Navigation v Conventional Techniques for Orthopaedic Surgery

soaring v effected Techniques for Orthopaedic SurgeryBone Cutting, Soft weave Balancing Cup Implant, Leg Length Discrepancy navigation vs. Conventional proficiency.IntroductionIn last decade, navigated introduceation has become very common and utilize in diverse areas of orthopedic surgeries. This may be in total knee prosthesis, total pelvic arch arthroplasty and to restore tholepin discrepancies. from each one(prenominal) above surgeries require an accurate alignment of the engraft, which is essential for implants long bourn survival. This is evident from the fact that in total knee permutation (TKR) surgeries decent osmium diagonalting is necessary 1, total knee arthroplasty (TKA) requires correct sonant thread balancing 2, appropriate implantation of instill and stem in total rose hip arthroplasty (THA) 3, correcting forking discrepancies in total hip replacement (THR) 4. Navigation system developed improves the reproducibility over accomplished methods a nd assists surgeons with info for optimal position of implant to each individual diligent. 2, 3It was hypothesized that seafaring aided technique would result in achieving bone cut accuracy, weaken touchy tissue balancing, good implant of cup and stem and deepen vocalize reconstruction and control in tholepin duration dissimilarity as compared to convention solelyy used methods.MethodsTo show place sentence and bone cut accuracy in total knee replacement (TKR).Study come to 40 patients (23 females, 17 males) assigned randomly to TKR mental process victimisation twain stately (n=20, mean patient age= 67.3 years) or Pivotal (n=20 mean patient age= 69.1 years) pillowcase stymies. Primary indication for working(a) treatment was osteoarthritis (n=36), rheumatoid arthritis (n=3) and secondary smudgetraumatic gonarthrosis after tibial plateau fracture (n=1). solely cases had posterior stabilized system with standard patellar component. The surgical approach used was mesial parapatellar (n=8) or midvastus (n=32) approach. The implants used during the adjoin were Scorpio PS (n=7), Scorpio Flex (n=20), Next Gen LPS (n=10) and LPS Flex Mobile bearing systems (n=4) rigid to bones by pins and screws. Accurate positioning was obtained by using gliding system. Block position was finalized by surgeon using this navigation system. statistical resistences in time and cut angles were measured by Mann-Whitney stress ( 2-tailed SPSS for Windows, mutant 11.5). The significance level was set at p 0.05 for all in all analyses. 1To test downy tissue balancing in total knee arthroplasty (TKA).The discipline included 120 patients navigation assisted possible action-balancing (n=60) conventional resection technique (n=60), enrolled and randomise using reckoner-generated numbers. An inclusion criterion was substantial pain and loss of function imputable to osteoarthritis of knee, with any stage of knee varum deformity. An exclusion criterion was genu valgum deformity, earlier knee surgery that required removal of metallic implant, or revision of TKA. Four patients were lost to obey up and at that placefore excluded from study. All surgeries were done by single surgeon. Both patient pigeonholingings showed no earthshaking leavings in terms of demographic characteristics, knee functions, preoperative hospital-for-special-surgery (HSS) scores and degree of preoperative deformity. Follow up period was stripped-down 24 months post-surgery (mean come through up = 28 months). Surgical technique was similar in all patients consisting of midline skin incision and a average parapatellar approach. Gap meter was done at full extension and at 90 of crease on medial and asquint pass sides of knee pronounce and defined as medial extension pause (MEG), medial plication gap (MFG), lateral extension gap (LEG), and lateral fold gap (LFG).Clinical expiry sagacity was measured by HSS and ranges of doubtfulness (ROM) scores at lat est follow up. All patients went through pre and post-operative (3months after surgery) standing skiagraphic assessment of AP and lateral views of entire lower outgrowth. Students t-test or MannWhitney U tests was used for comparison of four variables in study, postoperative post-operative windup(prenominal) axes, HSS scores, and ROMs, between the twain groups. The chi-square test was used for comparison of proportion of outliers (trapezoidal gaps) in symmetric gap and mechanical axis. 2To Test good implant of cup and stem in Total articulatio coxae Arthroplasty (THA)The study mired 84 patients in twain groups Navigated (42) Nonnavigated (42), with surgeries accomplished by investigator. Implant position was evaluated in post-operative anteroposterior radiography 2-3months after ability surgery. Pelvic radiographs were taken in standing position of patient. Operated hip joints categorize on basis of preoperative radiographs in three subgroups Group 1 preoperative leg impr ovidentening (5 mm) Group 2 preoperative leg distance compeerity (5 mm) Group 3 preoperative perpetuation of the operated leg (5 mm). Projected values for caput collum diaphysis (CCD) classified in three subgroups 135. If any change in leg length was measured using distal line between teardrop material body and proximal corner of the littleer trochanter as an anatomical landmark. Scaling of pre and post-operative radiographs was remoteness between deuce teardrops and the head diameter of the hip replacement. Radiographic cup positions were measured for inclination with watch over to teardrop line. All surgeries were done when patient was in 30 to 45 position. Any complication aroused during intraoperative and post operation was documented. General data (CCD angle, age, BMI) for both groups were compared as per Mann-Whitney U test for nonparametric values and chi-square test for distribution of operated leg, gender and indication. 3To Test enhanced joint reconstruction and co ntrol in leg length deviationRetrospective study involved 44 patients divided in two groups A (n=22 navigation/computer assisted THR) B (n=22 conventional assuage hand THR). Inclusion criteria involved patients with BMI 2 cm), or a major deformity of the femoral head or make love were excluded from study. Each patient in group A was matched in group B. This matching was done on basis of age (max remnant +3 years), sex, arthritis level, preoperative diagnosis, and preoperative branch length discrepancy (max difference. + 0.3 cm). The length of involved limbs was less than or equal to that of the contralateral limb in all cases. The two groups were also compared according to hip function and number of postoperative dislocations. The same posterolateral approach was made to the hip joint in both groups, and the same prosthesis was used in all cases. The duration of surgery was documented. Digital radiographs (as per standardised protocol using same magnification) were used for pre and post-operative measurements of limb length discrepancy and femoral offset. Radiographs were repeated if any mistake detected and these radiographs were assessed by independent radiologist blinded to original procedure. All episodes of hip dislocation were documented. At minimum follow-up of 3 months clinical outcome was evaluated using Harris articulatio coxae score. statistical analysis was carried out using SPSS for Windows wipe out 11.0. Differences between two groups were measured using independent Students t-test or Mann-Whitney nonparametric test depending on the data distribution of the continuous variables. 4ResultsPivotal block consumed approximately half the time to adjust saw blade and perform proximal tibial and anterior and femoral resections as compared to conventional block. statistically significant difference was observed in Pivotal and conventional blocks with respect to angular difference between instrument slots and resultant bone cuts in frontal plane. Also, Pivotal blocks eliminated angular differences 1. 1The mean intraoperative gap in conventional resection technique group for MFG (medial flexion gap) was significantly greater (24 3 mm) than navigation assisted (NA) gap-balancing (22 3 mm) (p = 0.028), but other three gaps (LFG, MEG, and LEG) did not differ significantly between the two groups (p = 0.167, 0.693, and 0.471, respectively). Statistical significant difference was seen in terms of kind of gaps in both groups NA group, 88% (53 knees) - angular gaps and 12% (7knees)-trapezoidal gaps. Whereas in conventional group 75% (42 knees) -rectangular gaps and 25% (14knees) had trapezoidal gaps. great difference in medial gap difference (MGD MFG-MEG) outliers in conventional group (23%) than NA group (5%) (p = 0.025). No difference was noticed in average postoperative mechanical axis of lower limb between NA and conventional group (1 2 vs. 1 3 p=0.558). Greater number of outliers were seen in mechanical axis (183 or Statis tical difference was noted in patients age at time THA, with p value slightly below 0.05. evidentiary difference was seen during radiologic analysis of cup position Non-navigated 53, SD 8.1 Navigated 44, SD 5.6, p135. No implant related or navigation technology related complications and no joint dislocations in both groups were noted. 3There was no statistically significant difference in patient demographics. In both groups preoperative limb length discrepancy, no significant differences were noted. (0.9 cm navigation/computer assisted THR vs. 1.1cm free hand/conventional THR). Mean surgical time was 102.6 min, comparatively longitudinal in navigation/computer assisted THR than free hand/conventional THR (87.7 min) Statistically significant difference was seen in mean postoperative leg length discrepancy of 0.4 cm in navigation/computer assisted THR to that of 0.8 cm (free hand/conventional THR). There were no cases of postoperative cases with leg length discrepancy 1.0 cm 2.0 c m for navigation/computer assisted THR. However, in 9% cases (2patients) postoperative cases with leg length discrepancy 1.0 cm was noted and 3patients (13.6%) had postoperative over lengthening mean of 0.4 cm in Free hand/conventional THR group. Recreation of femoral offset check in navigation/computer assisted THR than free hand/conventional THR group. Preoperative and postoperative femoral offset difference less in navigation/computer assisted THR than free hand/conventional THR, which was statistically significant. No statistically significant differences in Harris informed Score in both groups. 4DiscussionThe comparison of patient groups in navigated and non-navigated techniques may be a possible method for obtaining useful tuition regarding various orthopaedic surgeries. In our studies long term survival of prosthesis can be improved by accurate positioning of implant. This can save time and improve accuracy of the procedure.Klima, 2008 showed pivotal blocks used during su rgery improved bone cuts and reduced time for positioning and adjustment by nearly 50%. In addition, navigation technique used allowed initial positioning to be achieved in 5-10 seconds. Also, navigation system indicated that all patients were within 3 in frontal plane angular bone cut deviations of ideal mechanical axis. Conventional blocks used were found to be associated with some degree of motion during insertion of pins, but this was not the case with pivotal blocks. 1Lee. et al, 2010 showed, soft tissue balance can be achieved by having equal extension and flexion gaps after bone cutting and no inclination between medial and lateral bony surfaces. Any error in bone cutting can affect overall postoperative mechanical alignment and quicken of wear process. In study it was found that use of navigation head gap balancing technique improved in creating accuracy of rectangular space between bones as compared to conventional measured resection technique. tho 12% (7 of 60 patients) in navigation TKAs had outliers of 3mm either medially or laterally in extension gap or 90 flexion were seen as compared to conventional TKAs (25%) 14 of 56 patients. As compared to earlier studies, this study had outliers of the medial and lateral compartments together. There was no significant gap differences (FGD, EGD, and LGD) in both navigation assisted and conventional groups, in spite of that navigation steer technique proved to be more reliable in attaining equal joint gaps as there were small proportion of outliers in that group. Significant difference was seen in medial gap difference (MGD) in two groups. There were limited outliers in MGD observed and moreover navigation technique can be easily reproduced as compared to conventional technique, so this prevents inessential any over release of medial soft tissue during TKA. In addition, navigation system helped surgeon in correcting any kind of deformed alignment. Clinical outcomes were similar to both groups even though navigation group showed more accurate gap balancing than conventional group. This can be attributed to the fact that relatively small amount of asymmetry in soft tissue balancing in conventional group. Also, both groups had relatively short term follow up and inaccurate scoring system. The study had some(prenominal)(prenominal) limitations during gap measurement patella was in laterally everted position, which is not anatomically correct. Ligament balancing was not taken in consideration. Gap measurements was done by surgeon who performed operation in the study, this may have led to bias. 2In a study by Mainard, 2008 showed that comparing navigated and non-navigated techniques can lead to information about benefits and any improvement required for position of implant. In this study, there was a clear and significant improvement of acetabular cup positioning by use of THA navigation. In both methods average total limb lengthening of operated joint was below 10mm (9.2 mm Non-navigat ed, 8.5 mm Navigated ), i.e. below clinical relevance value and comparable to other studies (mean lengthening 7mm). Mean post-operative limb discrepancy is close to 5 mm (6.2mm Non-Navigated 4.4mm Navigated) comparable to 3.9 mm in other study with patient pool of 420. This study however had several limitations retrospective in nature Measurements of implant position are less accurate than CT based measurements Radiologic and ante-version taken in standing positions with anteroposterior radiographs (not to fall out deviation of 5 mm compared with CT) Limb length data of un-operated hip joint is small (+ 1.3 mm- navigated -1.3mm nonnavigated) Cup position measurements unimproved as patients radiograph is not in standing position No change in leg lengthening data using navigated or non-navigated technique. 3In a study by Confalonieri, et al, 2008 showed that to resurface hip arthroplasty short stem prostheses is an showy alternative option with same selected indications. In this s tudy 22 patients in each group were match paired using same modular short stemmed femoral component. Strict criteria were adhered to achieve the match. At minimum follow up of 3 months after surgical intervention results showed computer navigation provided better results in correction of limb length discrepancy and restoring original offset. However, there were few limitations associated with the study Retrospective patients were not randomized short follow up small number of cases in each group (hence, no clinical difference detected and findings for improvement in dislocation risk). 4ConclusionFrom above studies it can be concluded that assumption correct indications navigation guided technique is a minimally encroaching(a) surgical option and is significantly better than conventionally used technique in orthopaedic surgeries which proves our original hypothesis. Though it might take a little longer time but can give better and improved results in bone cutting, soft tissue balan cing, acetabular implant and correction of limb length discrepancy and restoring original offset depending on patient anatomy. Further research in this area is still directed.ReferencesKlima S, Zeh A, Josten C Comparison of operative time and accuracy using conventional dictated navigation cutting blocks and adjustable Pivotal TM cutting blocks calculator Aided Surgery, July 2008 13(4) 225232.Lee DH Park JH Song DI Padhy D Jeong WK Han SB accuracy of soft tissue balancing in TKA comparison between navigation-assisted gap balancing and conventional measured resection Knee Surg Sports Traumatol Arthrosc (2010) 18381387.Mainard D, Navigated and Nonnavigated Total Hip Arthroplasty Results of Two Consecutive Series Using a Cementless Straight Hip Stem Orthopedics Oct 2008 31 (10) 22-26.Confalonieri N Manzotti A Montironi F Pullen C Leg Length Discrepancy, Dislocation Rate, and Offset in Total Hip Replacement Using a Short Modular Stem Navigation vs Conventional Free-hand Orthopedics O ct 2008 31 (10) 35-39.1