Digital TKA Alignment Training with a New Digital Simulation Tool (Knee-CAT) Improves Process Quality, Efficiency, and Confidence.

Individual alignment techniques have been introduced to restore patients' unique anatomical variations during total knee arthroplasty. The transition from conventional mechanical alignment to individualised approaches, with the assistance of computer and/or robotic technologies, is challenging. The objective of this study was to develop a digital training platform with real patient data to educate and simulate various modern alignment philosophies. The aim was to evaluate the training effect of the tool by measuring the process quality and efficiency, as well as the post-training surgeon's confidence with new alignment philosophies. Based on 1000 data sets, a web-based interactive TKA computer navigation simulator (Knee-CAT) was developed. Quantitative decisions on bone cuts were linked to the extension and flexion gap values. Eleven different alignment workflows were introduced. A fully automatic evaluation system for each workflow, with a comparison function for all workflows, was implemented to increase the learning effect. The results of 40 surgeons with different experience levels using the platform were assessed. Initial data were analysed regarding process quality and efficiency and compared after two training courses. Process quality measured by the percentage of correct decisions was increased by the two training courses from 45% to 87.5%. The main reasons for failure were wrong decisions on the joint line, tibia slope, femoral rotation, and gap balancing. Efficiency was obtained with a reduction in time spent per exercise from 4 min 28 s to 2 min 35 s (42%) after the training courses. All volunteers rated the training tool as helpful or extremely helpful for learning new alignment philosophies. Separating the learning experience from OR performance was mentioned as one of the main advantages. A novel digital simulation tool for the case-based learning of various alignment philosophies in TKA surgery was developed and introduced. The simulation tool, together with the training courses, improved surgeon confidence and their ability to learn new alignment techniques in a stress-free out-of-theatre environment and to become more time efficient in making correct alignment decisions.

Proximal femur anatomy-implant geometry discrepancies.

OBJECTIVES: Due to ongoing concern about femur anatomy-implant mismatches, this cross-sectional study aimed to create a geometric femur profile and used it to identify and quantify possible mismatches between femur anatomy and cephalomedullary nail dimensions. The work further aimed to assess whether patient demographics affect anatomy-implant coherence. METHODS: One hundred skeletally mature complete femur computer tomography (CT) scans were collected and exported to software enabling landmark placement and measures with multiplanar reconstruction techniques. RESULTS: Clinically relevant anatomy-implant discrepancies included the femur neck and shaft axis offset 6.1 ± 1.7 mm (95% CI [5.7-6.4]), femur radius of curvature 1.2 ± 0.3 m (95% CI [1.1-1.2]), femur anteversion 18.8 ± 9.2 (95% CI [16.9-20.6]). The implants reviewed in this study did not compensate for the femur neck and shaft axis offset and had a larger radius of curvature than the studied population. Clinically significant demographic geometry differences were not identified. CONCLUSION: There were discrepancies between femur anatomy and cephalomedullary nail implant design; however, no clinically significant femur feature inconsistency was identified among the demographic subgroups. Due to the identified anatomy-implant discrepancies, including the femur neck and shaft axis offset, we suggest that these measurements be considered for future implant design and surgical technique.

Access to care for low trauma hip fractures in South Africa.

RATIONALE: Early surgery is recommended for hip fractures. MAIN RESULT: In this study only one-third of subjects with hip fractures were admitted within 24 h of the fracture, and surgery was delayed beyond 48 h in the majority. SIGNIFICANCE: These findings highlight the need to improve access to care for hip fracture subjects. PURPOSE: There is limited data on the timing of admission and surgery following a low trauma hip fracture (HF) in South Africa (SA). METHODS: A prospective, observational study was conducted at public and private hospitals in three provinces, Gauteng (GP), KwaZulu-Natal (KZN) and the Western Cape (WC), in SA to determine time from fracture to admission and from admission to surgery in patients presenting with low trauma HF. Associations with delayed admission and surgery were explored using logistic regression. RESULTS: The median age of the 1996 subjects was 73 years (IQR 63-81 years), the majority were women (1346, 67%) and 1347 (67%) were admitted to the public hospitals. In one-third of subjects (661, 33%), admission was delayed to beyond 24 h after the fracture. There was a significantly longer time to admission in public compared to private hospitals (21 h [IQR 10.0-48.5] versus 6 h [IQR 3.3-14.1], p < 0.001), in subjects < 65 years, the WC and when admission occurred on a weekday. Surgery was delayed beyond 48 h in the majority (1272, 69%) of subjects and was significantly longer in public compared to private hospitals (130 h [IQR 62.6-212.4] versus 45.4 h [IQR 24.0-75.5], p < 0.001), in KZN, and when admission occurred after hours. CONCLUSION: The burden of HFs is higher at public hospitals in SA, where there is a significant delay in admission after a fracture and surgery after admission. This highlights the need for a review of HF care pathways, resources and policies.