Femoral prosthesis alignment of augmented reality-assisted versus accelerometer-based navigation in total knee arthroplasty: A noninferiority analysis

Tsukada, Sachiyuki; Kizaki, Kazuha; Saito, Masayoshi; Kurosaka, Kenji; Hirasawa, Naoyuki; Ogawa, Hiroyuki

doi:10.1016/j.jos.2023.10.011

Cited by 3 publications

(1 citation statement)

References 24 publications

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“…As technology progresses, we can anticipate the development of more efficient, interactive robotic systems that seamlessly integrate augmented reality (AR). Tsukada et al [ 79 ] conducted studies on the AR-KNEE navigation system, first in a pilot study using 10 femoral bone specimens to verify its accuracy, then in a clinical study on 74 patients to compare AR-TKA with a conventional intramedullary guide [ 80 ]. No preoperative CT scan was required, and real-time information was provided on a smartphone, allowing surgeons to visualize desired angles during surgery.…”

Section: Discussionmentioning

confidence: 99%

Robotic Total Knee Arthroplasty: An Update

Pipino,

Giai Via,

Ratano

et al. 2024

JPM

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Total knee arthroplasty (TKA) is a gold standard surgical procedure to improve pain and restore function in patients affected by moderate-to-severe severe gonarthrosis refractory to conservative treatments. Indeed, millions of these procedures are conducted yearly worldwide, with their number expected to increase in an ageing and more demanding population. Despite the progress that has been made in optimizing surgical techniques, prosthetic designs, and durability, up to 20% of patients are dissatisfied by the procedure or still report knee pain. From this perspective, the introduction of robotic TKA (R-TKA) in the late 1990s represented a valuable instrument in performing more accurate bone cuts and improving clinical outcomes. On the other hand, prolonged operative time, increased complications, and high costs of the devices slow down the diffusion of R-TKA. The advent of newer technological devices, including those using navigation systems, has made robotic surgery in the operatory room more common since the last decade. At present, many different robots are available, representing promising solutions to avoid persistent knee pain after TKA. We hereby describe their functionality, analyze potential benefits, and hint at future perspectives in this promising field.

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Section: Discussionmentioning

confidence: 99%

Robotic Total Knee Arthroplasty: An Update

Pipino,

Giai Via,

Ratano

et al. 2024

JPM

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Novel Surgical Technique for Total Knee Arthroplasty Integrating Kinematic Alignment and Real-Time Elongation of the Ligaments Using the NextAR System

Sabatini,

Ascani,

Vezza

et al. 2024

JPM

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This study introduces an innovative surgical approach for total knee arthroplasty (TKA) that combines kinematic alignment (KA) principles with real-time elongation of the knee ligaments through the range of motion, using augmented reality (AR). The novelty of the surgical technique lies in the possibility of enhancing the decision-making process to perform the cut on the tibia as for the KA caliper technique developed by Dr. Stephen Howell. The NextAR is a CT-based AR system that offers the possibility of performing three-dimensional surgical preoperative planning and an accurate execution in the surgical room through single-use infrared sensors, smart glasses, and a control unit. During the preoperative planning, the soft tissue is not considered and only the alignment based on bony reference is ensured. Thanks to the possibility of measuring in real time the elongation of the knee collateral lateral ligaments, the system assists the surgeon in optimizing the cut on the tibia after an accurate resurfacing of the femur as described in the KA surgical technique. The implant used in this novel approach is a medial pivot design (Medacta GMK Sphere) that allows the restoration of the physiological behavior of the software tissue and natural knee kinematics. In conclusion, this novel technique offers a promising approach to TKA, allowing personalized treatment tailored to each patient’s unique anatomy and soft tissue characteristics. The integration of KA and real-time soft tissue analysis provided by NextAR enhances surgical precision and outcomes, potentially improving patient satisfaction and functional results.

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Use of Mixed Reality Technologies by Orthopedic Surgery Residents: A Cross-Sectional Study of Trainee Perceptions

Gupta,

Walker,

Turnow

et al. 2024

Journal of Orthopaedic Experience &Amp; Innovation

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Introduction Recently within surgical education, the development of extended reality (XR) devices has become a topic of interest to improve trainees’ surgical technique outside of the operating room. There is a growing body of literature which supports the use of XR, and it is important to understand the perceptions of orthopedic surgery trainees on the use of XR as an adjunct during training. Purpose Understand the perceptions of orthopedic trainees on the use of XR as an adjunctive surgical training tool. Methods An internally validated 18-question survey was sent to all US orthopedic residency program coordinators with the intent for distribution to each program’s respective residents. Responses with ≥ 70% completion were considered complete. Results Overall, 33% and 18% of residents agreed XR is needed, and all programs should offer XR, respectively. There was overall agreement (67%) for XR’s ability to improve procedural confidence and improve skill progression (65% agreed). Only 25% of respondents felt XR could accurately simulate orthopedic procedures and 36% agreed it could effectively model patient-specific anatomy for preoperative planning. Regarding XR’s ability to reduce intraoperative navigational error, 45% of respondents agreed. However, responses were more neutral for XR’s ability to reduce inpatient length of stay (40%) and ability to improve the accuracy of hardware/prosthetic placement (31%). Finally, 53% of respondents agreed that the largest barrier to integration of XR is cost, while 35% felt that a lack of dedicated time to use the technology during their training program was a major barrier. Conclusion The need for adjunctive surgical training outside of the operating room is clearly demonstrated from our results. Although it is unclear if XR will become a standard tool across all residency programs, orthopedic surgery residents do feel that the technology is useful in terms of skills progression and operative confidence. Thus, this study provides a preliminary framework which suggests a potential role for XR in orthopedic surgery training and the need for further study to address barriers to widespread integration.

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Femoral prosthesis alignment of augmented reality-assisted versus accelerometer-based navigation in total knee arthroplasty: A noninferiority analysis

Cited by 3 publications

References 24 publications

Robotic Total Knee Arthroplasty: An Update

Robotic Total Knee Arthroplasty: An Update

Novel Surgical Technique for Total Knee Arthroplasty Integrating Kinematic Alignment and Real-Time Elongation of the Ligaments Using the NextAR System

Use of Mixed Reality Technologies by Orthopedic Surgery Residents: A Cross-Sectional Study of Trainee Perceptions

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