Laser-Guided Intraoperative Navigation in Total Ankle Replacement Surgery.

BACKGROUND: This study aimed to evaluate the effectiveness of laser-guided intraoperative navigation compared with the conventional method in determining the accuracy of coronal alignment setting in total ankle replacement (TAR). MATERIAL AND METHODS: Sixteen cadaveric ankles were randomly divided into two groups: laser-guided and conventional. Measurements were performed following coronal alignment setting in each ankle. All parameters were collected and compared between the two groups to determine the accuracy of coronal alignment setting regarding localization of possible mechanical axis (PMA) from each method. These parameters included the distance from the most medial point of tibial surface (TS) (intra-articular part) to the marked point that was possibly close to MA (MM-PMA). RESULTS: There were no significant differences between the two groups; however, there was a trend toward more neutralization of PMA in the laser-guided group in terms of MM-PMA distance (P = 0.19). In addition, the ratio of MM-PMA to TS demonstrated that the axis closer to the actual mechanical axis (AMA) with medial deviation was only 0.6% in laser group, whereas the axis caused increased lateralization from AMA in the conventional group, which was as high as 4.4% (P = 0.15). CONCLUSION: Despite the limited sample size and insignificant differences of outcomes between the two groups, laser-guided intraoperative navigation provided higher accuracy of coronal alignment setting than the conventional method in TAR.

Synovium removal from the articular side of the quadriceps tendon around the superior pole of patella reduces the crepitus after total knee arthroplasty.

PURPOSE: The purpose of this study was to investigate whether synovium removal from the articular side of the quadriceps tendon around the superior pole of the patella after total knee arthroplasty (TKA) reduced the incidence of patellar crepitus (PC) or not. METHODS: We retrospectively reviewed 134 consecutive patients who underwent primary posterior stabilized (PS)-TKA by one surgeon from 2010 to 2013. Sixty-seven patients performed without touching synovium at superior pole of patella and 67 patients performed with removing all synovium from superior pole of patella were compared; none had patellar resurfacing. Patients were followed up two and six weeks, three, six and 12 months and annually thereafter. The primary outcome was the incidence of PC, detected during follow-up, and was graded as absent (0), fine (1), or coarse (2). RESULTS: At one year of follow-up, the synovial removal (SR) group had a significant lower rate of PC compared to the synovial preserved (SP) group: 15/67 (22%) vs 34/67 (51%), adjusted odds ratio = 0.29, 95% confidence interval (CI) = 0.14 to 0.64, P = 0.002. All PC in SR group were grade 1 while four knees in SP group were grade 2. Mean PC onset was eight months after surgery (range 1.5 to 12, P = 0.78) in both groups. CONCLUSION: Removal of the synovium from the articular side of the quadriceps tendon around the superior pole of patellar reduced the incidence of PC after primary PS-TKA without patellar resurfacing. This is a promising technique and might enlighten surgeons to reduce the noise and improve patient satisfaction after total knee replacement.