All implantations were carried out by the use of the Orthopilot® (Aesculap AG, Tuttlingen, Germany) navigation system. Navigation was used in order to ensure alignment of the prosthesis in a defined position [5 (link), 7 (link), 8 (link), 14 (link), 15 (link)]. For inclusion the TKA has to be implanted in a defined range of alignment in all patients: mechanical femorotibial axis of 0° ± 3° and coronal orientation of the femoral and tibial component of 90° ± 2° and sagittal position of femur component 90° ± 2° and tibia component 90° − 4°.
Orthopilot
Manufactured by B. Braun
Sourced in Germany
OrthoPilot is a navigation system used in orthopedic surgery. It provides real-time guidance to surgeons during procedures by tracking the position of surgical instruments relative to the patient's anatomy.
Automatically generated - may contain errors
8 protocols using orthopilot
1
Navigated Total Knee Arthroplasty Alignment
2
Computer-Assisted Total Knee Arthroplasty
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OrthoPilot Navigation system (OrthoPilot, Aesculap) was used in all the computer-assisted navigation cases. The system works on the mechanism of imageless navigation. Transmitters were attached to the femur and tibia with 4.5 mm cortical self tapping screws and a mounting sleeve. All the cuts in the tibia as well as the femur were performed using the navigation system. The intramedullary canals of tibia and femur were not violated.
The hemoglobin (Hb) and the haematocrit (Hct) levels were measured in all the patients prior to the surgery and on the second postoperative (PO2) day. Intraoperative blood loss was assessed by weighing sponges and measuring suction volume. Postoperative blood loss was noted by measuring blood in the drain. The patient's blood volume (PBV) was calculated using the formula of Nadler et al.9) (link) i.e., PBV = k1 × height (m)3 + k2 × weight (kg) + k3, where k is constant, whose values are, k1 = 0.3669, k2 = 0.03219, k3 = 0.6041 for men; k1 = 0.3561, k2 = 0.03308, k3 = 0.1833 for women.
Multiplying the PBV by the hematocrit gave the total red cell volume. If a transfusion was performed, a unit of red cell concentrates containing the standard 250 mL of red blood cells (RBCs) was used.
The following formulas were used to calculate different blood loss variables:
The hemoglobin (Hb) and the haematocrit (Hct) levels were measured in all the patients prior to the surgery and on the second postoperative (PO2) day. Intraoperative blood loss was assessed by weighing sponges and measuring suction volume. Postoperative blood loss was noted by measuring blood in the drain. The patient's blood volume (PBV) was calculated using the formula of Nadler et al.9) (link) i.e., PBV = k1 × height (m)3 + k2 × weight (kg) + k3, where k is constant, whose values are, k1 = 0.3669, k2 = 0.03219, k3 = 0.6041 for men; k1 = 0.3561, k2 = 0.03308, k3 = 0.1833 for women.
Multiplying the PBV by the hematocrit gave the total red cell volume. If a transfusion was performed, a unit of red cell concentrates containing the standard 250 mL of red blood cells (RBCs) was used.
The following formulas were used to calculate different blood loss variables:
3
Biomechanical Effects of Femoral Drilling
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Seventy-five of the femoral specimens were used for destructive biomechanical tests following drilling: 25 right femora were used for the torsional test, 25 left femora were used for the 3-point bending test, and 15 right and 10 left femora were used for the compression test. The remaining 25 femora underwent micro-computed tomography (CT) scanning. The specimens for each test were randomly assigned to 5 groups: the intact control group (no drilling), standard drilling group, slightly eccentric drilling group, severely eccentric drilling group, and high drilling group (n = 5 each).
The diameter and direction of the drill hole were set in reference to the OrthoPilot (Aesculap) navigated TKA system (Figs. 1-A and1-B). Details regarding the size correspondence between rabbit and human femora are provided in Figure Sup1 and Table Sup1 in the Appendix. Drill holes were created using a 1.2-mm-diameter drill operated at a constant speed. Drilling was performed perpendicular to the bone, from anteromedial to posterolateral" (at 45° to the anteroposterior axis of the femur); the drilling height and eccentricity of each group are shown in Figure 1-C. Photographs and radiographs of each group were recorded (Figs. 1-D and1-E).
The diameter and direction of the drill hole were set in reference to the OrthoPilot (Aesculap) navigated TKA system (Figs. 1-A and1-B). Details regarding the size correspondence between rabbit and human femora are provided in Figure Sup1 and Table Sup1 in the Appendix. Drill holes were created using a 1.2-mm-diameter drill operated at a constant speed. Drilling was performed perpendicular to the bone, from anteromedial to posterolateral" (at 45° to the anteroposterior axis of the femur); the drilling height and eccentricity of each group are shown in Figure 1-C. Photographs and radiographs of each group were recorded (Figs. 1-D and1-E).
4
Retrospective Analysis of Primary Total Knee Replacements
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This is a retrospective analysis of prospectively collected data for all patients undergoing primary total knee replacement under the care of a single surgeon in a UK hospital between December 2007 and November 2009. No exclusions were made on the basis of pathology of joint disease or severity of deformity.
Pre-operative Oxford Knee Score (OKS) [13 (link)] and body mass index (BMI) were collected at pre-assessment clinic appointments by independent arthroplasty practitioners within 12 weeks prior to surgery (all OKSs in this paper refer to a scale from 12 to 60, with a higher score indicating poorer outcome). At this time, patients had a standing long leg AP radiograph, including hip, knee and ankle, taken to assess FTMA. All the TKAs were performed using computer navigation by a single surgeon or by his assistant in his presence. Two commercially available computer navigation systems were used: eNlite Navigation System, Navigation System II (Stryker, Mahwah, NJ) or OrthoPilot (BBraun Aesculap, Tuttlingen, Germany). Two implant designs were used: Triathlon (Stryker) (118 knees) and Columbus (BBraun) (105 knees), implanted with the Stryker and OrthoPilot navigation systems, respectively. All knees were cruciate retaining (CR) and cemented.
Pre-operative Oxford Knee Score (OKS) [13 (link)] and body mass index (BMI) were collected at pre-assessment clinic appointments by independent arthroplasty practitioners within 12 weeks prior to surgery (all OKSs in this paper refer to a scale from 12 to 60, with a higher score indicating poorer outcome). At this time, patients had a standing long leg AP radiograph, including hip, knee and ankle, taken to assess FTMA. All the TKAs were performed using computer navigation by a single surgeon or by his assistant in his presence. Two commercially available computer navigation systems were used: eNlite Navigation System, Navigation System II (Stryker, Mahwah, NJ) or OrthoPilot (BBraun Aesculap, Tuttlingen, Germany). Two implant designs were used: Triathlon (Stryker) (118 knees) and Columbus (BBraun) (105 knees), implanted with the Stryker and OrthoPilot navigation systems, respectively. All knees were cruciate retaining (CR) and cemented.
5
Retrospective Analysis of Cemented TKA
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Data of patients who underwent primary TKA were reviewed retrospectively. Inclusion criteria were a primary cemented TKA using Columbus ® (B. Braun, Melsungen, Germany) implant performed between 2010 and 2018 in our institute by a single surgeon. If a patient underwent TKA on both knees, then both sides of the knee were analyzed. Total 699 knees were enrolled. Exclusion criteria were previous knee surgery, inflammatory arthritis, and missing preoperative or postoperative standing lower extremity view. This series included 235 patients and 329 knees. Of these 235 patients, 215 were females and 20 were males. Their mean age was 72.87 years (95% confidence interval ¼ 72.14-73.60 years; range 53-94 years). The preoperative mean ROM was 107 . If the navigation system was available, the CAS-TKA was performed using navigation system. When the navigation system was being used by another surgeon or system failure, the conventional TKA was performed. A total of 246 (75%) TKAs were performed using computer-assisted navigation system OrthoPilot ® (B. Braun). The number of conventional TKA was 83 (25%). This research has been approved by the Institutional Review Board of the authors' affiliated institution (protocol number: KBSMC 2018-06-020).
6
Modified Hardinge Approach for Cementless Hip Arthroplasty
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Surgeries were performed using the same technique for all patients. We used a modified Hardinge approach with a skin incision of 10 cm or less with the patient in the lateral position. All hips were implanted with a cementless cup (Plasma cup BTM, B/Braun-Aesculap, Germany) and a cementless stem (Bicontact TM B/Braun-Aesculap, Germany). This stem is designed to have a flat, square cross section that enables some allowance for rotational adjustment. Regarding cup positioning, inclination and anteversion angles were targeted at 40°-45° and 15°-20°, respectively, using imageless navigation (OrthoPilot; B/BRAUN-Aesculap, Germany). The stem anteversion was arbitrarily adjusted under manual control. In postoperative rehabilitation, postoperative gait exercise with full weight-bearing was allowed the day after surgery.
7
Intraoperative Validation of Knee Implant Placement
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The parameters of bony resection and soft tissue balance, including tibia resection angle, frontal femoral angle, axial femoral angle, medial and lateral gap in extension, and flexion position and joint line translation were assessed and recorded intraoperatively (Figure 5 ). Additionally, the size of the femoral implant and the total height of tibial component (metal plate with PE inlay) were assessed to reach maximum feasible coverage to avoid notching or overhanging. Intraoperative validation was performed immediately after tibial and femoral resection by the attached navigation transmitters (OrthoPilot®; B. Braun Aesculap, Tuttlingen, Germany) according to prior planning.
8
Knee Navigation Device Positioning
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The patient was placed in the supine position with the operative knee flexed at 90°. The position of the navigation device (OrthoPilot®; B. Braun Aesculap, Tuttlingen, Germany) was leveled with the contralateral shoulder of the patient at a 45° angle to the longitudinal axis of the patient.
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