Sakellariou E, Alevrogiannis P, Alevrogianni F, Galanis A, Vavourakis M, Karampinas P, Gavriil P, Vlamis J, Alevrogiannis S. Single-center experience with Knee+™ augmented reality navigation system in primary total knee arthroplasty. World J Orthop 2024; 15(3): 247-256 [PMID: 38596188 DOI: 10.5312/wjo.v15.i3.247]
Corresponding Author of This Article
Michail Vavourakis, MD, MSc, PhD, Doctor, Surgeon, The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Nikis 2, Athens 14561, Greece. michail.vavourakis@outlook.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Mar 18, 2024; 15(3): 247-256 Published online Mar 18, 2024. doi: 10.5312/wjo.v15.i3.247
Single-center experience with Knee+™ augmented reality navigation system in primary total knee arthroplasty
Evangelos Sakellariou, Panagiotis Alevrogiannis, Fani Alevrogianni, Athanasios Galanis, Michail Vavourakis, Panagiotis Karampinas, Panagiotis Gavriil, John Vlamis, Stavros Alevrogiannis
Evangelos Sakellariou, Athanasios Galanis, Michail Vavourakis, Panagiotis Karampinas, John Vlamis, The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
Panagiotis Alevrogiannis, Panagiotis Gavriil, The 1st Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, Attikon General Hospital, Athens 14561, Greece
Fani Alevrogianni, Department of Anesthesiology, KAT General Hospital, Athens 14561, Greece
Stavros Alevrogiannis, Department of Robotic Hip & Knee Orthopaedic Surgery, Metropolitan General Hospital, Athens 14561, Greece
Author contributions: Sakellariou E contributed to study design, manuscript preparation–original draft presentation; Alevrogiannis P contributed to manuscript preparation–original draft presentation; Alevrogianni F contributed to literature search; Galanis A contributed to data collection, data interpretation; Karampinas P contributed to data collection, data interpretation; Vavourakis M contributed to literature search; Gavriil P contributed to statistical analysis; Vlamis J contributed to study design, manuscript preparation–review and editing; Alevrogiannis S contributed to manuscript preparation–review and editing, supervision.
Institutional review board statement: Our institution’s board committee with the No 29/28-09-2021 decision, approved this research.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All raw data are available to access should they be requested at michail.vavourakis@outlook.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michail Vavourakis, MD, MSc, PhD, Doctor, Surgeon, The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Nikis 2, Athens 14561, Greece. michail.vavourakis@outlook.com
Received: October 29, 2023 Peer-review started: October 29, 2023 First decision: December 19, 2023 Revised: January 15, 2024 Accepted: March 4, 2024 Article in press: March 4, 2024 Published online: March 18, 2024 Processing time: 137 Days and 15.4 Hours
Abstract
BACKGROUND
Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years, as they enhance precision compared to conventional hardware. The expansion of computer assistance is evolving with the employment of augmented reality. Yet, the accuracy of augmented reality navigation systems has not been determined.
AIM
To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty (TKA), utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon.
METHODS
From May 2021 to December 2021, 30 patients, 25 women and five men, underwent a primary unilateral TKA. Revision cases were excluded. A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment. All patients were operated on by the same team, without a tourniquet, utilizing three distinct prostheses with the assistance of the Knee+™ augmented reality navigation system in every operation. Postoperatively, the same radiographic exam protocol was executed to evaluate the implants’ position, orientation and coronal plane alignment. We recorded measurements in 3 stages regarding femoral varus and flexion, tibial varus and posterior slope. Firstly, the expected values from the Augmented Reality system were documented. Then we calculated the same values after each cut and finally, the same measurements were recorded radiologically after the operations. Concerning statistical analysis, Lin’s concordance correlation coefficient was estimated, while Wilcoxon Signed Rank Test was performed when needed.
RESULTS
A statistically significant difference was observed regarding mean expected values and radiographic measurements for femoral flexion measurements only (Z score = 2.67, P value = 0.01). Nonetheless, this difference was statistically significantly lower than 1 degree (Z score = -4.21, P value < 0.01). In terms of discrepancies in the calculations of expected values and controlled measurements, a statistically significant difference between tibial varus values was detected (Z score = -2.33, P value = 0.02), which was also statistically significantly lower than 1 degree (Z score = -4.99, P value < 0.01).
CONCLUSION
The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized. Augmented reality navigation systems can bolster orthopaedic surgeons’ accuracy in achieving precise axial alignment. However, further research is required to further evaluate their efficacy and potential.
Core Tip: Augmented reality navigation systems can bolster orthopaedic surgeons’ accuracy in achieving precise axial alignment. Our study unveils compelling evidence showcasing how Augmented Reality (AR) aids surgeons in achieving meticulous axial alignment. This innovative approach significantly enhances accuracy, marking a paradigm shift in surgical procedures. Surgeons leveraging AR navigation exhibit heightened precision, promising improved patient outcomes. Delve into the full manuscript to grasp the groundbreaking findings propelling orthopaedic surgery into a new era of technological advancement. Elevate your understanding and practice within the realm of AR-guided orthopaedic surgery.
