Precision proteoform design for 4R tau isoform selective templated aggregation.

Prion-like spread of disease-specific tau conformers is a hallmark of all tauopathies. A 19-residue probe peptide containing a P301L mutation and spanning the R2/R3 splice junction of tau folds and stacks into seeding-competent fibrils and induces aggregation of 4R, but not 3R tau. These tau peptide fibrils propagate aggregated intracellular tau over multiple generations, have a high ß-sheet content, a colocalized lipid signal, and adopt a well-defined U-shaped fold found in 4R tauopathy brain-derived fibrils. Fully atomistic replica exchange molecular dynamics (MD) simulations were used to compute the free energy landscapes of the conformational ensemble of the peptide monomers. These identified an aggregation-prohibiting ß-hairpin structure and an aggregation-competent U-fold unique to 4R tauopathy fibrils. Guided by MD simulations, we identified that the N-terminal-flanking residues to PHF6, which slightly vary between 4R and 3R isoforms, modulate seeding. Strikingly, when a single amino acid switch at position 305 replaced the serine of 4R tau with a lysine from the corresponding position in the first repeat of 3R tau, the seeding induced by the 19-residue peptide was markedly reduced. Conversely, a 4R tau mimic with three repeats, prepared by replacing those amino acids in the first repeat with those amino acids uniquely present in the second repeat, recovered aggregation when exposed to the 19-residue peptide. These peptide fibrils function as partial prions to recruit naive 4R tau-ten times the length of the peptide-and serve as a critical template for 4R tauopathy propagation. These results hint at opportunities for tau isoform-specific therapeutic interventions.

Evolutionary Design of Self-Templated Supramolecular Fibrils Using M13 Bacteriophage for Tissue Engineering.

Biomaterials in nature form hierarchical structures and functions across various length scales through binding and assembly processes. Inspired by nature, we developed hierarchically organized tissue engineering materials through evolutionary screening and self-templating assembly. Leveraging the M13 bacteriophage (phage), we employed an evolutionary selection process against hydroxyapatite (HA) to isolate HA-binding phage (HAPh). The newly discovered phage exhibits a bimodal length, comprising 950 nm and 240 nm, where the synergistic effect of these dual lengths promotes the formation of supramolecular fibrils with periodic banded structures. The assembled HAPh fibrils show the capability of HA mineralization and the directional growth of osteoblast cells. When applied to a dentin surface, it induces the regeneration of dentin-like tissue structures, showcasing its potential applications as a scaffold in tissue engineering. The integration of evolutionary screening and self-templating assembly holds promise for the future development of hierarchically organized tissue engineering materials.

Super-Elastic and Temperature-Tolerant Hydrogel Electrodes for Supercapacitors via MXene Enhanced Ice-Templating Synthesis.

Developing flexible energy storage devices with good deformation resistance under extreme operating conditions is highly desirable yet remains very challenging. Super-elastic MXene-enhanced polyvinyl alcohol/polyaniline (AMPH) hydrogel electrodes are designed and synthesized through vertical gradient ice templating-induced polymerization. This approach allows for the unidirectional growth of polyaniline (PANI) and 2D MXene layers along the elongated arrayed ice crystals in a controlled manner. The resulting 3D unidirectional AMPH hydrogel exhibits inherent stretchability and electronic conductivity, with the ability to completely recover its shape even under extreme conditions, such as 500% tensile strain, 50% compressive strain. The presence of MXene in the hydrogel electrode enhances its resilience to mechanical compression and stretching, resulting in less variation in resistance. AMPH has a specific capacitance of 130.68 and 88.02 mF cm-2 at a current density of 0.2 and 2 mA cm-2, respectively, and retains 90% and 70% of its original capacitance at elongation of 100% and 200%, respectively. AMPH-based supercapacitors demonstrate exceptional performance in high salinity environments and wide temperature ranges (-30-80 °C). The high electrochemical activity, temperature tolerance, and mechanical robustness of AMPH-based supercapacitor endow it promising as the power supply for flexible and wearable electronic devices.

3D Carbon Microspheres with a Maze-Like Structure and Large Mesopore Tunnels Built From Rapid Aerosol-Confined Coherent Salt/Surfactant Templating.

Hierarchically porous carbons with tailor-made properties are essential for applications wherein rich active sites and fast mass transfer are required. Herein, a rapid aerosol-confined salt/surfactant templating approach is proposed for synthesizing hierarchically porous carbon microspheres (HPCMs) with a maze-like structure and large mesopore tunnels for high-performance tri-phase catalytic ozonation. The confined assembly in drying microdroplets is crucial for coherent salt (NaCl) and surfactant (F127) dual templating without macroscopic phase separation. The HPCMs possess tunable sizes, a maze-like structure with highly open macropores (0.3-30 µm) templated from NaCl crystal arrays, large intrawall mesopore tunnels (10-45 nm) templated from F127, and rich micropores (surface area >1000 m2 g-1 ) and oxygen heteroatoms originated from NaCl-confined carbonization of phenolic resin. The structure formation mechanism of the HPCMs and several influencing factors on properties are elaborated. The HPCMs exhibit superior performance in gas-liquid-solid tri-phase catalytic ozonation for oxalate degradation, owing to their hierarchical pore structure for fast mass transfer and rich defects and oxygen-containing groups (especially carbonyl) for efficient O3 activation. The reactive oxygen species responsible for oxalate degradation and the influences of several structure parameters on performance are discussed. This work may provide a platform for producing hierarchically porous materials for various applications.

Superelastic Cellulose Sub-Micron Fibers/Carbon Black Aerogel for Highly Sensitive Pressure Sensing.

Superelastic aerogels with rapid response and recovery times, as well as exceptional shape recovery performance even from large deformation, are in high demand for wearable sensor applications. In this study, a novel conductive and superelastic cellulose-based aerogel is successfully developed. The aerogel incorporates networks of cellulose sub-micron fibers and carbon black (SMF/CB) nanoparticles, achieved through a combination of dual ice templating assembly and electrostatic assembly methods. The incorporation of assembled cellulose sub-micron fibers imparts remarkable superelasticity to the aerogel, enabling it to retain 94.6% of its original height even after undergoing 10 000 compression/recovery cycles. Furthermore, the electrostatically assembled CB nanoparticles contribute to exceptional electrical conductivity in the cellulose-based aerogel. This combination of electrical conductivity and superelasticity results in an impressive response time of 7.7 ms and a recovery time of 12.8 ms for the SMF/CB aerogel, surpassing many of the aerogel sensors reported in previous studies. As a proof of concept, the SMF/CB aerogel is utilized to construct a pressure sensor and a sensing array, which exhibit exceptional responsiveness to both minor and substantial human motions, indicating its significant potential for applications in human health monitoring and human-machine interaction.

Silicon Radical-Induced CH4 Dissociation for Uniform Graphene Coating on Silica Surface.

Due to the manufacturability of highly well-defined structures and wide-range versatility in its microstructure, SiO2 is an attractive template for synthesizing graphene frameworks with the desired pore structure. However, its intrinsic inertness constrains the graphene formation via methane chemical vapor deposition. This work overcomes this challenge by successfully achieving uniform graphene coating on a trimethylsilyl-modified SiO2 (denote TMS-MPS). Remarkably, the onset temperature for graphene growth dropped to 720 °C for the TMS-MPS, as compared to the 885 °C of the pristine SiO2. This is found to be mainly from the Si radicals formed from the decomposition of the surface TMS groups. Both experimental and computational results suggest a strong catalytic effect of the Si radicals on the CH4 dissociation. The surface engineering of SiO2 templates facilitates the synthesis of high-quality graphene sheets. As a result, the graphene-coated SiO2 composite exhibits a high electrical conductivity of 0.25 S cm-1. Moreover, the removal of the TMP-MPS template has released a graphene framework that replicates the parental TMS-MPS template on both micro- and nano- scales. This study provides tremendous insights into graphene growth chemistries as well as establishes a promising methodology for synthesizing graphene-based materials with pre-designed microstructures and porosity.

Unprecedented Organogermanium Functionalized GeIV-SbIII-Templating Polyoxotungstate Nanocluster for Photothermal-Chemodynamic Cancer Therapy.

The function-oriented synthesis of polyoxometalate (POM) nanoclusters has become an increasingly important area of research. Herein, the well-known broad-spectrum anticancer drug Ge-132 which contains GeIV as potential heteroatoms and carboxyl coordination sites, is introduced to the POM system, leading to the first organogermanium functionalized GeIV-SbIII-templating POM nanocluster Na4[H2N(CH3)2]16 H18[Sm4(H2O)12W4O14Ge(CH2CH2COOH)]2[SbW9O33]4[Ge(CH2CH2COOH) SbW15O54]2·62H2O (1). An unprecedented organogermanium templating Dawson-like [Ge(CH2CH2COOH)SbW15O54]12- building block is discovered. To take advantage of the potential pharmaceutical activity of such an organogermanium-functionalized POM cluster, 1 is further composited with gold nanoparticles (NPs) to prepare 1-Au NPs, which doubles the blood circulation time of 1-based nanodrug. Efficient separation of photogenerated charges in 1-Au NPs largely boosts the photothermal conversion efficiency (PCE = 55.0%), which is nearly 2.1 times that of either single 1 (PCE = 26.7%) or Au NPs (PCE = 26.2%), and simultaneously facilitate the generation of toxic activate reactive oxygen species in tumor microenvironment. Based on these findings, it is demonstrated that 1-Au NPs are a multifunctional and renal clearable nanomedicine with great potential in photoacoustic imaging guiding photothermal-chemodynamic therapy for breast cancer.

Immobilizing Bimetallic RuCo Nanoalloys on Few-Layered MXene as a Robust Bifunctional Electrocatalyst for Overall Water Splitting.

Doping Co atoms into Ru lattices can tune the electronic structure of active sites, and the conductive MXene can adjust the electrical conductivity of catalysts, which are both favorable for improving the electrocatalytic activity of the catalyst for water splitting. Here, ruthenium-cobalt bimetallic nanoalloys coupled with exfoliated Ti3 C2 Tx MXene (RuCo-Ti3 C2 Tx ) have been constructed by ice-templated and thermal activation. Due to the strong interaction between the RuCo nanoalloys and conductive MXene, RuCo-Ti3 C2 Tx not only exhibits an excellent hydrogen evolution reaction (HER) performance with a low overpotential and Tafel slope (60 mV, 34.8 mV dec-1 in 0.5 M H2 SO4 and 52 mV, 38.7 mV dec-1 in 1 M KOH), but also good oxygen evolution reaction (OER) performance in an alkaline electrolyte (266 mV, 111.1 mV dec-1 in 1 M KOH). The assembled RuCo-Ti3 C2 Tx ||RuCo-Ti3 C2 Tx electrolyzer requires a lower potential (1.56 V) than does the Pt/C||RuO2 electrolyzer at 10 mA cm-2 . A boosted catalytic HER activity from immobilizing the RuCo nanoalloys on MXene was unveiled by density functional theory calculations. This study provides a feasible and efficient strategy for developing MXene-based catalysts for overall water splitting.

Accuracy and clinical role of digital templating for total knee arthroplasty performed on haemophilic knees.

INTRODUCTION: In total knee arthroplasty (TKA), choosing the correct implant size is important. There is lack of data on accuracy of templating on haemophilic knees. Our aim was to test the accuracy of 2D digital templating for TKA on haemophilic arthropathy (HA) of knee. MATERIALS AND METHODS: TKAs performed on HA between January 2011 and January 2022 were screened. Osteoarthritis (OA) group was created as control group by a one-to-one matching regarding type of implant used. Intra- and interobserver correlations were measured in HA, then correlation between templated and implanted sizes was investigated in four assessments (femur AP, femur lateral, tibia AP, tibia lateral), then compared with OA group. Fifty-eight knees in each group included. RESULTS: Regarding intraobserver correlation in HA, there was excellent correlation for femur AP [.93 (.73-.98)], femur lateral [.98 (.91-.99)], and tibia AP (1.0) templating. Regarding interobserver correlation in HA, excellent correlation was observed for femur lateral [.93 (.74-.98)] and tibia AP templating [.90 (.65-.97)]. Regarding correlation of templated and applied sizes in HA; tibia AP, tibia lateral and femur lateral templating showed good correlation [.81 (.70-.89), .86 (.77-.91), .79 (.67-.87) while femur AP templating showed moderate correlation [.67 (.50-.79)]. Comparing HA and OA, there was no difference in correlation levels regarding femur AP, femur lateral, tibia AP and tibia lateral templating (p = .056, p = .781, p = .761, p = .083, respectively). CONCLUSION: Although 2D digital templating shows comparable correlation in HA and OA, clinical applicability of templating on HA appears to be limited in its current state.

Solidification of Polyurethane Model Foams via Catalyst Drainage from a Secondary Foam.

Due to their unique mechanical and thermal properties, polyurethane foams are widely used in multiple fields of applications, including cushioning, thermal insulation or biomedical engineering. However, the way polyurethane foams are usually manufactured - via chemical foaming - produces samples where blowing and gelling occur at the same time, resulting in a morphology control achieved by trial and error processes. Here, a novel strategy is introduced to build model homogeneous polyurethane foams of controlled density with millimetric bubbles from liquid templates. By producing a polyurethane foam via physical bubbling without a catalyst and gently depositing a secondary foam containing catalyst on the top of this first foam, it is possible to take advantage of drainage mechanisms to trigger the solidification of the bottom foam. The characterization of the samples performed by X-ray microtomography allows to study quantitatively the structure of the final solid foam, at the global and at the local scale. Using the tomographic 3D images of the foam architectures, the superimposed foam technique introduced in this article is shown to be promising to produce foams with a good homogeneity along the vertical direction, with a density controlled by varying the concentration of catalyst in the secondary foam.

Mixed-reality improves execution of templated glenoid component positioning in shoulder arthroplasty: a CT imaging analysis.

INTRODUCTION: Glenoid placement is critical for successful outcomes in total shoulder arthroplasty (TSA). Preoperative templating with three-dimensional imaging has improved implant positioning, but deviations from the planned inclination and version still occur. Mixed-Reality (MR) is a novel technology that allows surgeons intra-operative access to three-dimensional imaging and templates, capable of overlaying the surgical field to help guide component positioning. The purpose of this study was to compare the execution of preoperative templates using MR vs.standard instruments (SIs). METHODS: Retrospective review of 97 total shoulder arthroplasties (18 anatomic, 79 reverse) from a single high-volume shoulder surgeon between January 2021 and February 2023, including only primary diagnoses of osteoarthritis, rotator cuff arthropathy, or a massive irreparable rotator cuff tear. To be included, patients needed a templated preoperative plan and then a postoperative computed tomography scan. Allocation to MR vs. SI was based on availability of the MR headset, industry technical personnel, and the templated preoperative plan loaded into the software, but preoperative or intraoperative patient factors did not contribute to the allocation decision. Postoperative inclination and version were measured by two independent, blinded physicians and compared to the preoperative template. From these measurements, we calculated the mean difference, standard deviation (SD), and variance to compare MR and SI. RESULTS: Comparing 25 MR to 72 SI cases, MR significantly improved both inclination (P < .001) and version (P < .001). Specifically, MR improved the mean difference from preoperative templates (by 1.9° inclination, 2.4° version), narrowed the SD (by 1.7° inclination, 1.8° version), and decreased the variance (11.7-3.0 inclination, 14.9-4.3 version). A scatterplot of the data demonstrates a concentration of MR cases within 5° of plan relative to SI cases typically within 10° of plan. There was no difference in operative time. CONCLUSION: MR improved the accuracy and precision of glenoid positioning. Although it is unlikely that 2° makes a detectable clinical difference, our results demonstrate the potential ability for technology like MR to narrow the bell curve and decrease the outliers in glenoid placement. This will be particularly relevant as MR and other similar technologies continue to evolve into more effective methods in guiding surgical execution.

3-dimensionally printed patient-specific glenoid drill guides vs. standard nonspecific instrumentation: a randomized controlled trial comparing the accuracy of glenoid component placement in anatomic total shoulder arthroplasty.

BACKGROUND: Traditional, commercially sourced patient-specific instrumentation (PSI) systems for shoulder arthroplasty improve glenoid component placement but can involve considerable cost and outsourcing delays. The purpose of this randomized controlled trial was to compare the accuracy of glenoid component positioning in anatomic total shoulder arthroplasty (aTSA) using an in-house, point-of-care, 3-dimensionally (3D) printed patient-specific glenoid drill guide vs. standard nonspecific instrumentation. METHODS: This single-center randomized controlled trial included 36 adult patients undergoing primary aTSA. Patients were blinded and randomized 1:1 to either the PSI or the standard aTSA guide groups. The primary endpoint was the accuracy of glenoid component placement (version and inclination), which was determined using a metal-suppression computed tomography scan taken between 6 weeks and 1 year postoperatively. Deviation from the preoperative 3D templating plan was calculated for each patient. Blinded postoperative computed tomography measurements were performed by a fellowship-trained shoulder surgeon and a musculoskeletal radiologist. RESULTS: Nineteen patients were randomized to the patient-specific glenoid drill guide group, and 17 patients were allocated to the standard instrumentation control group. There were no significant differences between the 2 groups for native version (P = .527) or inclination (P = .415). The version correction was similar between the 2 groups (P = .551), and the PSI group was significantly more accurate when correcting version than the control group (P = .042). The PSI group required a significantly greater inclination correction than the control group (P = .002); however, the 2 groups still had similar accuracy when correcting inclination (P = .851). For the PSI group, there was no correlation between the accuracy of component placement and native version, native inclination, or the Walch classification of glenoid wear (P > .05). For the control group, accuracy when correcting version was inversely correlated with native version (P = .033), but accuracy was not correlated with native inclination or the Walch classification of glenoid wear (P > .05). The intraclass correlation coefficient was 0.703 and 0.848 when measuring version and inclination accuracy, respectively. CONCLUSION: When compared with standard instrumentation, the use of in-house, 3D printed, patient-specific glenoid drill guides during aTSA led to more accurate glenoid component version correction and similarly accurate inclination correction. Additional research should examine the influence of proper component position and use of PSI on clinical outcomes.

THA-Net: A Deep Learning Solution for Next-Generation Templating and Patient-specific Surgical Execution.

BACKGROUND: This study introduces THA-Net, a deep learning inpainting algorithm for simulating postoperative total hip arthroplasty (THA) radiographs from a single preoperative pelvis radiograph input, while being able to generate predictions either unconditionally (algorithm chooses implants) or conditionally (surgeon chooses implants). METHODS: The THA-Net is a deep learning algorithm which receives an input preoperative radiograph and subsequently replaces the target hip joint with THA implants to generate a synthetic yet realistic postoperative radiograph. We trained THA-Net on 356,305 pairs of radiographs from 14,357 patients from a single institution's total joint registry and evaluated the validity (quality of surgical execution) and realism (ability to differentiate real and synthetic radiographs) of its outputs against both human-based and software-based criteria. RESULTS: The surgical validity of synthetic postoperative radiographs was significantly higher than their real counterparts (mean difference: 0.8 to 1.1 points on 10-point Likert scale, P < .001), but they were not able to be differentiated in terms of realism in blinded expert review. Synthetic images showed excellent validity and realism when analyzed with already validated deep learning models. CONCLUSION: We developed a THA next-generation templating tool that can generate synthetic radiographs graded higher on ultimate surgical execution than real radiographs from training data. Further refinement of this tool may potentiate patient-specific surgical planning and enable technologies such as robotics, navigation, and augmented reality (an online demo of THA-Net is available at: https://demo.osail.ai/tha_net).

Structural Design of Electrocatalyst-Decorated MXenes on Sulfur Spheres for Lithium-Sulfur Batteries.

Lithium-sulfur batteries (LSBs) are known to be potential next-generation energy storage devices. Recently, our group reported an LSB cathode made using sulfur spheres that has been spherically templated by MXene nanosheets decorated with CoSe2 nanoparticles, forming a "loose-templating" configuration. It was postulated that the minimal restacking of the outer nanoparticle-decorated MXene layer helps to enable facile ionic transport. However, as the nanosheets do not adhere conformally to the internal sphere's surface, such a configuration can be controversial, thus requiring a more systematic understanding. In this work, we report and quantify for the first time the independent and dependent variables involved in this morphology, allowing us to identify that having smaller nanoparticles resulted in better Li+ ion transport and enhanced electrochemical performances. The optimized cathode structure exhibited an initial specific capacity of 1274 mAh/g and a 0.06% decay rate per cycle at 0.5 C over 1000 cycles in LSBs.

Mesoporous Semiconductive Bi2Se3 Films.

Bi2Se3 is a semiconductive material possessing a bandgap of 0.3 eV, and its unique band structure has paved the way for diverse applications. Herein, we demonstrate a robust platform for synthesizing mesoporous Bi2Se3 films with uniform pore sizes via electrodeposition. Block copolymer micelles act as soft templates in the electrolyte to create a 3D porous nanoarchitecture. By controlling the length of the block copolymer, the pore size is adjusted to 9 and 17 nm precisely. The nonporous Bi2Se3 film exhibits a tunneling current in a vertical direction of 52.0 nA, but upon introducing porosity (9 nm pores), the tunneling current increases significantly to 684.6 nA, suggesting that the conductivity of Bi2Se3 films is dependent on the pore structure and surface area. The abundant porous architecture exposes a larger surface area of Bi2Se3 to the surrounding air within the same volume, thereby augmenting its metallic properties.

In-Situ Measurement of Magnetoelectric Coupling and Strain Transfer in Multiferroic Nanocomposites of CoFe2O4 and Hf0.5Zr0.5O2 with Residual Porosity.

With increasing applications for voltage-controlled magnetism, the need to more fully understand magnetoelectric coupling and strain transfer in nanostructured multiferroic composites has also increased. Here, multiferroic nanocomposites were synthesized using block copolymer templating to create mesoporous cobalt ferrite (CFO), followed by partly filling the pores with ferroelectric zirconium-substituted hafnia (HZO) using atomic layer deposition (ALD) to produce a porous multiferroic composite with enhanced mechanical flexibility. Upon electrical poling of the nanocomposite, we observed large changes in the magnetization. These changes partly relaxed upon removing the electric field, suggesting a strain-mediated mechanism. Both the anisotropic strain transfer from HZO to CFO and the strain relaxation after the field was removed were confirmed using high-resolution X-ray diffraction measurements collected during in-situ poling. The in-situ observation of both anisotropic strain transfer and large magnetization changes allows us to directly characterize the strong multiferroic coupling that can occur in flexible, nanostructured composites.

Accuracy of two-dimensional digital planning in uncemented primary hip arthroplasty: monocentric analysis of eight hundred implants.

PURPOSE: In the last decades, there has been a refinement in total hip arthroplasty, which allowed surgeons to achieve the highest performance and better patient outcomes. Preoperative planning in primary hip arthroplasty is an essential step that guides the surgeon in restoring the anatomy and biomechanics of the joint. This study aims to evaluate the accuracy of the 2D digital planning, considering cup sizing, stem sizing, and limb length discrepancy. Additionally, we conducted a multivariable analysis of demographic data and comorbidities to find factors influencing preoperative planning. METHODS: This retrospective study analyzed the planning accuracy in 800 consecutive uncemented primary total hip arthroplasty. We compared the preoperatively planned total hip arthroplasty with postoperative results regarding the planned component size, the implanted size, and the lower limb length restoration. Therefore, we investigated factors influencing planning accuracy: overweight and obesity, sex, age, past medical history, comorbidities, and implant design. All the surgeries were performed in the posterolateral approach by one expert surgeon who did the preoperative planning. The preoperative planning was determined to be (a) exact if the planned and the implanted components were the same size and (b) accurate if exact ± one size. The restoration of postoperative limb length discrepancy was classified into three groups: ± 3 mm, ± 5 mm, and ± 10 mm. This assessment was performed through a digital method 2D based on a standard hip X-ray. RESULTS: This court of 800 implants showed that planning was exact in 60% of the cups and 44% of the stems and was accurate in 94% of the cups and 80% of the stems. The postoperative limb length discrepancy was ± 3 mm in 91% and ± 5 mm in 97%. CONCLUSIONS: This study showed preoperative 2D digital planning great precision and reliability, and we demonstrated that it was accurate in 94% of the cups and 80% of the stems. Therefore, the preoperative limb length discrepancy analysis was essential to guarantee the recovery of the operated limb's correct length.

Artificial intelligence-based three-dimensional templating for total joint arthroplasty planning: a scoping review.

PURPOSE: The purpose of this review is to evaluate the current status of research on the application of artificial intelligence (AI)-based three-dimensional (3D) templating in preoperative planning of total joint arthroplasty. METHODS: This scoping review followed the PRISMA, PRISMA-ScR guidelines, and five stage methodological framework for scoping reviews. Studies of patients undergoing primary or revision joint arthroplasty surgery that utilised AI-based 3D templating for surgical planning were included. Outcome measures included dataset and model development characteristics, AI performance metrics, and time performance. After AI-based 3D planning, the accuracy of component size and placement estimation and postoperative outcome data were collected. RESULTS: Nine studies satisfied inclusion criteria including a focus on computed tomography (CT) or magnetic resonance imaging (MRI)-based AI templating for use in hip or knee arthroplasty. AI-based 3D templating systems reduced surgical planning time and improved implant size/position and imaging feature estimation compared to conventional radiographic templating. Several components of data processing and model development and testing were insufficiently covered in the studies included in this scoping review. CONCLUSIONS: AI-based 3D templating systems have the potential to improve preoperative planning for joint arthroplasty surgery. This technology offers more accurate and personalized preoperative planning, which has potential to improve functional outcomes for patients. However, deficiencies in several key areas, including data handling, model development, and testing, can potentially hinder the reproducibility and reliability of the methods proposed. As such, further research is needed to definitively evaluate the efficacy and feasibility of these systems.

Intraoperative live measurement of femoral head size for acetabular cup sizing: simple, accurate, and green!

PURPOSE: Templating is the first step in achieving a successful total hip arthroplasty. We hypothesize that native head size is highly correlated with implanted cup size. Therefore, the purpose of this study is to look for a correlation between sizes of the intra-operative measurement of the femoral head and the implanted cup. METHODS: This is a monocentric observational study conducted from December 2018 till January 2023. All patients admitted for a primary total hip arthroplasty were included and retrospectively reviewed. Intra-operative femoral head measurement, radiographic femoral head diameter, templated (planned) cup size, and definitive implanted cup size were recorded. RESULTS: The sample included 154 patients (85 female and 69 males) with a mean age of 66.2 ± 10.4 years. There were 157 THA cases; 82 on the right side and 75 on the left side. The native head size and acetate template on digital radiographs were the most significantly positively correlated with cup size (P < 0.0001) while the radiological head size was significantly negatively correlated with cup size (P = 0.009). The implanted cup was on average 2 ± 2 mm bigger than the native head size measured intra-operatively. CONCLUSION: The native femoral head diameter measured intra-operatively is a simple and reliable tool to help the surgeons choose the proper size of the acetabular cup, preventing complications during surgery hence optimizing results post operatively. This technique would contribute to a more ecofriendly orthopaedic reconstructive surgery.

Does two dimensional templating allow for the use of reduced-size ancillaries in total hip arthroplasty?

PURPOSE: Rising costs in healthcare for total hip arthroplasty (THA) mean that new solutions must be considered, such as the use of single-use ancillaries (SUA). The goal of this study was to assess the accuracy of 2D templating in primary THA for the use of reduced-size SUA. Our hypothesis was that the accuracy of 2D templating in primary THA would be higher than 95%, give or take two sizes. METHOD: This single-centre prospective study included all primary THAs performed over two years. Templating was carried out using 2D templating on anteroposterior pelvic X-rays. The template sizes were compared to the implant sizes. The primary endpoint was the rate of coincidence between digitally templated estimates and the actual implant sizes. The secondary endpoint was the difference of accuracy based on patient parameters. RESULTS: We analysed 512 cases of THA. Accuracy within two sizes was 96.9% for acetabular implants and 98.5% for femoral implants. Accuracy was below the 95% threshold only in patients under 55 and over 85 years old. A BMI above 30.0 kg/m2 significantly reduced accuracy but did not fall below the 95% threshold. The operated hip, the type of implant, and the operative indication did not significantly influence templating accuracy. CONCLUSION: Using reduced-size SUA with five rasps and five reamers depending on template sizes means that THA can be performed in more than 95% of cases allowing the use of compact single use ancillaries.