Archives: Publications

Abstract

To explore the application value of an artificial intelligence (AI)-based cartilage model evaluation system in the decision-making of knee joint replacement procedures (total knee arthroplasty [TKA] vs. unicompartmental knee arthroplasty [UKA]), and to compare the dynamic differences in postoperative functional recovery between the two procedures. Eighty patients with advanced knee osteoarthritis evaluated by the AI cartilage model were retrospectively included, with 40 patients in each of the TKA group and the UKA group. The AI model performed thin-slice MRI scans of the knee joints, selected the fat-suppressed three-dimensional isotropic intermediate-weight VISTA sequence to improve image identification, and imported the data into an MRI-based intelligent reconstruction system to achieve intelligent segmentation and reconstruction of MRI. It reconstructed 15 structures including the femur, tibia, patella, their cartilages, and ligaments. The surgical procedures were decided based on the cartilage damage. The Knee Society Score (KSS, including knee score and function score), Visual Analog Pain Score (VAS), and WOMAC Osteoarthritis Index (pain, stiffness, function dimensions) were recorded before surgery and 1, 3, 6, and 12 months after surgery in both groups. Simultaneously record the preoperative and postoperative hip–knee–ankle (HKA) angles and their differences for both patient groups, the location of preoperative pain, and the preoperative and 12-month postoperative knee range of motion (ROM) and their differences. There were no statistically significant differences in gender and average BMI between the unicompartmental knee replacement group and the total knee replacement group (P > 0.05); however, there was a statistically significant difference in average age between the two groups (P < 0.05). Within each group, there were statistically significant differences in all scores (KSS knee score, KSS function score, VAS score, WOMAC score) at 1 month, 3 months, 6 months, and 12 months after surgery compared with those before surgery (P < 0.05). In the inter-group comparison (comparison between unicompartmental knee replacement patients and total knee replacement patients), for the KSS knee score, P = 0.27 before surgery, P < 0.05 at 1 month after surgery; P = 0.46 at 3 months after surgery, P = 0.33 at 6 months after surgery, and P = 0.08 at 12 months after surgery. For the KSS function score, P < 0.05 before surgery, P < 0.05 at 1 month after surgery, P < 0.05 at 3 months after surgery, P = 0.73 at 6 months after surgery, and P = 0.76 at 12 months after surgery. For the VAS score, P = 0.51 before surgery, P < 0.05 at 1 month and 3 months after surgery, P = 0.82 at 6 months after surgery, and P = 0.80 at 12 months after surgery. For the WOMAC score, P < 0.05 at all time points before and after surgery. In the unicompartmental knee arthroplasty (UKA) group, the preoperative hip–knee–ankle (HKA) angle was 175.8° ± 1.4°, the postoperative HKA angle was 178.6° ± 1.0°, and the change was 2.9° ± 0.6°. In the total knee arthroplasty (TKA) group, the preoperative HKA angle was 175.1° ± 2.5°, the postoperative HKA angle was 179.2° ± 0.9°, and the change was 8.1° ± 1.8°. Comparison between the two groups showed no significant difference in the preoperative HKA angle (p = 0.12), whereas the postoperative HKA angle and the change from baseline were significantly different (both p < 0.05). In the UKA group, pain was located medially in 35 cases (87.5%) and laterally in 5 cases (12.5%). In the TKA group, pain was located medially in 25 cases (62.5%), laterally in 10 cases (25.0%), and in the patellofemoral joint in 5 cases (12.5%). For range of motion (ROM), the UKA group had a preoperative ROM of 105.8° ± 6.4°, a 12-month postoperative ROM of 130.8° ± 5.2°, and a change of 25.0° ± 1.5°. The TKA group had a preoperative ROM of 89.0° ± 6.8°, a 12-month postoperative ROM of 121.0° ± 4.5°, and a change of 32.0° ± 2.5°. Intergroup comparisons of preoperative, postoperative, and change values all showed statistically significant differences (all p < 0.05). The AI cartilage model can accurately distinguish the indications for TKA and UKA by quantifying the morphology of cartilage damage. UKA is more suitable for local cartilage damage in the medial compartment, and it has a significant advantage in early functional recovery; while TKA has better long-term stability in patients with extensive cartilage degeneration. This study provides an evidence-based basis for AI-assisted personalized selection of knee joint replacement procedures.

Abstract

Background

Positioning implant components and restoring patient anatomy during total hip arthroplasty (THA) are essential for joint stability, polyethylene liner wear, and range of motion. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during the posterior or posterolateral approach have reported conflicting results. This meta-analysis evaluated if intraoperative fluoroscopy improves component positioning and femoral component position compared to no fluoroscopy during posterior or posterolateral approach total hip arthroplasty.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed when conducting the systematic review. We searched Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving Intraoperative fluoroscopy versus no fluoroscopy during posterior or posterolateral approach total hip arthroplasty. Finally, we identified 1133 patients (1145 hips) assessed in seven studies.

Results

There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.43), ACIA within safe zone rate (P = 0.58), acetabular cup anteversion angle (ACAA, P = 0.46); ACAA within safe zone rate (P = 0.72), Combined safe zone rate (P = 0.28), dislocation rate (P = 0.64) and infection rate (P = 0.94) between two groups. Compared with the no fluoroscopy group, the intraoperative fluoroscopy group had more operation time (P < 0.00001), less femoral component offset difference (FCOD, P = 0.03), and less LLD (P < 0.00001).

Conclusion

Even though intraoperative fluoroscopy was not related to an improvement in cup location or dislocation incidence. Our findings demonstrate that the restoration of leg lengths and femoral offset can be significantly improved by using intraoperative fluoroscopy to supplement good surgical skills in THA. The advantages of intraoperative fluoroscopy might become more apparent for surgeons with less experience. To ascertain whether intraoperative fluoroscopy for posterior or posterolateral approach total hip arthroplasty will have clinical benefits and improve the survival of prostheses, more well-powered and well-designed long-term follow-up studies were necessary.

Abstract

Objective

To evaluate the biomechanical characteristics of grafts from three different anterior cruciate ligament (ACL) reconstructive surgeries and to determine which method is better at restoring knee joint stability.

Methods

A 31-year-old female volunteer was enrolled in the study. According to the magnetic resonance imaging of her left knee, a three-dimensional model consisting of the distal femur, proximal tibia and fibula, ACL, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament was established. Then, the ACL was removed from the original model to simulate the knee joint after ACL rupture. Based on the knee joint model without the ACL, single-bundle ACL reconstruction, double-bundle ACL reconstruction, and flat-tunnel ACL reconstruction were performed. The cross-sectional diameters of the grafts were equally set as 6 mm in the three groups. The bone tissues had a Young’s modulus of 17 GPa and a Poisson’s ratio of 0.36. The ligaments and grafts had a Young’s modulus of 390 MPa and a Poisson’s ratio of 0.4. Six probes were placed in an ACL or a graft to obtain the values of the equivalent stress, maximum principal stress, and maximum shear stress. After pulling the proximal tibia with a forward force of 134 N, the distance that the tibia moved and the stress distribution in the ACL or the graft, reflected by 30 mechanical values, were measured.

Results

The anterior tibial translation values were similar among the three groups, with the double-bundle ACL reconstruction group performing the best, followed closely by the patellar tendon ACL reconstruction group. In terms of stress distribution, 13 out of 30 mechanical values indicated that the grafts reconstructed by flat bone tunnels had better performance than the grafts in the other groups, while 12 out of 30 showed comparable outcomes, and 5 out of 30 had worse outcomes.

Conclusion

Compared with traditional single-bundle and double-bundle ACL reconstructions, flat-tunnel ACL reconstruction has advantages in terms of stress dispersion. Additionally, flat-tunnel ACL reconstruction falls between traditional double-bundle and single-bundle ACL reconstructions in terms of restoring knee joint stability and is superior to single-bundle ACL reconstruction.

Abstract

Objective

The study aims to evaluate the accuracy of an MRI-based artificial intelligence (AI) segmentation cartilage model by comparing it to the natural tibial plateau cartilage.

Methods

This study included 33 patients (41 knees) with severe knee osteoarthritis scheduled to undergo total knee arthroplasty (TKA). All patients had a thin-section MRI before TKA. Our study is mainly divided into two parts: (i) In order to evaluate the MRI-based AI segmentation cartilage model’s 2D accuracy, the natural tibial plateau was used as gold standard. The MRI-based AI segmentation cartilage model and the natural tibial plateau were represented in binary visualization (black and white) simulated photographed images by the application of Simulation Photography Technology. Both simulated photographed images were compared to evaluate the 2D Dice similarity coefficients (DSC). (ii) In order to evaluate the MRI-based AI segmentation cartilage model’s 3D accuracy. Hand-crafted cartilage model based on knee CT was established. We used these hand-crafted CT-based knee cartilage model as gold standard to evaluate 2D and 3D consistency of between the MRI-based AI segmentation cartilage model and hand-crafted CT-based cartilage model. 3D registration technology was used for both models. Correlations between the MRI-based AI knee cartilage model and CT-based knee cartilage model were also assessed with the Pearson correlation coefficient.

Results

The AI segmentation cartilage model produced reasonably high two-dimensional DSC. The average 2D DSC between MRI-based AI cartilage model and the tibial plateau cartilage is 0.83. The average 2D DSC between the AI segmentation cartilage model and the CT-based cartilage model is 0.82. As for 3D consistency, the average 3D DSC between MRI-based AI cartilage model and CT-based cartilage model is 0.52. However, the quantification of cartilage segmentation with the AI and CT-based models showed excellent correlation (r = 0.725; P values < 0.05).

Conclusion

Our study demonstrated that our MRI-based AI cartilage model can reliably extract morphologic features such as cartilage shape and defect location of the tibial plateau cartilage. This approach could potentially benefit clinical practices such as diagnosing osteoarthritis. However, in terms of cartilage thickness and three-dimensional accuracy, MRI-based AI cartilage model underestimate the actual cartilage volume. The previous AI verification methods may not be completely accurate and should be verified with natural cartilage images. Combining multiple verification methods will improve the accuracy of the AI model.

Abstract

Natural articular cartilage is a typical self-healing and superlubrication system capable of maintaining extremely low friction under physiological loadings. Cartilage wear and accidental trauma can cause irreversible defects to cartilage and subchondral bone with a significant decrease in intra-articular lubrication, leading to the development of severe osteoarthritis and osteochondral defect. To address the important clinical problem of osteochondral defect, a bioinspired hard–soft (PEEK-lubrication hydrogel) composite scaffold is designed and developed. The polymerization of polyethylene glycol diacrylamide (PEGDAA) and 2-methacryloyloxyethyl phosphorylcholine (MPC) on polyetheretherketone (PEEK) substrate is achieved by UV initiation to form a strong interfacial bonding, and nano-hydroxyapatite is deposited on porous PEEK substrate via polydopamine coating to improve osteogenic capability. Accordingly, the composite scaffold is successfully developed with lubrication and osteogenic activity. The tribological tests show that the lubrication performance of the composite scaffold is based on the hydration lubrication mechanism of the upper hydrogel layer, and the in vitro and in vivo experiments demonstrate that the composite scaffold is endowed with excellent biocompatibility and bioactivity. In conclusion, the bioinspired strategy for preparing a hard–soft composite scaffold shows a promising way in the treatment of osteochondral defect and provided a guideline for designing functional PEEK-based biomaterials in tissue engineering scaffolds.

Abstract

Background

Positioning implant components and restoring patient anatomy during total hip arthroplasty (THA) are essential for joint stability, polyethylene liner wear, and range of motion. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during the posterior or posterolateral approach have reported conflicting results. This meta-analysis evaluated if intraoperative fluoroscopy improves component positioning and femoral component position compared to no fluoroscopy during posterior or posterolateral approach total hip arthroplasty.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed when conducting the systematic review. We searched Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving Intraoperative fluoroscopy versus no fluoroscopy during posterior or posterolateral approach total hip arthroplasty. Finally, we identified 1133 patients (1145 hips) assessed in seven studies.

Results

There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.43), ACIA within safe zone rate (P = 0.58), acetabular cup anteversion angle (ACAA, P = 0.46); ACAA within safe zone rate (P = 0.72), Combined safe zone rate (P = 0.28), dislocation rate (P = 0.64) and infection rate (P = 0.94) between two groups. Compared with the no fluoroscopy group, the intraoperative fluoroscopy group had more operation time (P < 0.00001), less femoral component offset difference (FCOD, P = 0.03), and less LLD (P < 0.00001).

Conclusion

Even though intraoperative fluoroscopy was not related to an improvement in cup location or dislocation incidence. Our findings demonstrate that the restoration of leg lengths and femoral offset can be significantly improved by using intraoperative fluoroscopy to supplement good surgical skills in THA. The advantages of intraoperative fluoroscopy might become more apparent for surgeons with less experience. To ascertain whether intraoperative fluoroscopy for posterior or posterolateral approach total hip arthroplasty will have clinical benefits and improve the survival of prostheses, more well-powered and well-designed long-term follow-up studies were necessary.