-specific instrumentation (PSI), portable accelerometer-based navigation (PN), and conventional methods (C) for THA procedures. We searched MEDLINE, EMBASE, Cochrane, Central Register of Controlled Trials, International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. databases. The primary outcomes included revision surgery and postoperative clinical scores, and the secondary outcomes encompassed cup placement accuracy, acetabular cup placement outliers from the Lewinnek safe zone, surgical time, and complications. We used a Bayesian random-effects NMA, and confidence of evidence was assessed using confidence in NMA. We identified 45 studies including 2,122 patients. We did not find large differences in revision surgery, clinical outcome scores, cup inclination, or anteversion angle accuracy among the modalities. AR, CAS, and PSI exhibited a lower risk of outliers from safe zones than C. In addition, RAS and CAS had a longer surgical time than C. Robotic and navigation tools did not reduce the revision risk or enhance clinical outcomes. AR, CAS, PSI, and PN may decrease the risk of cup placement outliers in safe zones. However, the cup placement accuracy was equivalent, and the surgical time may be longer in RAS and CAS than in C. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Revolutionizing Shoulder Arthroplasty: The Transformative Impact of Extended Reality, Robotics, and Artificial Intelligence on Training, Planning, and Execution

Technological innovations in shoulder arthroplasty could play a major role in addressing problems of implant positioning, stability, and longevity and optimizing patient outcomes. This review discusses the role of extended reality, navigation, patient-specific instrumentation, robotics and artificial intelligence and their applications in training, preoperative planning and intraoperative execution. These nascent technologies have the potential to deliver extraordinary value to patients requiring shoulder arthroplasty but long-term prospective clinical data justifying their mainstream use is currently lacking.