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- 저자 : ( Morteza Meftah ) (검색결과 3 건)
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The use of imageless navigation to quantify cutting error in total knee arthroplasty
( Ran Schwarzkopf ),( Morteza Meftah ),( Scott E. Marwin ),( Michelle A. Zabat ),( Jeffrey M. Muir ),( Iain R. Lamb ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-
Purpose: Navigated total knee arthroplasty (TKA) improves implant alignment by providing feedback on resection parameters based on femoral and tibial cutting guide positions. However, saw blade thickness, deflection, and cutting guide motion may lead to final bone cuts differing from planned resections, potentially contributing to suboptimal component alignment. We used an imageless navigation device to intraoperatively quantify the magnitude of error between planned and actual resections, hypothesizing final bone cuts will differ from planned alignment. Materials and methods: A retrospective study including 60 consecutive patients undergoing primary TKA using a novel imageless navigation device was conducted. Device measurements of resection parameters were obtained via attachment of optical trackers to femoral and tibial cutting guides prior to resection. Following resection, optical trackers were placed directly on the bone cut surface and measurements were recorded. Cutting guide and bone resection measurements of both femoral and tibial varus/valgus, femoral flexion, tibial slope angles, and both femoral and tibial medial and lateral resection depths were compared using a Student’s t-test. Results: Femoral cutting guide position differed from the actual cut by an average 0.6 ± 0.5° (p = 0.85) in the varus/ valgus angle and 1.0 ± 1.0° (p = 0.003) in the flexion/extension angle. The difference between planned and actual cut measurements for medial and lateral femoral resection depth was 1.1 ± 1.1 mm (p = 0.32) and 1.2 ± 1.0 mm (p = 0.067), respectively. Planned cut measurements based on tibial guide position differed from the actual cut by an average of 0.9 ± 0.8° (p = 0.63) in the varus/valgus angle and 1.1 ± 1.0° (p = 0.95) in slope angle. Measurement of medial and lateral tibial resection depth differed by an average of 0.1 ± 1.8 mm (p = 0.78) and 0.2 ± 2.1 mm (p = 0.85), respectively. Conclusions: Significant discrepancies between planned and actual femoral bone resection were demonstrated for flexion/extension angle, likely the result of cutting error. Our data highlights the importance of cut verification postresection to confirm planned resections are achieved, and suggests imageless navigation may be a source of feedback that would allow surgeons to intraoperatively adjust resections to achieve optimal implant alignment.
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Impact of time to revision total knee arthroplasty on outcomes following aseptic failure
( Mackenzie A. Roof ),( Shankar Narayanan ),( Nathan Lorentz ),( Vinay K. Aggarwal ),( Morteza Meftah ),( Ran Schwarzkopf ) 대한슬관절학회 2023 대한슬관절학회지 Vol.35 No.-
Introduction Prior studies have demonstrated an association between time to revision total knee arthroplasty (rTKA) and indication; however, the impact of early versus late revision on post-operative outcomes has not been reported. Materials and methods A retrospective, observational study examined patients who underwent unilateral, aseptic rTKA at an academic orthopedic hospital between 6/2011 and 4/2020 with > 1-year of follow-up. Patients were early revisions if they were revised within 2 years of primary TKA (pTKA) or late revisions if revised after greater than 2 years. Patient demographics, surgical factors, and post-operative outcomes were compared. Results 470 rTKA were included (199 early, 271 late). Early rTKA patients were younger by 2.5 years (p = 0.002). The predominant indications for early rTKA were instability (28.6%) and arthrofibrosis/stiffness (26.6%), and the predominant indications for late rTKA were aseptic loosening (45.8%) and instability (26.2%; p < 0.001). Late rTKA had longer operative times (119.20 ± 51.94 vs. 103.93 ± 44.66 min; p < 0.001). There were no differences in rTKA type, disposition, hospital length of stay, all-cause 90-day emergency department visits and readmissions, reoperations, and number of re-revisions. Conclusions Aseptic rTKA performed before 2 years had different indications but demonstrated similar outcomes to those performed later. Early revisions had shorter surgical times, which could be attributed to differences in rTKA indication. Level of evidence III, retrospective observational analysis.
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Comparing Outcomes of Bicruciate-Stabilized and Cruciate-Retaining Total Knee Arthroplasty
Lorena Hernandez,Ittai Shichman,Thomas H. Christensen,Joshua C. Rozell,Morteza Meftah,Ran Schwarzkopf 대한정형외과학회 2024 Clinics in Orthopedic Surgery Vol.16 No.1
Background: Bicruciate-stabilized (BCS) total knee arthroplasty (TKA) aims to restore normal kinematics by replicating the function of both cruciate ligaments. Conventional cruciate-retaining (CR) design in TKA has shown previous clinical success with lower complication rates. This study compared the patient-reported outcomes between the BCS and CR TKA designs. Methods: This retrospective study examined patients who underwent primary TKA using a CR or a BCS implant. Patient demographics, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), and Forgotten Joint Score (FJS) were compared between two cohorts. Patient-reported outcome measures were analyzed using independent samples t -tests. Results: There were no significant preoperative demographic differences between groups. The CR cohort (n = 756) had significantly higher average KOOS, JR Scores compared to the BCS cohort (n = 652) at 3 months (59.7 ± 3.8 vs. 53.0 ± 3.9, p < 0.001) and 2 years (62.6 ± 8.0 vs. 53.8 ± 6.7, p = 0.001) after TKA. Within the cohort, KOOS, JR delta differences were not significant for CR when comparing patient scores 3 months to 1 year after surgery. Meanwhile, the BCS patients did show significant delta improvement (4.1 ± 1.9, p = 0.030) when compared 3 months to 1 year after surgery. One year postoperatively, the BCS cohort (n = 134) showed a significantly higher average FJS score (49.5 ± 31.4, vs. 36.8 ± 28.5, p = 0.028) than the CR cohort (n = 203). Both cohorts displayed a significant difference in delta improvements within their respective cohort when measuring FJS from 3 months to 1 year, 2 years, and 3 years after surgery. Conclusions: The CR cohort performed better on average, compared to the BCS cohort in measures of KOOS, JR scores at the 2-year follow-up. The BCS cohort performed marginally better regarding FJS only at 1-year follow-up.
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