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Smart Sensors Applications in Total Joint Arthroplasty

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A special issue of Sensors (ISSN 1424-8220). This special issue belongs to the section "Biosensors".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 18655

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Special Issue Editors

Dr. Pier Francesco Indelli

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Guest Editor

Orthopaedics and Traumatology, School of Medicine, Stanford University, Stanford, CA, USA
Interests: Total Knee Arthroplasty, Periprosthetic Joint Infections, Gait analysis
Special Issues, Collections and Topics in MDPI journals

Dr. Stefano Bini MD

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Guest Editor

University California San Francisco (UCSF), USA
Interests: Adult Reconstruction

Dr. Luigi Sabatini M.D.

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Co-Guest Editor

Department of Orthopaedics and Traumatology University of Turin, Città della Salute e della Scienza - C.T.O. Hospital via Zuretti 29, 10126 Torino Italy
Interests: Knee Surgery

Special Issue Information

Dear Colleagues,

Instability following total joint arthroplasty (TJA) has been reported as a major cause for early or delayed revision. Balancing the joint remains an inexact art with no standardized protocol to optimize soft-tissue tension. To address this problem and to make ligament balancing less operator dependent, several advances in technology have been proposed over the past decades. Among the most used are computer-assisted surgery (CAS), patient specific instrumentation (PSI), robotics and intra-operative sensors, which represent very appealing instruments.

Recently, sensor technology was proposed to quantify intraoperative joint reactive loads, determine components alignment, evaluate intra-operative kinematic and check soft-tissue balance during total joint arthroplasty trial reduction and final implant positioning. This special issue of Sensors will host few world experts describing their experience with the use of different sensing technologies during knee, hip and shoulder total joint surgery. This special issue will represent a state of the art textbook for orthopaedic surgeons willing to include the use of sensor technologies in their adult reconstruction daily practice.

The topic of this Special Issue, “Smart Sensors Applications in Total Joint Arthroplasty” fits very well with the scope of Sensors. This topic will include Remote Sensors, Smart Sensors, Sensor Devices, Sensor Technology and Application, Human-Computer Interaction, all in the scope of this journal.

Prof. Pier Francesco Indelli
Dr. Stefano Bini
Dr. Luigi Sabatini
Guest Editors

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Keywords

total joint arthroplasty
sensor
ligament balance
total knee arthroplasty
total hip arthroplasty
total shoulder arthroplasty
outcomes
smart tibial trials
instability
knee

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Published Papers (6 papers)

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12 pages, 2913 KiB

Open AccessArticle

Kinetic Sensors for Ligament Balance and Kinematic Evaluation in Anatomic Bi-Cruciate Stabilized Total Knee Arthroplasty

by Luigi Sabatini, Francesco Bosco, Luca Barberis, Daniele Camazzola, Alessandro Bistolfi, Salvatore Risitano, Alessandro Massè and Pier Francesco Indelli

Sensors 2021, 21(16), 5427; https://doi.org/10.3390/s21165427 - 11 Aug 2021

Cited by 17 | Viewed by 2967

Abstract

Sensor technology was introduced to intraoperatively analyse the differential pressure between the medial and lateral compartments of the knee during primary TKA using a sensor to assess if further balancing procedures are needed to achieve a “balanced” knee. The prognostic role of epidemiological and radiological parameters was also analysed. A consecutive series of 21 patients with primary knee osteoarthritis were enrolled and programmed for TKA in our unit between 1 September 2020 and 31 March 2021. The VERASENSE Knee System (OrthoSensor Inc., Dania Beach, FL, USA) has been proposed as an instrument that quantifies the differential pressure between the compartments of the knee intraoperatively throughout the full range of motion during primary TKA, designed with a J-curve anatomical femoral design and a PS “medially congruent” polyethylene insert. Thirteen patients (61.90%) showed a “balanced” knee, and eight patients (38.10%) showed an intra-operative “unbalanced” knee and required additional procedures. A total of 13 additional balancing procedures were performed. At the end of surgical knee procedures, a quantitatively balanced knee was obtained in all patients. In addition, a correlation was found between the compartment pressure of phase I and phase II at 10° of flexion and higher absolute pressures were found in the medial compartment than in the lateral compartment in each ROM degree investigated. Moreover, those pressure values showed a trend to decrease with the increase in flexion degrees in both compartments. The “Kinetic Tracking” function displays the knee’s dynamic motion through the full ROM to evaluate joint kinetics. The obtained kinetic traces reproduced the knee’s medial pivot and femoral rollback, mimicking natural knee biomechanics. Moreover, we reported a statistically significant correlation between the need for soft tissue or bone resection rebalancing and severity of the initial coronal deformity (>10°) and a preoperative JLCA value >2°. The use of quantitative sensor-guided pressure evaluation during TKA leads to a more reproducible “balanced” knee. The surgeon, evaluating radiological parameters before surgery, may anticipate difficulties in knee balance and require those devices to achieve the desired result objectively. Full article

(This article belongs to the Special Issue Smart Sensors Applications in Total Joint Arthroplasty)

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10 pages, 1386 KiB

Open AccessCommunication

Can Intraoperative Intra-Articular Loads Predict Postoperative Knee Joint Laxity Following Total Knee Arthroplasty? A Cadaver Study with Smart Tibial Trays

by Darshan S. Shah, Orçun Taylan, Matthias Verstraete, Pieter Berger, Hilde Vandenneucker and Lennart Scheys

Sensors 2021, 21(15), 5078; https://doi.org/10.3390/s21155078 - 27 Jul 2021

Cited by 5 | Viewed by 2223

Abstract

Ligament balancing during total knee arthroplasty (TKA) often relies on subjective surgeon experience. Although instrumented tibial trays facilitate an objective assessment of intraoperative joint balance through quantification of intra-articular joint loads, postoperative clinical assessment of joint balance relies on passive stress tests quantifying varus–valgus joint laxity. This study aimed at correlating the intraoperative and postoperative metrics used to assess joint balance while also comparing joint loads obtained during passive assessment and active functional motions. Four experienced surgical fellows were assigned a fresh-frozen lower limb each to plan and perform posterior-stabilised TKA. An instrumented tibial insert measured intraoperative intra-articular loads. Specimens were then subjected to passive flexion–extension, open-chain extension, active squatting, and varus–valgus laxity tests on a validated knee simulator. Intra-articular loads were recorded using the instrumented insert and tibiofemoral kinematics using an optical motion capture system. A negative correlation was observed between mean intraoperative intra-articular loads and corresponding mean postoperative tibial abduction angle during laxity tests (medial: R = −0.93, p = 0.02; lateral: R = −0.88, p = 0.04); however, this was not observed for each specimen. Peak intra-articular load distribution for active squatting was lateral-heavy, contrasting to the medial-heavy distribution observed in passive intraoperative measurements, for all specimens. These aspects should be given due consideration while assessing intraoperative and postoperative joint stability following TKA. Full article

(This article belongs to the Special Issue Smart Sensors Applications in Total Joint Arthroplasty)

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13 pages, 4681 KiB

Open AccessArticle

The Accuracy of Patient-Specific Instrumentation with Laser Guidance in a Dynamic Total Hip Arthroplasty: A Radiological Evaluation

by Andrea Ferretti, Ferdinando Iannotti, Lorenzo Proietti, Carlo Massafra, Attilio Speranza, Andrea Laghi and Raffaele Iorio

Sensors 2021, 21(12), 4232; https://doi.org/10.3390/s21124232 - 20 Jun 2021

Cited by 10 | Viewed by 3289

Abstract

The functional positioning of components in a total hip arthroplasty (THA) and its relationship with individual lumbopelvic kinematics and a patient’s anatomy are being extensively studied. Patient-specific kinematic planning could be a game-changer; however, it should be accurately delivered intraoperatively. The main purpose of this study was to verify the reliability and accuracy of a patient-specific instrumentation (PSI) and laser-guided technique to replicate preoperative dynamic planning. Thirty-six patients were prospectively enrolled and received dynamic hip preoperative planning based on three functional lateral spinopelvic X-rays and a low dose CT scan. Three-dimensional (3D) printed PSI guides and laser-guided instrumentation were used intraoperatively. The orientation of the components, osteotomy level and change in hip length and offset were measured on postoperative CT scans and compared with the planned preoperative values. The length of surgery was compared with that of a matched group of thirty-six patients who underwent a conventional THA. The mean absolute deviation from the planned inclination and anteversion was 3.9° and 4.4°, respectively. In 92% of cases, both the inclination and anteversion were within +/− 10° of the planned values. Regarding the osteotomy level, offset change and limb length change, the mean deviation was, respectively, 1.6 mm, 2.6 mm and 2 mm. No statistically significant difference was detected when comparing the planned values with the achieved values. The mean surgical time was 71.4 min in the PSI group and 60.4 min in the conventional THA group (p < 0.05). Patient-specific and laser-guided instrumentation is safe and accurately reproduces dynamic planning in terms of the orientation of the components, osteotomy level, leg length and offset. Moreover, the increase in surgical time is negligible. Full article

(This article belongs to the Special Issue Smart Sensors Applications in Total Joint Arthroplasty)

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14 pages, 3459 KiB

Open AccessArticle

Validated Ultrasound Speckle Tracking Method for Measuring Strains of Knee Collateral Ligaments In-Situ during Varus/Valgus Loading

by Félix Dandois, Orçun Taylan, Johan Bellemans, Jan D’hooge, Hilde Vandenneucker, Laura Slane and Lennart Scheys

Sensors 2021, 21(5), 1895; https://doi.org/10.3390/s21051895 - 8 Mar 2021

Cited by 9 | Viewed by 2485

Abstract

Current ultrasound techniques face several challenges to measure strains when translated from large tendon to in-situ knee collateral ligament applications, despite the potential to reduce knee arthroplasty failures attributed to ligament imbalance. Therefore, we developed, optimized and validated an ultrasound speckle tracking method to assess the in-situ strains of the medial and lateral collateral ligaments. Nine cadaveric legs with total knee implants were submitted to varus/valgus loading and divided into two groups: “optimization” and “validation”. Reference strains were measured using digital image correlation technique, while ultrasound data were processed with a custom-built speckle tracking approach. Using specimens from the “optimization” group, several tracking parameters were tuned towards an optimized tracking performance. The parameters were ranked according to three comparative measures between the ultrasound-based and reference strains: R², mean absolute error and strains differences at 40 N. Specimens from the “validation” group, processed with the optimal parameters, showed good correlations, along with small mean absolute differences, with correlation values above 0.99 and 0.89 and differences below 0.57% and 0.27% for the lateral and medial collateral ligaments, respectively. This study showed that ultrasound speckle tracking could assess knee collateral ligaments strains in situ and has the potential to be translated to clinics for knee arthroplasty-related procedures. Full article

(This article belongs to the Special Issue Smart Sensors Applications in Total Joint Arthroplasty)

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13 pages, 2972 KiB

Open AccessArticle

Achieving a Balanced Knee in Robotic TKA

by Alexander C Gordon, Michael A Conditt and Matthias A Verstraete

Sensors 2021, 21(2), 535; https://doi.org/10.3390/s21020535 - 13 Jan 2021

Cited by 16 | Viewed by 3528

Abstract

Total knee arthroplasty (TKA) surgery with manual instruments provides a quantitatively balanced knee in approximately 50% of cases. This study examined the effect of combining robotics technology with real-time intra-operative sensor feedback on the number of quantitatively balanced cases in a consecutive series of 200 robotic-assisted primary TKAs. The robotics platform was used to plan the implant component position using correctable poses in extension and a manual, centrally pivoting the balancer in flexion, prior to committing to the femoral cuts. During the initial trialing, the quantitative state of balance was assessed using an instrumented tibial tray that measured the intra-articular loads in the medial and lateral compartments. These sensor readings informed a number of surgical corrections, including bone recuts, soft-tissue corrections, and cement adjustments. During initial trialing, a quantitatively balanced knee was achieved in only 65% of cases. After performing the relevant soft-tissue corrections, bone recuts, and cement adjustments, 87% of cases ended balanced through the range of motion. Meanwhile, this resulted in a wide range of coronal alignment conditions, ranging from 6° valgus to 9° varus. It is therefore concluded that gaps derived from robotics navigation are not indicative for a quantitatively balanced knee, which was only consistently achieved when combining the robotics platform with real-time feedback from intra-operative load sensors. Full article

(This article belongs to the Special Issue Smart Sensors Applications in Total Joint Arthroplasty)

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11 pages, 2870 KiB

Open AccessLetter

How to Quantitatively Balance a Total Knee? A Surgical Algorithm to Assure Balance and Control Alignment

by Ryan E. Moore, Michael A. Conditt, Martin W. Roche and Matthias A. Verstraete

Sensors 2021, 21(3), 700; https://doi.org/10.3390/s21030700 - 20 Jan 2021

Cited by 9 | Viewed by 2744

Abstract

To achieve a balanced total knee, various surgical corrections can be performed, while intra-operative sensors and surgical navigation provide quantitative, patient-specific feedback. To understand the impact of these corrections, this paper evaluates the quantitative impact of both soft tissue releases and bone recuts on knee balance and overall limb alignment. This was achieved by statistically analyzing the alignment and load readings before and after each surgical correction performed on 479 consecutive primary total knees. An average of three surgical corrections were required following the initial bone cuts to achieve a well aligned, balanced total knee. Various surgical corrections, such as an arcuate release or increasing the tibial polyethylene insert thickness, significantly affected the maximum terminal extension. The coronal alignment was significantly impacted by pie-crusting the MCL, adding varus to the tibia, or releasing the arcuate ligament or popliteus tendon. Each surgical correction also had a specific impact on the intra-articular loads in flexion and/or extension. A surgical algorithm is presented that helps achieve a well-balanced knee while maintaining the sagittal and coronal alignment within the desired boundaries. This analysis additionally indicated the significant effect that soft tissue adjustments can have on the limb alignment in both anatomical planes. Full article

(This article belongs to the Special Issue Smart Sensors Applications in Total Joint Arthroplasty)

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