Comparison of the Usefulness of Computer-Assisted Three-Dimensional Analysis and Weight-Bearing Radiographs in Ankle Osteoarthritis.

Background: To evaluate the degree of deformation in patients with ankle osteoarthritis (OA), it is essential to measure the three-dimensional (3D), in other words, stereoscopic alignment of the ankle, subtalar, and foot arches. Generally, measurement of radiological parameters use two-dimensional (2D) anteroposterior and lateral radiographs in a weight-bearing state; however, computer-aided 3D analysis (Disior) using weight-bearing cone-beam computed tomography (CBCT) has recently been introduced. Methods: In this study, we compared the 2D human radiographic method with a stereoscopic image in patients with ankle arthritis. We enrolled 57 patients diagnosed with OA (28 left and 29 right) and obtained both standing radiographs and weight-bearing CBCT. Patients were divided by the Takakura stage. The interclass correlation coefficient (ICC) for each result was confirmed. Results: On the ICC between 2D radiographs and 3D analysis, the tibiotalar surface angle and lateral talo-1st metatarsal angle showed a good ICC grade (> 0.6), while other parameters did not have significant ICC results. Three-dimension was superior to radiographs in terms of statistical significance. Conclusions: We demonstrated that 2D and stereoscopic images are useful for the diagnosis of OA. Our study also confirmed that the radiographic features affected by ankle OA varied. However, according to the results, the typical radiography is not sufficient to diagnose and determine a treatment plan for ankle OA. Therefore, the method of using 3D images should be considered.

Assessment of a novel deep learning-based software developed for automatic feature extraction and grading of radiographic knee osteoarthritis.

BACKGROUND: The Kellgren-Lawrence (KL) grading system is the most widely used method to classify the severity of osteoarthritis (OA) of the knee. However, due to ambiguity of terminology, the KL system showed inferior inter- and intra-observer reliability. For a more reliable evaluation, we recently developed novel deep learning (DL) software known as MediAI-OA to extract each radiographic feature of knee OA and to grade OA severity based on the KL system. METHODS: This research used data from the Osteoarthritis Initiative for training and validation of MediAI-OA. 44,193 radiographs and 810 radiographs were set as the training data and used as validation data, respectively. This AI model was developed to automatically quantify the degree of joint space narrowing (JSN) of medial and lateral tibiofemoral joint, to automatically detect osteophytes in four regions (medial distal femur, lateral distal femur, medial proximal tibia and lateral proximal tibia) of the knee joint, to classify the KL grade, and present the results of these three OA features together. The model was tested by using 400 test datasets, and the results were compared to the ground truth. The accuracy of the JSN quantification and osteophyte detection was evaluated. The KL grade classification performance was evaluated by precision, recall, F1 score, accuracy, and Cohen's kappa coefficient. In addition, we defined KL grade 2 or higher as clinically significant OA, and accuracy of OA diagnosis were obtained. RESULTS: The mean squared error of JSN rate quantification was 0.067 and average osteophyte detection accuracy of the MediAI-OA was 0.84. The accuracy of KL grading was 0.83, and the kappa coefficient between the AI model and ground truth was 0.768, which demonstrated substantial consistency. The OA diagnosis accuracy of this software was 0.92. CONCLUSIONS: The novel DL software known as MediAI-OA demonstrated satisfactory performance comparable to that of experienced orthopedic surgeons and radiologists for analyzing features of knee OA, KL grading and OA diagnosis. Therefore, reliable KL grading can be performed and the burden of the radiologist can be reduced by using MediAI-OA.

The Validation of Two-Dimensional and Three-Dimensional Radiographic Measurements of Host Bone Coverage in Total Hip Arthroplasty for Hip Dysplasia: A Comparison with Intra-Operative Measurements.

Several methods have been introduced to measure the host bone coverage of the acetabular component after total hip arthroplasty (THA). The aims of this study were (1) to validate two-dimensional- and three-dimensional-based host bone coverage measurements by comparing intra-operative measurements, and (2) to determine the minimum host bone coverage for achieving stable cup fixation after THA in hip dysplasia. The clinical outcomes of each patient were evaluated during their final follow-up period using the Harris Hip score (HHS). The coverage of the host bone was analyzed by comparing 2D-based, 3D-based, and intraoperative assessments. The mean HHS was increased significantly from 60.84 ± 14.21 pre-operatively to 93.13 ± 4.59 (p < 0.0001). The host bone coverage ratio measured intraoperatively was 83.67 ± 3.40%, while the ratio measured by 3D CT reconstruction was 82.72 ± 3.59%. There was a strong positive correlation between the intra-operative host bone coverage and the 3D-based one (r = 0.826, p < 0.0001). It is recommended that 3D-based measurements are used to evaluate the host bone coverage after THA in patients with hip dysplasia. In addition, achieving a minimum host bone coverage of 75% is recommended for the attainment of stable cup fixation.

Posterior Medial Meniscus Root Repair Using Two Transtibial Tunnels with Modified Mason-Allen Stitches: A Technical Note.

Complete tear of the posterior medial meniscus root can result in a loss of hoop tension and increased contact pressure. Thus, medial meniscus posterior root tear (MMPRT) is increasingly recognized as an important pathology. Although several surgical techniques for MMPRT have recently been introduced, the ideal technique is not yet established. This technical note is aimed at introducing a novel surgical technique using two transtibial tunnels with modified Mason-Allen stitches in the treatment of MMPRT.

Using the Axial Oblique View of Computed Tomography (CT) in Evaluating Femoral Anteversion: A Comparative Cadaveric Study.

Twenty-five cadaveric adult femora's anteversion angles were measured to develop a highly efficient and reproducible femoral anteversion measurement method using computed tomography (CT). Digital photography captured the proximal femur's two reference lines, head-to-neck (H-N) and head-to-greater trochanter (H-G). Six reference lines (A/B in transverse section; C, axial oblique section; D/E, conventional 3D reconstruction; and M, volumetric 3D reconstruction) from CT scans were used. The posterior condylar line was used as a distal femoral reference. As measured with the H-N and H-G lines, the anteversion means were 10.43° and 19.50°, respectively. Gross anteversion measured with the H-G line had less interobserver bias (ICC; H-N = 0.956, H-G = 0.982). The 2D transverse and volumetric 3D CT sections' B/M lines were consistent with the H-N line (p: B = 0.925, M = 0.122) and the 2D axial oblique section's C line was consistent with the H-G line (p < 0.1). The D/E lines differed significantly from the actual gross images (p < 0.05). Among several CT scan femoral anteversion measurement methods, the novel anteversion angle measurement method using CT scans' axial oblique section was approximated with actual gross femoral anteversion angle from the femoral head to the greater trochanter.

The Comparison of Lower Extremity Length and Angle between Computed Radiography-Based Teleoroentgenogram and EOS® Imaging System.

Background and objectives: The differences between computed radiography-based teleoroentgenograms (CR-based teleoroentgenograms) and an EOS® imaging system were evaluated by measuring lower extremity lengths and alignments. Materials and methods: The leg length [L], femur length [F], tibia length [T], and hip−knee−ankle (HKA) angle were measured in 101 patients with lower extremity disease by a CR-based teleoroentgenogram with computed radiography and an EOS®. The additive length of the femoral and tibial segments (F + T) was determined by adding the two length values. Then, the differences among all five parameters between the two techniques were analyzed. The magnification (mm) was calculated by subtracting the length measurements on the EOS® from those in the scanogram. Furthermore, the magnification percentage (%) was calculated by dividing the magnification with the measurements on the EOS®. Results: The magnification errors (mean ± standard deviation), when comparing both right and left sides, were 7.80 ± 1.41%, 7.3 ± 6.01%, 5.16 ± 1.25%, and 6.45 ± 0.94% for L, F, T, and F + T, respectively. For limb length, the CR-based teleoroentgenogram had an average magnification of 6.8% (range, 5.2 to 7.8%) compared to the EOS® imaging. The two groups displayed a statistical difference (p < 0.01), except for the HKA angle. Conclusions: The CR-based teleoroentgenogram had a magnification of about 6.8% compared to the EOS® imaging system in evaluating lower extremity length. Therefore, more attention must be given to CR-based teleoroentgenograms to correct angular deformities.

Reduction of postoperative nausea and vomiting risk in the second stage during bilateral total knee arthroplasty with a 1-week interval.

PURPOSE: Total knee arthroplasty (TKA) is often performed sequentially on both sides during a single hospital stay. Patients who experience postoperative nausea and vomiting (PONV) after the first operation are concerned about PONV recurrence after the second operation. However, there are few studies regarding the incidence of PONV in staged bilateral TKA with a ≥ 1-week interval. This study aimed to identify the differences in (1) PONV incidence, (2) use of rescue antiemetics, and (3) the amount of opioid consumption between the first and second operations for staged bilateral TKA with a 1-week interval. Based on our anecdotal experience, the hypothesis of this study was that during staged bilateral TKA at a 1-week interval, the PONV incidence and rescue antiemetic requirement after the second operation will be lower than those after the first operation, regardless of opioid consumption. METHODS: Fifty-eight consecutive patients who underwent staged bilateral TKA with a 1-week interval were retrospectively reviewed. All second-stage operations were performed with the same anaesthesia protocol and perioperative patient management protocol as the first-stage operation. PONV incidence was the primary outcome. The requirement for rescue antiemetic drugs and the amount of opioid consumption were secondary outcome variables. The outcome variables were recorded during three postoperative days (Days 0-2) for each stage and were compared between the first and second operations. RESULTS: The incidence rates of nausea and vomiting on Day 0 (p = 0.001 and p = 0.004, respectively) and nausea on Day 1 (p = 0.008) were significantly lower after the second operation. Rescue antiemetic use on Day 0 was significantly lower after the second operation (p = 0.001). The total opioid consumption 72 h after surgery was significantly higher after the second operation (61.76 vs. 34.28 mg, p < 0.001). CONCLUSION: During staged bilateral TKA with a 1-week interval, PONV incidence was lower after the second operation, even with increased opioid consumption. LEVEL OF EVIDENCE: III.

Affecting Factors and Correction Ratio in Genu Valgum or Varum Treated with Percutaneous Epiphysiodesis Using Transphyseal Screws.

This study evaluated the correction rates of idiopathic genu valgum or varum after percutaneous epiphysiodesis using transphyseal screws (PETS) and analyzed the affecting factors. A total of 35 children without underlying diseases were enrolled containing 64 physes (44 distal femoral (DT), 20 proximal tibial (PT)). Anatomic tibiofemoral angle (aTFA) and the mechanical axis deviation (MAD) were taken from teleroentgenograms before PETS surgery and screw removal. The correction rates of the valgus and varus deformities for patients treated with PETS were 1.146°/month and 0.639°/month using aTFA while using MAD showed rates of 4.884%/month and 3.094%/month. After aTFA (p < 0.001) and MAD (p < 0.001) analyses, the correction rate of DF was significantly faster than that of PT. Under multivariable analysis, the aTFA correction rate was significantly faster in younger patients (p < 0.001), in males (p < 0.001), in patients with lower weights (p < 0.001), and in the group that was screwed at DF (p < 0.001). Meanwhile, the MAD correction rate was significantly faster in patients with lower heights (p = 0.003). PETS is an effective treatment method for valgus and varus deformities in growing children and clinical characters should be considered to estimate the correction rate.

Revision Arthroscopic Bankart Repair: A Systematic Review of Clinical Outcomes.

Although the frequency of arthroscopic revision surgery is increasing in patients with recurrent dislocation after a primary shoulder stabilization, the literature describing arthroscopic revision Bankart repair has been limited. Preferred reporting items for systematic meta-analyses guidelines were followed by utilizing PubMed, EMBASE, Scopus, and Cochrane Library databases. Keywords included shoulder dislocation, anterior shoulder instability, revision surgery, stabilization, and arthroscopic Bankart repair. Quality assessments were performed with criteria from the methodological index for nonrandomized studies (MINORS). A total of 14 articles were included in this analysis. The mean MINORS score was 12.43. A total of 339 shoulders (337 patients) were included (281 males and 56 females). The mean follow-up period was 36.7 months. Primary surgeries were as follows: arthroscopic procedures (n = 172, 50.7%), open procedure (n = 87, 25.7%), and unknown (n = 80, 23.6%). The mean rate of recurrent instability after revision arthroscopic Bankart repair was 15.3% (n = 52), and an additional re-revision procedure was needed in 6.5% of cases (n = 22). Overall, there were 18.0% (n = 61) of complications reported. This systematic review suggests that arthroscopic revision Bankart repair can lead to an improvement in functional outcomes and reasonable patient satisfaction with proper patient selection.