Validating a Novel 2D to 3D Knee Reconstruction Method on Preoperative Total Knee Arthroplasty Patient Anatomies.

BACKGROUND: As advanced technology continues to evolve, incorporating robotics into surgical procedures has become imperative for precision and accuracy in preoperative planning. Nevertheless, the integration of three-dimensional (3D) imaging into these processes presents both financial considerations and potential patient safety concerns. This study aims to assess the accuracy of a novel 2D-to-3D knee reconstruction solution, RSIP XPlan.ai™ (RSIP Vision, Jerusalem, Israel), on preoperative total knee arthroplasty (TKA) patient anatomies. METHODS: Accuracy was calculated by measuring the Root Mean Square Error (RMSE) between X-ray-based 3D bone models generated by the algorithm and corresponding CT bone segmentations (distances of each mesh vertex to the closest vertex in the second mesh). The RMSE was computed globally for each bone, locally for eight clinically relevant bony landmark regions, and along simulated bone cut contours. In addition, the accuracies of three anatomical axes were assessed by comparing angular deviations to inter- and intra-observer baseline values. RESULTS: The global RMSE was 0.93 ± 0.25 mm for the femur and 0.88 ± 0.14 mm for the tibia. Local RMSE values for bony landmark regions were 0.51 ± 0.33 mm for the five femoral landmarks and 0.47 ± 0.17 mm for the three tibial landmarks. The RMSE along simulated cut contours was 0.75 ± 0.35 mm for the distal femur cut and 0.63 ± 0.27 mm for the proximal tibial cut. Anatomical axial average angular deviations were 1.89° for the trans epicondylar axis (with an inter- and intra-observer baseline of 1.43°), 1.78° for the posterior condylar axis (with a baseline of 1.71°), and 2.82° (with a baseline of 2.56°) for the medial-lateral transverse axis. CONCLUSIONS: The study findings demonstrate promising results regarding the accuracy of XPlan.ai™ in reconstructing 3D bone models from plain-film X-rays. The observed accuracy on real-world TKA patient anatomies in anatomically relevant regions, including bony landmarks, cut contours, and axes, suggests the potential utility of this method in various clinical scenarios. Further validation studies on larger cohorts are warranted to fully assess the reliability and generalizability of our results. Nonetheless, our findings lay the groundwork for potential advancements in future robotic arthroplasty technologies, with XPlan.ai™ offering a promising alternative to conventional CT scans in certain clinical contexts.

Getting the drop on Staphylococcus aureus: Semiquantitative Staphylococcus aureus nasal colony reduction in orthopedic surgery reduces surgical site infection.

BACKGROUND: Surgical site infection (SSI) is a frequent health care-associated infection. We aimed to reduce SSI risk after joint arthroplasty and spine surgery by reducing Staphylococcus aureus colonization burden with presurgery intranasal povidone-iodine (PVP-I) application in conjunction with skin antisepsis ("the intervention"). METHODS: Retrospective case-control study; postintervention cohort versus a historical cohort. Adults who underwent joint arthroplasty or spine surgery during February 2018 through October 2021 ("post-intervention cohort") included. In the analysis cases any patient who underwent surgery and developed SSI within 90 days postsurgery, controls had no SSI. Postintervention cohort data were compared with a similar retrospective 2016 to 2017 patient cohort that did not use intranasal PVP-I. RESULTS: The postintervention cohort comprised 688 consecutive patients aged 65y/o, 48.8% male, 28 cases, and 660 controls. Relatively more cases than controls had diabetes mellitus (P = .019). There was a 39.6% eradication rate of S aureus nasal colonization post intranasal PVP-I (P < .0001). SSI rate was higher in patients positive versus those negative for S aureus on a 24-hour postsurgery nasal culture (P < .0001). The deep SSI rate per 100 operations postintervention versus the historical cohort decreased for all surgical procedures. CONCLUSIONS: Semiquantitative S aureus nasal colony reduction using intranasal PVP-I is effective for decreasing SSI rate in joint arthroplasty and spine surgery. In patients with presurgery S aureus nasal colonization additional intranasal PVP-I postsurgery application should be considered.

Periprosthetic fractures of the knee: a comprehensive review.

Demographic changes have resulted in an increase in the number of older patients diagnosed with degenerative joint disease. Developments in the field of joint arthroplasty allow a broader population to improve their lifestyles. An increased demand for knee arthroplasty has led to a rise in operations performed worldwide. Although there has been a constant propagation of technology and an increase in medical staffing at a professional level, many patients still encounter complications. Though rare, these factors may lead to life-threatening scenarios and a devastating effect on the success of the operation. One such rare complication includes periprosthetic fractures around the knee, a complex injury which requires a cautious and experienced approach. In this review, we analyze the prevalence, risk factors and classification, investigation and treatment options for periprosthetic fractures with total knee arthroplasty.

Post-traumatic os odontoideum - case presentation and literature review.

Os odontoideum is a rare condition. Nevertheless this condition was described by Giacomini in 1886. It is defined radiologicaly as an oval or round-shaped ossicle of variable size with smooth circumferential cortical margins representing the odontoid process that has no continuity with the body of C2. It is important to review this topic since the upper cervical spinal region is complex from anatomical point of view and has many vital structures passing in close relation to each other. If a person suffers from hyper mobile dens due to insufficiency of its ligamentous complex, it may cause translation of the atlas on the axis and may compress the cervical cord or vertebral arteries. There are cases where patients suffering from Os odontoideum became quadriplegic after a minor trauma. This lesion usually present in pediatric population and its cause is widely debatable today. In our paper we present a review of Os odontoideum in general and present a specific case of a young woman that was diagnosed with Os odontoideum together with the methods that were used to examine, stabilize and finally treat her.

New approach for the rehabilitation of patients following total knee arthroplasty.

PURPOSE: To investigate the effect of a biomechanical therapy on gait, function and clinical condition in patients following total knee arthroplasty (TKA). METHODS: Seventeen TKA patients participated in the study. Patients received a biomechanical therapy AposTherapy). Patients underwent a gait test, clinical examination and an assessment of pain, function and quality of life (QOL). Patients were examined again at one, three and six month follow-ups. RESULTS: A significant improvement over time was found in most gait measurements. Significant improvements were also found in pain, function and QOL. CONCLUSIONS: The examined biomechanical therapy may help in the rehabilitation process following TKA.

A non-invasive biomechanical device and treatment for patients following total hip arthroplasty: results of a 6-month pilot investigation.

BACKGROUND: The purpose of the study was to examine the effect of a foot-worn biomechanical device on the clinical measurements and gait patterns of patients with total hip arthroplasty (THA). METHODS: Nineteen patients, up to 3 months post-THA, were enrolled to the study. Patients underwent a computerized gait analysis to calculate spatiotemporal parameters and completed the Western Ontario and McMaster Universities osteoarthritis index and the SF-36 health survey. Patients then began therapy with a non-invasive foot-worn biomechanical device coupled with a treatment methodology (AposTherapy). Patients received exercise guidelines and used the device daily during their regular activities at their own environment. Follow-up examinations were conducted after 4, 12, and 26 weeks of therapy. Repeated measures ANOVA was used to evaluate changes over time. The clinical significance of the treatment effect was evaluated by computing the Cohen's effect sizes (ES statistic). RESULTS: After 26 weeks of therapy, a significant improvement was seen in gait velocity (50.3%), involved step length (22.9%), and involved single limb support (16.5%). Additionally, a significant reduction in pain (85.4%) and improvement in function (81.1%) and quality of life (52.1%) were noted. CONCLUSIONS: Patients following THA demonstrated a significant improvement in gait parameters and in self-assessment evaluations of pain, function, and quality of life. We recommend further RCTs to examine the effect of this therapy compared to other rehabilitation modalities following THA and compared to healthy matched controls. TRIAL REGISTRATION: Clinical trial registration number NCT01266382.

Differences in gait pattern parameters between medial and anterior knee pain in patients with osteoarthritis of the knee.

BACKGROUND: Patients with osteoarthritis of the knee have unique spatiotemporal gait alterations. These gait changes have not yet been differentiated according to the location of knee pain. The purpose of this study was to compare the gait patterns of patients with symptomatic knee osteoarthritis that exhibit either anterior or medial joint pain. METHODS: 240 Patients with knee osteoarthritis were evaluated at one therapy center. Patients were divided into two groups according to the location of greatest pain in their worse knee. Patients underwent a computerized spatiotemporal gait analysis. Differences in gait patterns between the two knee pain locations were also examined within each gender. FINDINGS: Compared with patients with pain in the anterior knee compartment, those with pain in the medial knee compartment exhibited a significantly slower walking speed (P<0.01), shorter step length (P<0.01), lower single-limb-support phase (P<0.01). These differences are witnessed mainly between the females in each group, whereas males differed only in single-limb-support. INTERPRETATION: The results of this study suggested underlying gait differences in the nature of medial and anterior knee pain. Furthermore, gender differences in gait may exist between patients with medial knee pain compared to patients with anterior knee pain.

The Diagnostic Value of the Vacuum Phenomenon during Hip Arthroscopy.

The diagnostic value of the vacuum phenomenon between the femoral head and the acetabulum, and time frame of its occurrence after application of traction is an important clinical question. The resulting arthrogram may outline the shape, location, and extent of cartilage lesions prior to arthroscopy of the hip joint. The presence, duration, and diagnostic information of the vacuum phenomenon were evaluated in 24 hips that underwent arthroscopy. The operative diagnosis was compared to the results of imaging studies and to findings obtained during a traction trial prior to arthroscopy. Indications for arthroscopy included avascular necrosis, labral tears, loose bodies, osteoarthrosis, and intractable hip pain. In 22 hips the vacuum phenomenon developed within 30 seconds after application of traction. The most important data obtained from the vacuum phenomenon was the location and extent of femoral head articular cartilage detachment and the presence of nonossified loose bodies. The vacuum phenomenon did not reveal labral or acetabular cartilage pathology in any of these patients. The vacuum phenomenon obtained during the trial of traction can add valuable information prior to hip arthroscopy. Femoral head articular cartilage detachment was best documented by this method. The hip arthroscopist should utilize this diagnostic window routinely prior to hip arthroscopy.

[Hip arthroscopy--indications, surgical technique and implementation].

Hip arthroscopy was first described by Burman in 1931. During the 1980's this procedure was performed by a limited group of orthopedic surgeons. Implementation and development of the surgical procedure received most attention during those years, together with the formulation of specific indications to perform hip arthroscopy. In contrast to other large joints (knee, shoulder), where accurate diagnosis is feasible using standard imaging procedures such as plain radiographs, computed tomography and magnetic resonance imaging, the hip joint often presents as a diagnostic anomaly. In specific cases hip arthroscopy can add invaluable information, which, in correlation with the symptoms of the patient, can lead to an accurate diagnosis. Hip arthroscopy has various indications including the removal of foreign or loose bodies, irrigation of an infected hip joint and evaluation of the cartilage. The list of indications is still expanding as more surgeons become familiar with the technique. Hip arthroscopy is a safe and efficient procedure in experienced hands. This review of the literature describes the surgical procedure, various clinical situations, indications and the therapeutic potential of hip arthroscopy.