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Hiroaki Nakamura - One of the best experts on this subject based on the ideXlab platform.
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Design improvement in patient-specific instrumentation for total knee arthroplasty improved the accuracy of the tibial Prosthetic Alignment in the coronal and axial planes.
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2019Co-Authors: Kazumasa Yamamura, Suguru Nakamura, Hideki Ueyama, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:The accuracy of patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) is still controversial, especially in the tibial prosthesis. It was hypothesized that the design modification of PSI improved the tibial Prosthetic Alignment and reduced the associated complications. The aim of this study was to compare the accuracy of a conventional PSI with that of a newly designed PSI for total knee arthroplasty (TKA) using a new three-dimensional (3D) measurement method. Thirty TKAs each using the conventional and newly designed PSIs were studied. The postoperative 3D-computed tomography (3D CT) image was superimposed on the preoperative 3D CT plan. The absolute differences in the tibial Prosthetic Alignment between the preoperative and postoperative 3D CT images were directly measured in the coronal, sagittal, and axial planes. Knees in which the difference in the Prosthetic Alignment was > 3° were considered deviations. The new PSI showed less mean absolute differences and lower rate of deviations than the conventional PSI in the coronal and axial planes (p = 0.045 and p = 0.004, respectively). The deviations (> 3°) of the tibial prosthesis using the conventional PSI were 27, 30, and 63% and of those using the new PSI were 0, 20, and 20% in the coronal, sagittal, and axial planes, respectively. This is the first report to evaluate the effect of improvement in PSI design on the postoperative Alignment using 3D method, and it clearly showed that the modification significantly improved the accuracy of Alignment and reduced the deviations. Therapeutic study, case–control study, Level III.
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An accelerometer-based portable navigation system improved Prosthetic Alignment after total knee arthroplasty in 3D measurements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:PurposeThis study aimed to compare Prosthetic Alignment using three-dimensional (3D) measurements following total knee arthroplasty (TKA) performed using an accelerometer-based portable navigation system (KneeAlign2) versus the conventional technique.MethodsA total of 159 patients who had primary osteoarthritis of the knee with varus deformity underwent TKA. The KneeAlign2 system was used for distal femoral resection and tibial resection in 78 knees, and the conventional instrumentation (intramedullary for the femur and extramedullary for the tibia) was used in 81 knees. 3D computed tomography (CT) scans of the whole leg were taken after TKA. Femoral and tibial Prosthetic Alignments in the coronal, sagittal, and axial planes were measured using computer software. The operation time and estimated blood loss were calculated. Deep venous thrombosis (DVT) and pulmonary embolism (PE) were evaluated using the contrast-enhanced multi-detector row CT at 1 week after TKA.ResultsIn the femoral coronal plane, the mean and standard deviation of Prosthetic Alignment from neutral Alignment were 1.2° [95% confidence interval (CI) 1.0°–1.4°) in the navigation group and 1.6° (95% CI 1.3°–2.0°) in the conventional group (p = 0.03). The femoral component outliers (> 3° away from the goal Alignment) using the navigation system and the conventional technique were 3 and 15%, respectively, in the coronal plane (p
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an accelerometer based portable navigation system improved Prosthetic Alignment after total knee arthroplasty in 3d measurements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:This study aimed to compare Prosthetic Alignment using three-dimensional (3D) measurements following total knee arthroplasty (TKA) performed using an accelerometer-based portable navigation system (KneeAlign2) versus the conventional technique. A total of 159 patients who had primary osteoarthritis of the knee with varus deformity underwent TKA. The KneeAlign2 system was used for distal femoral resection and tibial resection in 78 knees, and the conventional instrumentation (intramedullary for the femur and extramedullary for the tibia) was used in 81 knees. 3D computed tomography (CT) scans of the whole leg were taken after TKA. Femoral and tibial Prosthetic Alignments in the coronal, sagittal, and axial planes were measured using computer software. The operation time and estimated blood loss were calculated. Deep venous thrombosis (DVT) and pulmonary embolism (PE) were evaluated using the contrast-enhanced multi-detector row CT at 1 week after TKA. In the femoral coronal plane, the mean and standard deviation of Prosthetic Alignment from neutral Alignment were 1.2° [95% confidence interval (CI) 1.0°–1.4°) in the navigation group and 1.6° (95% CI 1.3°–2.0°) in the conventional group (p = 0.03). The femoral component outliers (> 3° away from the goal Alignment) using the navigation system and the conventional technique were 3 and 15%, respectively, in the coronal plane (p < 0.01), and 15 and 43%, respectively, in the sagittal plane (p < 0.01). The outliers in tibial coronal and tibial sagittal planes were not statistically different between the two groups. There were no statistically significant differences between the two groups in operation time, blood loss, DVT, and PE. Using an accelerometer-based portable navigation system decreased the outliers of Prosthetic Alignment in femoral coronal and sagittal planes, and did not increase the complications such as operation time, blood loss, DVT, and PE. To our knowledge, this study is the first to investigate the usefulness of an accelerometer-based portable navigation system using the validated 3D measurement. III.
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Two-dimensional measurement misidentifies Alignment outliers in total knee arthroplasty: a comparison of two- and three-dimensional measurements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:Purpose Two-dimensional (2D) and three-dimensional (3D) measurements of Prosthetic Alignment and “outliers” after total knee arthroplasty (TKA) might not necessarily be comparable. The aim of this study was to compare the use of 2D and 3D measurements in the identification of Prosthetic Alignment and outliers after TKA. Methods This cross-sectional study included 159 consecutive TKAs. All patients underwent plain radiography, fluoroscopy-guided radiography, and computed tomography after TKA. The same baseline was used for 2D and 3D measurements. The reliability of Prosthetic Alignment and outlier identification (> 3° from neutral Alignment) was compared between the 2D and 3D measurements. Results The mean Prosthetic Alignment and rate of outliers were not significantly different the between 2D and 3D measurements. The inter- and intra-observer reliabilities were higher for the 3D measurements than for the 2D measurements. The agreement between 2D and 3D measurements in outlier identification was poor, except for femoral coronal Alignment. Cohen’s κ coefficients were 0.19 in femoral sagittal (poor), 0.02 in tibial coronal (poor), and 0.10 in tibial sagittal (poor) on plain radiography. The values were 0.23 in tibial coronal (poor) and 0.002 in tibial sagittal (poor) on fluoroscopy-guided radiography. Conclusions The agreement between 2D and 3D measurements in the identification of outliers was poor, even on fluoroscopy-guided radiography. Since 2D measurements have an inherent risk of misidentifying Alignment outliers, this finding is clinically relevant. To properly analyze the correlation between outliers and clinical results, such as longevity, patient satisfaction, and patient-reported outcome, 3D measurements for Prosthetic Alignment are desirable. Level of evidence III.
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Two-dimensional measurement misidentifies Alignment outliers in total knee arthroplasty: a comparison of two- and three-dimensional measurements.
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2018Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:Purpose Two-dimensional (2D) and three-dimensional (3D) measurements of Prosthetic Alignment and “outliers” after total knee arthroplasty (TKA) might not necessarily be comparable. The aim of this study was to compare the use of 2D and 3D measurements in the identification of Prosthetic Alignment and outliers after TKA.
Yukihide Minoda - One of the best experts on this subject based on the ideXlab platform.
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Design improvement in patient-specific instrumentation for total knee arthroplasty improved the accuracy of the tibial Prosthetic Alignment in the coronal and axial planes.
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2019Co-Authors: Kazumasa Yamamura, Suguru Nakamura, Hideki Ueyama, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:The accuracy of patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) is still controversial, especially in the tibial prosthesis. It was hypothesized that the design modification of PSI improved the tibial Prosthetic Alignment and reduced the associated complications. The aim of this study was to compare the accuracy of a conventional PSI with that of a newly designed PSI for total knee arthroplasty (TKA) using a new three-dimensional (3D) measurement method. Thirty TKAs each using the conventional and newly designed PSIs were studied. The postoperative 3D-computed tomography (3D CT) image was superimposed on the preoperative 3D CT plan. The absolute differences in the tibial Prosthetic Alignment between the preoperative and postoperative 3D CT images were directly measured in the coronal, sagittal, and axial planes. Knees in which the difference in the Prosthetic Alignment was > 3° were considered deviations. The new PSI showed less mean absolute differences and lower rate of deviations than the conventional PSI in the coronal and axial planes (p = 0.045 and p = 0.004, respectively). The deviations (> 3°) of the tibial prosthesis using the conventional PSI were 27, 30, and 63% and of those using the new PSI were 0, 20, and 20% in the coronal, sagittal, and axial planes, respectively. This is the first report to evaluate the effect of improvement in PSI design on the postoperative Alignment using 3D method, and it clearly showed that the modification significantly improved the accuracy of Alignment and reduced the deviations. Therapeutic study, case–control study, Level III.
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An accelerometer-based portable navigation system improved Prosthetic Alignment after total knee arthroplasty in 3D measurements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:PurposeThis study aimed to compare Prosthetic Alignment using three-dimensional (3D) measurements following total knee arthroplasty (TKA) performed using an accelerometer-based portable navigation system (KneeAlign2) versus the conventional technique.MethodsA total of 159 patients who had primary osteoarthritis of the knee with varus deformity underwent TKA. The KneeAlign2 system was used for distal femoral resection and tibial resection in 78 knees, and the conventional instrumentation (intramedullary for the femur and extramedullary for the tibia) was used in 81 knees. 3D computed tomography (CT) scans of the whole leg were taken after TKA. Femoral and tibial Prosthetic Alignments in the coronal, sagittal, and axial planes were measured using computer software. The operation time and estimated blood loss were calculated. Deep venous thrombosis (DVT) and pulmonary embolism (PE) were evaluated using the contrast-enhanced multi-detector row CT at 1 week after TKA.ResultsIn the femoral coronal plane, the mean and standard deviation of Prosthetic Alignment from neutral Alignment were 1.2° [95% confidence interval (CI) 1.0°–1.4°) in the navigation group and 1.6° (95% CI 1.3°–2.0°) in the conventional group (p = 0.03). The femoral component outliers (> 3° away from the goal Alignment) using the navigation system and the conventional technique were 3 and 15%, respectively, in the coronal plane (p
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an accelerometer based portable navigation system improved Prosthetic Alignment after total knee arthroplasty in 3d measurements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:This study aimed to compare Prosthetic Alignment using three-dimensional (3D) measurements following total knee arthroplasty (TKA) performed using an accelerometer-based portable navigation system (KneeAlign2) versus the conventional technique. A total of 159 patients who had primary osteoarthritis of the knee with varus deformity underwent TKA. The KneeAlign2 system was used for distal femoral resection and tibial resection in 78 knees, and the conventional instrumentation (intramedullary for the femur and extramedullary for the tibia) was used in 81 knees. 3D computed tomography (CT) scans of the whole leg were taken after TKA. Femoral and tibial Prosthetic Alignments in the coronal, sagittal, and axial planes were measured using computer software. The operation time and estimated blood loss were calculated. Deep venous thrombosis (DVT) and pulmonary embolism (PE) were evaluated using the contrast-enhanced multi-detector row CT at 1 week after TKA. In the femoral coronal plane, the mean and standard deviation of Prosthetic Alignment from neutral Alignment were 1.2° [95% confidence interval (CI) 1.0°–1.4°) in the navigation group and 1.6° (95% CI 1.3°–2.0°) in the conventional group (p = 0.03). The femoral component outliers (> 3° away from the goal Alignment) using the navigation system and the conventional technique were 3 and 15%, respectively, in the coronal plane (p < 0.01), and 15 and 43%, respectively, in the sagittal plane (p < 0.01). The outliers in tibial coronal and tibial sagittal planes were not statistically different between the two groups. There were no statistically significant differences between the two groups in operation time, blood loss, DVT, and PE. Using an accelerometer-based portable navigation system decreased the outliers of Prosthetic Alignment in femoral coronal and sagittal planes, and did not increase the complications such as operation time, blood loss, DVT, and PE. To our knowledge, this study is the first to investigate the usefulness of an accelerometer-based portable navigation system using the validated 3D measurement. III.
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Two-dimensional measurement misidentifies Alignment outliers in total knee arthroplasty: a comparison of two- and three-dimensional measurements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:Purpose Two-dimensional (2D) and three-dimensional (3D) measurements of Prosthetic Alignment and “outliers” after total knee arthroplasty (TKA) might not necessarily be comparable. The aim of this study was to compare the use of 2D and 3D measurements in the identification of Prosthetic Alignment and outliers after TKA. Methods This cross-sectional study included 159 consecutive TKAs. All patients underwent plain radiography, fluoroscopy-guided radiography, and computed tomography after TKA. The same baseline was used for 2D and 3D measurements. The reliability of Prosthetic Alignment and outlier identification (> 3° from neutral Alignment) was compared between the 2D and 3D measurements. Results The mean Prosthetic Alignment and rate of outliers were not significantly different the between 2D and 3D measurements. The inter- and intra-observer reliabilities were higher for the 3D measurements than for the 2D measurements. The agreement between 2D and 3D measurements in outlier identification was poor, except for femoral coronal Alignment. Cohen’s κ coefficients were 0.19 in femoral sagittal (poor), 0.02 in tibial coronal (poor), and 0.10 in tibial sagittal (poor) on plain radiography. The values were 0.23 in tibial coronal (poor) and 0.002 in tibial sagittal (poor) on fluoroscopy-guided radiography. Conclusions The agreement between 2D and 3D measurements in the identification of outliers was poor, even on fluoroscopy-guided radiography. Since 2D measurements have an inherent risk of misidentifying Alignment outliers, this finding is clinically relevant. To properly analyze the correlation between outliers and clinical results, such as longevity, patient satisfaction, and patient-reported outcome, 3D measurements for Prosthetic Alignment are desirable. Level of evidence III.
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Two-dimensional measurement misidentifies Alignment outliers in total knee arthroplasty: a comparison of two- and three-dimensional measurements.
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2018Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:Purpose Two-dimensional (2D) and three-dimensional (3D) measurements of Prosthetic Alignment and “outliers” after total knee arthroplasty (TKA) might not necessarily be comparable. The aim of this study was to compare the use of 2D and 3D measurements in the identification of Prosthetic Alignment and outliers after TKA.
Shinichi Yoshiya - One of the best experts on this subject based on the ideXlab platform.
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ACCURACY OF COMBINED ANTEVERSION IN THE COMBINED ANTEVERSION TECHNIQUE WITH IMAGE-FREE NAVIGATED TOTAL HIP ARTHROPLASTY
2018Co-Authors: Shigeo Fukunishi, Yuki Fujihara, Yu Takeda, Shinichi YoshiyaAbstract:IntroductionIn recent literatures dealing with optimisation of Prosthetic Alignment in total hip arthroplasty (THA), the concept of combined anteversion (CA), sum of acetabular anteversion (AV) and femoral antetorsion (AT), has been addressed. We have been using an image-free THA navigation system?OrthoPilot THAPro?to achieve improved overall Alignment with both stem and cup. In the use of this system, we have used the stem-first procedure so-called CA technique. In this technique, the femur was prepared first with the target angle corresponding to the native femoral AT and the cup AV was decided considering CA calculated with the formula of Widmer (37.3°= cup AV + 0.7 stem AT). The purpose of this study was to evaluate the accuracy of CA by using CA technique with image-free navigated THA.MethodsFifty hips underwent primary THA using OrthoPilot THApro with CA technique. In CA technique, the femur was prepared first and the target angle of AT value was basically determined by for the individual native fem...
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ACCURACY OF COMBINED ANTEVERSION IN THE COMBINED ANTEVERSION TECHNIQUE WITH IMAGE-FREE NAVIGATED TOTAL HIP ARTHROPLASTY
Journal of Bone and Joint Surgery-british Volume, 2016Co-Authors: Shigeo Fukunishi, Yuki Fujihara, Yu Takeda, Shinichi YoshiyaAbstract:Introduction In recent literatures dealing with optimisation of Prosthetic Alignment in total hip arthroplasty (THA), the concept of combined anteversion (CA), sum of acetabular anteversion (AV) and femoral antetorsion (AT), has been addressed. We have been using an image-free THA navigation system?OrthoPilot THAPro?to achieve improved overall Alignment with both stem and cup. In the use of this system, we have used the stem-first procedure so-called CA technique. In this technique, the femur was prepared first with the target angle corresponding to the native femoral AT and the cup AV was decided considering CA calculated with the formula of Widmer (37.3°= cup AV + 0.7 stem AT). The purpose of this study was to evaluate the accuracy of CA by using CA technique with image-free navigated THA. Methods Fifty hips underwent primary THA using OrthoPilot THApro with CA technique. In CA technique, the femur was prepared first and the target angle of AT value was basically determined by for the individual native femoral AT angle. After the femur was prepared, the cup AV was decided based on the formula of Widmer. All included patients underwent postoperative CT examination, and the Prosthetic Alignment was assessed using the 3D-Template system (Zed Hip, LEXI). Results In the assessment of accuracy of the navigation systems in 50 consecutive THA9s, comparison of intraoperative navigation value and postoperative CT evaluation indicated that the absolute discrepancy of cup AV, and stem AT was 4.5° ± 3.5°and 5.9° ± 4.3° respectively. In the assessment of the cup AV with postoperative CT evaluation, the measured values averaged 20.7° ± 6.2° while AT values averaged 20.9° ± 10.6°. Distribution of AT values showed large SD. By contrast, the average Widmer9s CA values (cup AV + 0.7 stem AT) were 35.2° ± 5.7°. In the assessment of overall Alignment, the Widmer9s CA values were within 37° ± 5° in 40 hips and 37° ± 10° in 46 hips. Conclusion The present study proposed that the confirming stem AT prior to cup placement could be important to achieve appropriate CA value. CA technique with image-free navigated THA could achieve accurate and consistent control of CA value.
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Accuracy of combined anteversion in image-free navigated total hip arthroplasty: stem-first or cup-first technique?
International orthopaedics, 2015Co-Authors: Shigeo Fukunishi, Shoji Nishio, Yuki Fujihara, Shohei Okahisa, Yu Takeda, Tomokazu Fukui, Shinichi YoshiyaAbstract:Purpose In total hip arthroplasty (THA), combined anteversion (CA) is used as a parameter for assessment of overall Prosthetic Alignment. The purpose of this study was to comparatively examine the CA value in patients who underwent primary THA using the image-free navigation system either with a cup-first or stem-first technique.
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Combined anteversion of the total hip arthroplasty implanted with image-free cup navigation and without stem navigation.
Orthopedic reviews, 2012Co-Authors: Shigeo Fukunishi, Shoji Nishio, Yuki Fujihara, Shohei Okahisa, Tomokazu Fukui, Shinichi YoshiyaAbstract:In total hip arthroplasty (THA), combined anteversion (CA), the sum of cup anteversion (AV) and stem antetorsion (AT) are used as parameters to assess the appropriateness of overall Prosthetic Alignment. In this study, we evaluated the CA value based on the post-operative computed tomography (CT) measurements in our patient population who underwent THA using the OrthoPilot TM
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Prosthetic Alignment and sizing in computer-assisted total knee arthroplasty
International Orthopaedics, 2004Co-Authors: Tomoyuki Matsumoto, Nobuhiro Tsumura, Masahiro Kurosaka, Hirotsugu Muratsu, Ryosuke Kuroda, Katsuhiko Ishimoto, Kazuo Tsujimoto, Ryoichi Shiba, Shinichi YoshiyaAbstract:Nous avons implanté 60 prothèses totales postéro-stabilisées du genou (P.F.C. Sigma, DePuy). Dans 30 cas nous avons utilisé un système de navigation sans scanner (Vector vision R, Laboratoire du Cerveau, Heimstetten, Allemagne) et dans 30 contrôles appairés nous avons utilisé une implantation manuelle habituelle. Nous avons comparé les grandes radiographies postopératoires des membres inférieurs dans les deux groupes. Les résultats ont révélé une différence notable en faveur de la navigation. De plus nous avons comparé la dimension antéro-postérieure du condyle fémoral avant l’intervention avec la valeur postopératoire. Tandis qu’il n’y avait pas de différence notable dans la dimension antéro-postérieure préopératoire du condyle fémoral entre les deux groupes, la valeur postopératoire dans le groupe de la navigation était nettement plus grande que la valeur préopératoire. Par conséquent les chirurgiens qui utilisent des systèmes de navigation doivent prendre garde à ne pas implanter un composant fémoral sur-dimensionné. We implanted 60 posterior stabilized total knee prostheses (P.F.C. Sigma, DePuy, Warsaw, USA). In 30 cases, we used a CT-free navigation system (Vector Vision, Brain LAB, Heimstetten, Germany), and in 30 matched-paired controls, we used a conventional manual implantation. We compared postoperative long-leg radiographs in the two groups. The results revealed a significant difference in favor of navigation. In addition, we compared the preoperative anteroposterior dimension of the femoral condyle with the postoperative value. While there were no significant differences in the preoperative anteroposterior dimension of the femoral condyle between the two groups, the postoperative value in the navigation group was significantly larger than that of the preoperative value. Therefore, surgeons using navigation systems should guard against the possibility of oversizing when determining the size of the femoral component.
Inge H. F. Reininga - One of the best experts on this subject based on the ideXlab platform.
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THE INFLUENCE OF COMPUTER-ASSISTED TOTAL KNEE ARTHROPLASTY ON POST-OPERATIVE ROTATIONAL COMPONENT ORIENTATION: A QUALITATIVE AND SYSTEMATIC REVIEW
2018Co-Authors: Marrigje F. Meijer, Martin Stevens, Alexander L. Boerboom, Sjoerd K. Bulstra, Inge H. F. ReiningaAbstract:SummaryComputer assisted surgery (CAS) during total knee arthroplasty (TKA) is known to improve Prosthetic Alignment in coronal and sagittal plane. In this systematic review, no evidence is found t...
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INTER- AND INTRA-OBSERVER RELIABILITY OF A NEW LOW-DOSE STEREOGRAPHY SYSTEM FOR FOLLOW-UP AFTER REVISION TOTAL KNEE ARTHROPLASTY
2018Co-Authors: Marrigje F. Meijer, Martin Stevens, Alexander L. Boerboom, Sjoerd K. Bulstra, Inge H. F. ReiningaAbstract:SummaryThe EOS stereography system has been developed for the evaluation of Prosthetic Alignment. This new low-dose device provides reliable 2D/3D measurements of knee prosthesis Alignment.IntroductionAchieving optimal Prosthetic Alignment during Total Knee Arthroplasty (TKA) is an essential part of the surgical procedure since malpositioning can lead to early loosening of the prosthesis and eventually revision surgery. Conventional weight-bearing radiographs are part of the usual clinical follow-up after both primary TKA and revision TKA (rTKA), to assess Alignment in the coronal and sagittal planes. However, proportions and angles may not be correct on radiographs since divergence exists in the vertical and horizontal planes. Furthermore estimating the exact planes by looking at the position of the patella depends on rotation in the hip joint and this may be misinterpreted by the investigator. A computed tomography (CT) scanogram can also be used. However, due to high levels of radiation and costs it is...
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The Validity of a New Low-Dose Stereoradiography System to Perform 2D and 3D Knee Prosthetic Alignment Measurements
PloS one, 2016Co-Authors: Marrigje F. Meijer, Martin Stevens, Alexander L. Boerboom, Sjoerd K. Bulstra, Ton Velleman, Egbert Otten, Inge H. F. ReiningaAbstract:Introduction The EOS stereoradiography system has shown to provide reliable varus/valgus (VV) measurements of the lower limb in 2D (VV2D) and 3D (VV3D) after total knee arthroplasty (TKA). Validity of these measurements has not been investigated yet, therefore the purpose of this study was to determine validity of EOS VV2D and VV3D. Methods EOS images were made of a lower limb phantom containing a knee prosthesis, while varying VV angle from 15 degrees varus to 15 degrees valgus and flexion angle from 0 degrees to 20 degrees, and changing rotation from 20 degrees internal to 20 degrees external rotation. Differences between the actual VV position of the lower limb phantom and its position as measured on EOS 2D and 3D images were investigated. Results Rotation, flexion or VV angle alone had no major impact on VV2D or VV3D. Combination of VV angle and rotation with full extension did not show major differences in VV2D measurements either. Combination of flexion and rotation with a neutral VV angle showed variation of up to 7.4 degrees for VV2D; maximum variation for VV3D was only 1.5 degrees. A combination of the three variables showed an even greater distortion of VV2D, while VV3D stayed relatively constant. Maximum measurement difference between preset VV angle and VV2D was 9.8 degrees, while the difference with VV3D was only 1.9 degrees. The largest differences between the preset VV angle and VV2D were found when installing the leg in extreme angles, for example 15 degrees valgus, 20 degrees flexion and 20 degrees internal rotation. Conclusions After TKA, EOS VV3D were more valid than VV2D, indicating that 3D measurements compensate for malpositioning during acquisition. Caution is warranted when measuring VV angle on a conventional radiograph of a knee with a flexion contracture, varus or valgus angle and/or rotation of the knee joint during acquisition.
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INTER- AND INTRA-OBSERVER RELIABILITY OF A NEW LOW-DOSE STEREOGRAPHY SYSTEM FOR FOLLOW-UP AFTER REVISION TOTAL KNEE ARTHROPLASTY
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: Marrigje F. Meijer, Martin Stevens, Alexander L. Boerboom, Sjoerd K. Bulstra, Inge H. F. ReiningaAbstract:Summary The EOS stereography system has been developed for the evaluation of Prosthetic Alignment. This new low-dose device provides reliable 2D/3D measurements of knee prosthesis Alignment. Introduction Achieving optimal Prosthetic Alignment during Total Knee Arthroplasty (TKA) is an essential part of the surgical procedure since malpositioning can lead to early loosening of the prosthesis and eventually revision surgery. Conventional weight-bearing radiographs are part of the usual clinical follow-up after both primary TKA and revision TKA (rTKA), to assess Alignment in the coronal and sagittal planes. However, proportions and angles may not be correct on radiographs since divergence exists in the vertical and horizontal planes. Furthermore estimating the exact planes by looking at the position of the patella depends on rotation in the hip joint and this may be misinterpreted by the investigator. A computed tomography (CT) scanogram can also be used. However, due to high levels of radiation and costs it is not routinely used. To this end, a new device, the EOS stereography system, has been developed. With this biplanar low-dose X-ray technique, orthogonally made 2D images and 3D reconstructions can be obtained. Advantages of EOS are that images of the leg are obtained on a 1:1 scale with an amount of radiation 800–1000 times lower than CT-scans and 10 times lower than conventional radiographs. Another advantage is that the 3D reconstructions lead to determination of the real coronal and sagittal planes. However, the software for creating 3D reconstructions is developed for the lower limbs without knee prosthesis material. Consequently a reliability study concerning the generation of 2D images and 3D reconstructions of a leg containing a knee prosthesis has not been performed yet. Therefore objective of this study was to investigate interobserver and intraobserver reliability of knee Prosthetic Alignment measurements after rTKA using EOS. Patients and Methods Forty anteroposterior and lateral images of 37 rTKA patients were included. Two observers independently performed measurements on these images twice. Measured angles were varus/valgus angle in 2D (VV2D) and 3D (VV3D). Intraclass correlation coefficients (ICCs) were used to determine relative reliability and the Bland and Altman method was used to determine absolute reliability. T-tests were used to test potential differences between the two observers, first and second measurement sessions and 2D and 3D measurements. Results Relative interobserver reliability was excellent for both VV2D and VV3D with ICCs > 0.95, and no significant differences between the two observers. For the absolute reliability of VV2D, a bias of −0.16° (95%CI: −0.31–0.01) existed between both observers. Absolute reliability of VV3D was good. Relative intraobserver reliability was excellent for both VV2D and VV3D with ICCs > 0.97. No significant difference and no bias between the first and second measurements were found. A significant difference existed between the angles measured in 2D and 3D (p=0.01). Discussion / Conclusion The EOS low-dose stereography system provides reliable varus/valgus measurements in 2D and 3D for the Alignment of the knee joint with a knee prosthesis. However, significant differences exist between the varus/valgus measurements in 2D and in 3D. Therefore, a validation study is suggested to investigate the difference between the 2D measurements and 3D reconstructions and to find a possible explanation for this difference.
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Does Imageless Computer-assisted TKA Lead to Improved Rotational Alignment or Fewer Outliers? A Systematic Review
Clinical orthopaedics and related research, 2014Co-Authors: Marrigje F. Meijer, Alexander L. Boerboom, Sjoerd K. Bulstra, Inge H. F. Reininga, Martin StevensAbstract:Background Computer-assisted surgery (CAS) has been developed to enhance Prosthetic Alignment during primary TKAs. Imageless CAS improves coronal and sagittal Alignment compared with conventional TKA. However, the effect of imageless CAS on rotational Alignment remains unclear.
Hideki Ueyama - One of the best experts on this subject based on the ideXlab platform.
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Design improvement in patient-specific instrumentation for total knee arthroplasty improved the accuracy of the tibial Prosthetic Alignment in the coronal and axial planes.
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2019Co-Authors: Kazumasa Yamamura, Suguru Nakamura, Hideki Ueyama, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:The accuracy of patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) is still controversial, especially in the tibial prosthesis. It was hypothesized that the design modification of PSI improved the tibial Prosthetic Alignment and reduced the associated complications. The aim of this study was to compare the accuracy of a conventional PSI with that of a newly designed PSI for total knee arthroplasty (TKA) using a new three-dimensional (3D) measurement method. Thirty TKAs each using the conventional and newly designed PSIs were studied. The postoperative 3D-computed tomography (3D CT) image was superimposed on the preoperative 3D CT plan. The absolute differences in the tibial Prosthetic Alignment between the preoperative and postoperative 3D CT images were directly measured in the coronal, sagittal, and axial planes. Knees in which the difference in the Prosthetic Alignment was > 3° were considered deviations. The new PSI showed less mean absolute differences and lower rate of deviations than the conventional PSI in the coronal and axial planes (p = 0.045 and p = 0.004, respectively). The deviations (> 3°) of the tibial prosthesis using the conventional PSI were 27, 30, and 63% and of those using the new PSI were 0, 20, and 20% in the coronal, sagittal, and axial planes, respectively. This is the first report to evaluate the effect of improvement in PSI design on the postoperative Alignment using 3D method, and it clearly showed that the modification significantly improved the accuracy of Alignment and reduced the deviations. Therapeutic study, case–control study, Level III.
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An accelerometer-based portable navigation system improved Prosthetic Alignment after total knee arthroplasty in 3D measurements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:PurposeThis study aimed to compare Prosthetic Alignment using three-dimensional (3D) measurements following total knee arthroplasty (TKA) performed using an accelerometer-based portable navigation system (KneeAlign2) versus the conventional technique.MethodsA total of 159 patients who had primary osteoarthritis of the knee with varus deformity underwent TKA. The KneeAlign2 system was used for distal femoral resection and tibial resection in 78 knees, and the conventional instrumentation (intramedullary for the femur and extramedullary for the tibia) was used in 81 knees. 3D computed tomography (CT) scans of the whole leg were taken after TKA. Femoral and tibial Prosthetic Alignments in the coronal, sagittal, and axial planes were measured using computer software. The operation time and estimated blood loss were calculated. Deep venous thrombosis (DVT) and pulmonary embolism (PE) were evaluated using the contrast-enhanced multi-detector row CT at 1 week after TKA.ResultsIn the femoral coronal plane, the mean and standard deviation of Prosthetic Alignment from neutral Alignment were 1.2° [95% confidence interval (CI) 1.0°–1.4°) in the navigation group and 1.6° (95% CI 1.3°–2.0°) in the conventional group (p = 0.03). The femoral component outliers (> 3° away from the goal Alignment) using the navigation system and the conventional technique were 3 and 15%, respectively, in the coronal plane (p
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an accelerometer based portable navigation system improved Prosthetic Alignment after total knee arthroplasty in 3d measurements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:This study aimed to compare Prosthetic Alignment using three-dimensional (3D) measurements following total knee arthroplasty (TKA) performed using an accelerometer-based portable navigation system (KneeAlign2) versus the conventional technique. A total of 159 patients who had primary osteoarthritis of the knee with varus deformity underwent TKA. The KneeAlign2 system was used for distal femoral resection and tibial resection in 78 knees, and the conventional instrumentation (intramedullary for the femur and extramedullary for the tibia) was used in 81 knees. 3D computed tomography (CT) scans of the whole leg were taken after TKA. Femoral and tibial Prosthetic Alignments in the coronal, sagittal, and axial planes were measured using computer software. The operation time and estimated blood loss were calculated. Deep venous thrombosis (DVT) and pulmonary embolism (PE) were evaluated using the contrast-enhanced multi-detector row CT at 1 week after TKA. In the femoral coronal plane, the mean and standard deviation of Prosthetic Alignment from neutral Alignment were 1.2° [95% confidence interval (CI) 1.0°–1.4°) in the navigation group and 1.6° (95% CI 1.3°–2.0°) in the conventional group (p = 0.03). The femoral component outliers (> 3° away from the goal Alignment) using the navigation system and the conventional technique were 3 and 15%, respectively, in the coronal plane (p < 0.01), and 15 and 43%, respectively, in the sagittal plane (p < 0.01). The outliers in tibial coronal and tibial sagittal planes were not statistically different between the two groups. There were no statistically significant differences between the two groups in operation time, blood loss, DVT, and PE. Using an accelerometer-based portable navigation system decreased the outliers of Prosthetic Alignment in femoral coronal and sagittal planes, and did not increase the complications such as operation time, blood loss, DVT, and PE. To our knowledge, this study is the first to investigate the usefulness of an accelerometer-based portable navigation system using the validated 3D measurement. III.
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Two-dimensional measurement misidentifies Alignment outliers in total knee arthroplasty: a comparison of two- and three-dimensional measurements
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:Purpose Two-dimensional (2D) and three-dimensional (3D) measurements of Prosthetic Alignment and “outliers” after total knee arthroplasty (TKA) might not necessarily be comparable. The aim of this study was to compare the use of 2D and 3D measurements in the identification of Prosthetic Alignment and outliers after TKA. Methods This cross-sectional study included 159 consecutive TKAs. All patients underwent plain radiography, fluoroscopy-guided radiography, and computed tomography after TKA. The same baseline was used for 2D and 3D measurements. The reliability of Prosthetic Alignment and outlier identification (> 3° from neutral Alignment) was compared between the 2D and 3D measurements. Results The mean Prosthetic Alignment and rate of outliers were not significantly different the between 2D and 3D measurements. The inter- and intra-observer reliabilities were higher for the 3D measurements than for the 2D measurements. The agreement between 2D and 3D measurements in outlier identification was poor, except for femoral coronal Alignment. Cohen’s κ coefficients were 0.19 in femoral sagittal (poor), 0.02 in tibial coronal (poor), and 0.10 in tibial sagittal (poor) on plain radiography. The values were 0.23 in tibial coronal (poor) and 0.002 in tibial sagittal (poor) on fluoroscopy-guided radiography. Conclusions The agreement between 2D and 3D measurements in the identification of outliers was poor, even on fluoroscopy-guided radiography. Since 2D measurements have an inherent risk of misidentifying Alignment outliers, this finding is clinically relevant. To properly analyze the correlation between outliers and clinical results, such as longevity, patient satisfaction, and patient-reported outcome, 3D measurements for Prosthetic Alignment are desirable. Level of evidence III.
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Two-dimensional measurement misidentifies Alignment outliers in total knee arthroplasty: a comparison of two- and three-dimensional measurements.
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2018Co-Authors: Hideki Ueyama, Suguru Nakamura, Susumu Takemura, Kazumasa Yamamura, Yoichi Ohta, Ryo Sugama, Yukihide Minoda, Hiroaki NakamuraAbstract:Purpose Two-dimensional (2D) and three-dimensional (3D) measurements of Prosthetic Alignment and “outliers” after total knee arthroplasty (TKA) might not necessarily be comparable. The aim of this study was to compare the use of 2D and 3D measurements in the identification of Prosthetic Alignment and outliers after TKA.
