a-probing-device-for-quantitatively-measuring-mechanical-properties

A Probing Device for Quantitatively Measuring the Mechanical Properties of Soft Tissues during Arthroscopy

Probing in arthroscopic surgery is performed by pulling or pushing the soft tissue, which provides feedback for understanding the condition of the soft ...

Osaka Sangyo University

Preoperative femoral templating for total hip arthroplasty (THA) has been performed by antero-posterior radiographs of both hips which should be taken with the femur rotated internally to reduce the effect of femoral anteversion. However, there is no criterion to evaluate the optimal rotated radiograph. Here, we quantitatively investigated 50 femora whether the thickness of the lesser trochanter (TLT) was useful when evaluating the femoral rotation, and assessed the effect of prosthetic templating on the inappropriate rotated radiographs.

Preoperative templating of femoral components on plain X-rays. Rotational evaluation with synthetic X-rays on ORTHODOC.

The purpose of this study was to propose our CT-based planning approach for knee arthroplasty on the basis of the femoral flexion-extension (FE) axis, and to evaluate whether this approach was valid by comparing the results with those obtained using conventional anterior-referenced planning.

CT-based planning of a single-radius femoral component in total knee arthroplasty using the ROBODOC system.

The accuracy of a CT-based hip navigation might depend on surgical approaches, resulting in varying accuracy of implant alignment.

Comparison of navigation accuracy in THA between the mini-anterior and -posterior approaches.

A surgical guide made by the rapid prototyping (RP) technique for cup insertion in total hip arthroplasty might be useful to avoid malalignment of the cup, which indicates postoperative complications.

Tailor-made surgical guide based on rapid prototyping technique for cup insertion in total hip arthroplasty.

Malalignment of the cup in total hip arthroplasty (THA) increases the risks of postoperative complications such as neck cup impingement, dislocation, and wear. We asked whether a tailor-made surgical guide based on CT images would reduce the incidence of outliers beyond 10 degrees from preoperatively planned alignment of the cup compared with those without the surgical guide. We prospectively followed 38 patients (38 hips, Group 1) having primary THA with the conventional technique and 31 patients (31 hips, Group 2) using the surgical guide. We designed the guide for Group 2 based on CT images and fixed it to the acetabular edge with a Kirschner wire to indicate the planned cup direction. Postoperative CT images showed the guide reduced the number of outliers compared with the conventional method (Group 1, 23.7%; Group 2, 0%). The surgical guide provided more reliable cup insertion compared with conventional techniques.

Tailor-made Surgical Guide Reduces Incidence of Outliers of Cup Placement.

A Tensor/Balancer device has been recently developed in order to assess soft tissue balancing in total knee arthroplasty (TKA) under more physiological conditions. This device allows us to measure the joint gap with a trial femoral component in place with the patella reduced. The purpose of this study was to clarify whether the placement of the component changes the intraoperative gap difference (flexion gap distance minus extension gap distance). We prospectively investigated the extension (0°) and flexion (90°) gaps in 73 posterior-stabilized TKAs under 30 lb of joint distraction force. Then, we compared the gap difference with and without the trial femoral component in place. Our results showed that the intraoperative gap difference with the trial femoral component in place was larger than the intraoperative gap difference without the trial component (p=0.00003; with the trial component: mean 4.7 mm (standard deviation (SD): 3.0mm); without the trial component: mean 2.7 mm (SD: 3.3mm)). We consider that the change in gap difference with or without femoral component was caused by a relative difference in the elasticity and/or tightness of the soft tissue in extension versus flexion. Surgeons should be aware of this effect of the femoral component when considering intraoperative soft tissue balancing which leads to postoperative stability of the knee joint consequently.

The intraoperative gap difference (flexion gap minus extension gap) is altered by insertion of the trial femoral component.

The anterior impingement test is intended to detect anterosuperior acetabular labral lesions. In patients treated for labral lesions its sensitivity is reportedly 95% to 100%, and in a small group of patients undergoing periacetabular osteotomy, its sensitivity was 59% and specificity 100%. However, the sensitivity, specificity, positive predictive value, and negative predict value of this test to detect these labral lesions in unselected patients with hip pain are unknown.

Anterior impingement test for labral lesions has high positive predictive value.

Sagittal gap balancing (relation between flexion and extension gaps) with placement of trial femoral components and reduction of the patella in total knee arthroplasty (TKA) is important, but it is not easy. The purpose of this study was to investigate whether (1) the flexion and extension gaps were equal when a previously suggested three-dimensional planning for a single-radius femoral component (its sagittal centre is matched with flexion-extension axis of knee movement) is executed with patient-specific instrumentation (PSI) and whether (2) PSI was done with good accuracy, which did not affect the first purpose.

Sagittal gap balancing with the concept of a single radius femoral component in posterior cruciate sacrificing total knee arthroplasty with patient-specific instrumentation.

Hip arthroscopy techniques have continued to evolve for femoroacetabular impingement and other intra-articular pathologies. However, there is still debate about the importance and technique of routine capsular closure. We present an efficient and reliable technique for creating a watertight capsular closure to prevent iatrogenic macro and microinstability. This Technical Note details our stepwise technique using figure of eight sutures to obtain a complete and secure capsular closure.

Hip Arthroscopy Capsular Closure: The Figure of Eight Technique.

The aim of the present study was to assess the efficacy and safety of the oral administration of  extract (ADE) supplement to individuals with knee discomfort associated with physical activity. A randomized, double-blind, placebo-controlled study was conducted using 48 subjects. The subjects were randomly allocated to an ADE diet group (oral administration of ADE-containing diet, n=24) or a placebo group (n=24), and the intervention was conducted for 12 weeks. A total of 22 subjects in the placebo group and 22 subjects in the ADE diet group were assessed to be eligible for assessment of the efficacy of supplement. Knee function was assessed by changes in the scores of the Japanese Knee Osteoarthritis Measure (JKOM) questionnaire and the scores of the Japan Orthopedic Association (JOA) criteria, as well as by analyzing the levels of type II collagen synthesis and degradation biomarkers (procollagen II C-terminal propeptide, cross-linked C-telopeptide of type II collagen, collagen type II cleavage and matrix metalloproteinase-13). Outcomes were measured at the baseline and at 4, 8 and 12 weeks from the start of administration. Subscale II (joint flexion/stiffness) of the JOA criteria was markedly improved in the ADE diet group compared with the placebo group at 8 and 12 weeks during the intervention. Furthermore, in the subgroup analyses using subjects with mild knee discomfort, subscale II (pain/stiffness) and IV (general activities) scores of JKOM were significantly improved (P<0.05) and total JKOM score was markedly improved in the ADE diet group compared with the placebo group at week 8 of the intervention. No adverse effects were identified for the administration of ADE. In conclusion, these observations suggest that the administration of an ADE-containing diet is safe and improves joint function (flexion and stiffness) and general activity in subjects with mild knee discomfort. Therefore, ADE could be a promising candidate as a functional food that is beneficial to joint health.

Evaluation of the efficacy of  extract supplement in individuals with knee discomfort associated with physical activity: A randomized, double-blind, placebo-controlled study.

Probing to assess conditions of hip capsule and acetabular labrum is performed by "surgeons' feeling".

Article	Year
Preoperative templating of femoral components on plain X-rays. Rotational evaluation with synthetic X-rays on ORTHODOC. Archives of orthopaedic and trauma surgery\| PubMed ID: 17522880	2007
CT-based planning of a single-radius femoral component in total knee arthroplasty using the ROBODOC system. Computer aided surgery : official journal of the International Society for Computer Aided Surgery\| PubMed ID: 18240052	2008
Comparison of navigation accuracy in THA between the mini-anterior and -posterior approaches. The international journal of medical robotics + computer assisted surgery : MRCAS\| PubMed ID: 19107818	2009
Tailor-made surgical guide based on rapid prototyping technique for cup insertion in total hip arthroplasty. The international journal of medical robotics + computer assisted surgery : MRCAS\| PubMed ID: 19248055	2009
Tailor-made Surgical Guide Reduces Incidence of Outliers of Cup Placement. Clinical orthopaedics and related research\| PubMed ID: 19629605	2010
The intraoperative gap difference (flexion gap minus extension gap) is altered by insertion of the trial femoral component. The Knee\| PubMed ID: 21889347	2012
Anterior impingement test for labral lesions has high positive predictive value. Clinical orthopaedics and related research\| PubMed ID: 22767418	2012
Sagittal gap balancing with the concept of a single radius femoral component in posterior cruciate sacrificing total knee arthroplasty with patient-specific instrumentation. International orthopaedics\| PubMed ID: 25274129	2015
Hip Arthroscopy Capsular Closure: The Figure of Eight Technique. Arthroscopy techniques\| PubMed ID: 28580274	2017
Evaluation of the efficacy of extract supplement in individuals with knee discomfort associated with physical activity: A randomized, double-blind, placebo-controlled study. Experimental and therapeutic medicine\| PubMed ID: 29109757	2017
Quantitative evaluation of capsular and labral resistances in the hip joint using a probing device. Bio-medical materials and engineering\| PubMed ID: 31006659	2019

Takehito Hananouchi

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