JACIII Vol.21 No.7 pp. 1180-1188
doi: 10.20965/jaciii.2017.p1180


Interactive Surgery System with 3D Electromagnetic Motion Tracker for Training Surgeons in Skin Cutting Skills Needed in Total Knee Arthroplasty

Yosuke Uozumi* and Kouki Nagamune**

*Research Division on Advanced Information Technology, Cyberscience Center, Tohoku University
6-6-05 Aoba, Aramaki, Aoba-ku, Sendai 980-8579, Japan

**Department of Human and Artificial Intelligence Systems, Graduate School of Engineering, University of Fukui
3-9-1 Bunkyo, Fukui, Fukui 910-8507, Japan

April 7, 2017
July 31, 2017
November 20, 2017
total knee arthroplasty, surgical training system, computer-aided surgery

Total knee arthroplasty (TKA) is an effective surgery for knees damaged by osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. This procedure requires an expert surgeon with a high level of skill and experience. Although a navigation system for improving precision and shortening operative time has been already studied, there has not yet been a study done on an instruction system for improving the skills of surgeons. The purpose of this study is to develop a training system that teaches the TKA surgery so that non-expert surgeons can use it to obtain skin-cutting skills. The proposed method includes a simulator for a model knee with a 3D electromagnetism motion tracker. Through experimentation, a method of evaluating incisions into the skin is established by tracing a line with a mock scalpel. The proposed method is applied to six non-experts. The results for the length experiments are 87.82±8.88 (Set 1: non-teaching), 92.66±5.77 (Set 2: teaching), and 92.14±6.17 (Set 3: non-teaching). The results for the position experiments are 70.64±15.11 (Set 1: non-teaching), 83.63±10.07 (Set 2: teaching), and 82.05±7.80 (Set 3: non-teaching). In conclusion, the proposed method succeeds in teaching the operator scalpel incision skills.

  1. [1] M. H. M. Som, K. Nagamune, and T. Kamiya, “A Development of Force Distribution Measurement System with High Resolution for Total Knee Arthroplasty (Selected Papers from The 6th International Conference on Soft Computing and Intelligent Systems and The 13th International Symposium on Advanced Intelligence Systems (SCIS&ISIS2012)),” J. Adv. Comput. Intell. Intell. Inform., Vol.18, No.2, pp. 213-220, 2014.
  2. [2] R. Gandhi, H. Dhotar, F. Razak, P. Tso, J. R. Davey, and N. N. Mahomed, “Predicting the longer term outcomes of total knee arthroplasty,” The Knee, Vol.17, No.1, pp. 15-18, 2010.
  3. [3] T. J. Gioe, P. Sinner, S. Mehle, W. Ma, and K. K. Killeen, “Excellent survival of all-polyethylene tibial components in a community joint registry,” Clinical orthopaedics and related research, Vol.464, pp. 88–92, 2007.
  4. [4] J. Julin, E. Jämsen, T. Puolakka, Y. T. Konttinen, and T. Moilanen, “Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis: a follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register,” Acta orthopaedica, Vol.81, No.4, pp. 413-419, 2010.
  5. [5] S. J. Spencer, K. Baird, D. Young, and G. R. Tait, “The Rotaglide mobile bearing knee arthroplasty: A 10-to 13-year review from an independent centre,” The Knee, Vol.19, No.1, pp. 20-23, 2012.
  6. [6] S. Kurtz, K. Ong, E. Lau, F. Mowat, and M. Halpern, “Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030,” J Bone Joint Surg Am, Vol.89, No.4, pp. 780-785, 2007.
  7. [7] S. H. Palmer and M. Cross, “Total knee arthroplasty,” 2014.
  8. [8] N. Li, M. Liu, D. Wang, M. He, and L. Xia, “Comparison of complications in one-stage bilateral total knee arthroplasty with and without drainage,” J. of orthopaedic surgery and research, Vol.10, No.1, p. 1, 2015.
  9. [9] T. L. Kahn, A. Soheili, and R. Schwarzkopf, “Outcomes of Total Knee Arthroplasty in Relation to Preoperative Patient-Reported and Radiographic Measures Data From the Osteoarthritis Initiative,” Geriatric orthopaedic surgery & rehabilitation, Vol.4, No.4, pp. 117-126, 2013.
  10. [10] S. Kobashi, “Fuzzy image matching for pose recognition of occluded knee implants using fluoroscopy images,” J. Adv. Comput. Intell. Intell. Inform., Vol.9, No.2, pp. 181-195, 2005.
  11. [11] S. Kobashi, N. Shibanuma, and Y. Hata, “Fuzzy Visual Hull Algorithm for Three-Dimensional Shape Reconstruction of TKA Implants from X-Ray Cone-Beam Images,” J. Adv. Comput. Intell. Intell. Inform., Vol.14, No.2, pp. 122-127, 2010.
  12. [12] D. R. Diduch, J. N. Insall, W. N. Scott, G. R. Scuderi, and D. Font-Rodriguez, “Total Knee Replacement in Young, Active Patients. Long-Term Follow-up and Functional Outcome,” The J. of Bone & Joint Surgery, Vol.79, No.4, pp. 575–82, 1997.
  13. [13] M. C. Dixon, R. R. Brown, D. Parsch, and R. D. Scott, “Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament,” The J. of Bone & Joint Surgery, Vol.87, No.3, pp. 598-603, 2005.
  14. [14] A. J. Carr, O. Robertsson, S. Graves, A. J. Price, N. K. Arden, A. Judge, and D. J. Beard, “Knee replacement,” The Lancet, Vol.379, No.9823, pp. 1331-1340, 2012.
  15. [15] X. Zhao, J. Qin, Y. Tan, R. Mohanan, D. Hu, and L. Chen, “Efficacy of steroid addition to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis,” J. of orthopaedic surgery and research, Vol.10, No.1, p. 1, 2015.
  16. [16] R. L. Kane, K. J. Saleh, T. J. Wilt, B. Bershadsky, W. W. Cross III, R. M. MacDonald, and I. Rutks, “Total knee replacement,” US Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2003.
  17. [17] L. P. Jorn, R. Johnsson, and S. Toksvig-larsen, “Patient satisfaction, function and return to work after knee arthroplasty,” Acta Orthopaedica Scandinavica, Vol.70, No.4, pp. 343-347, 1999.
  18. [18] M. Murphy, S. Journeaux, and T. Russell, “High-flexion total knee arthroplasty: a systematic review,” Int. orthopaedics, Vol.33, No.4, pp. 887-893, 2009.
  19. [19] R. Dattani, S. Patnaik, A. Kantak, and G. Tselentakis, “Navigation knee replacement,” Int. orthopaedics, Vol.33, No.1, pp. 7-10, 2009.
  20. [20] E. A. Rankin, G. S. Alarcon, R. W. Chang, L. M. Cooney Jr, et al., “NIH Consensus Statement on Total Knee Replacement December 8-10, 2003*,” J. of Bone and Joint Surgery, Vol.86, No.6, pp. 1328, 2004.
  21. [21] H. Cost, U. P. Hcup, et al., “HCUP facts and figures: statistics on hospital-based care in the United States, 2008,” 2010.
  22. [22] A. A. O. Orthopaedic Surgeons et al., “Most commonly performed musculoskeletal-related procedures,” available at: research/stats/top_hospitalization_visits.pdf [accessed June 27, 2009]
  23. [23] S. Graves, D. Davidson, L. Ingerson, P. Ryan, E. Griffith, B. McDermott, and N. Pratt, “The Australian orthopaedic association national joint replacement registry,” Medical J. of Australia, Vol.180, No.5, pp. S31-S34, 2004.
  24. [24] Y. Kadono, H. Yasunaga, H. Horiguchi, H. Hashimoto, S. Matsuda, S. Tanaka, and K. Nakamura, “Statistics for orthopedic surgery 2006–2007: data from the Japanese Diagnosis Procedure Combination database,” J. of Orthopaedic Science, Vol.15, No.2, pp. 162-170, 2010.
  25. [25] U. S. Bone and J. Decade, “The burden of musculoskeletal diseases in the United States,” 2008.
  26. [26] D. Oec, “Health at a glance 2011: OECD indicators,” 2011.
  27. [27] “Health at a Glance: Europe 2010,” OECD Publishing, Dec 2010.
  28. [28] D. T. Felson, A. Naimark, J. Anderson, L. Kazis, W. Castelli, and R. F. Meenan, “The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study,” Arthritis & Rheumatism, Vol.30, No.8, pp. 914-918, 1987.
  29. [29] G. Peat, R. McCarney, and P. Croft, “Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care,” Annals of the rheumatic diseases, Vol.60, No.2, pp. 91-97, 2001.
  30. [30] Z. Wang, M. Wei, Q. Zhang, Z. Zhang, and Y. Cui, “Comparison of high-flexion and conventional implants in total knee arthroplasty: a Meta-analysis,” Medical science monitor: Int. Medical J. of Experimental and Clinical Research, Vol.21, pp. 1679, 2015.
  31. [31] G. Hawker, J. Wright, P. Coyte, J. Paul, R. Dittus, R. Croxford, B. Katz, C. Bombardier, D. Heck, and D. Freund, “Health-related quality of life after knee replacement. results of the knee replacement patient outcomes research team study,” The J. of Bone & Joint Surgery, Vol.80, No.2, pp. 163-73, 1998.
  32. [32] O. Robertsson, M. Dunbar, T. Pehrsson, K. Knutson, and L. Lidgren, “Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden,” Acta Orthopaedica Scandinavica, Vol.71, No.3, pp. 262-267, 2000.
  33. [33] R. B. Bourne, B. M. Chesworth, A. M. Davis, N. N. Mahomed, and K. D. Charron, “Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?,” Clinical Orthopaedics and Related Research, Vol.468, No.1, pp. 57-63, 2010.
  34. [34] P. Baker, J. V. d. Meulen, J. Lewsey, and P. Gregg, “The role of pain and function in determining patient satisfaction after total knee replacement Data from the National Joint Registry for England and Wales,” J. of Bone & Joint Surgery, British Volume, Vol.89, No.7, pp. 893-900, 2007.
  35. [35] V. A. Brander, S. D. Stulberg, A. D. Adams, R. N. Harden, S. Bruehl, S. P. Stanos, and T. Houle, “Ranawat Award Paper: Predicting Total Knee Replacement Pain: A Prospective, Observational Study.,” Clinical orthopaedics and related research, Vol.416, pp. 27-36, 2003.
  36. [36] V. Wylde, S. Hewlett, I. D. Learmonth, and P. Dieppe, “Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants,” PAIN, Vol.152, No.3, pp. 566-572, 2011.
  37. [37] P. A. Puolakka, M. G. Rorarius, M. Roviola, T. J. Puolakka, K. Nordhausen, and L. Lindgren, “Persistent pain following knee arthroplasty,” European J. of Anaesthesiology (EJA), Vol.27, No.5, pp. 455-460, 2010.
  38. [38] M. E. Forsythe, “Prospective relation between catastrophizing and residual pain following knee arthroplasty: two-year follow-up,” Pain Research & Management: The J. of the Canadian Pain Society, Vol.13, No.4, pp. 335, 2008.
  39. [39] T. S. Thornhill, “Painful total knee arthroplasty,” Orthopedics, Vol.25, No.9, pp. 965-967, 2002.
  40. [40] D. A. Dennis, “Evaluation of painful total knee arthroplasty,” The J. of arthroplasty, Vol.19, No.4, pp. 35-40, 2004.
  41. [41] A. Toms, V. Mandalia, R. Haigh, and B. Hopwood, “The management of patients with painful total knee replacement,” Bone & Joint J., Vol.91, No.2, pp. 143-150, 2009.
  42. [42] R. L. Kane, K. J. Saleh, T. J. Wilt, and B. Bershadsky, “The functional outcomes of total knee arthroplasty,” J Bone Joint Surg Am, Vol.87, No.8, pp. 1719-1724, 2005.
  43. [43] A. Price, J. Webb, H. Topf, C. Dodd, J. Goodfellow, D. Murray, et al., “Rapid recovery after Oxford unicompartmental arthroplasty through a short incision,” The J. of arthroplasty, Vol.16, No.8, pp. 970-976, 2001.
  44. [44] C. Wang, Z. Han, T. Zhang, J.-x. Ma, X. Jiang, Y. Wang, and X.-l. Ma, “The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis,” J. of orthopaedic surgery and research, Vol.9, No.1, p. 1, 2014.
  45. [45] B. Hopton, M. Tommichan, and F. Howell, “Reducing lateral skin flap numbness after total knee arthroplasty,” The Knee, Vol.11, No.4, pp. 289-291, 2004.
  46. [46] J. E. Paul, A. Arya, L. Hurlburt, J. Cheng, L. Thabane, A. Tidy, and Y. Murthy, “Femoral nerve block improves analgesia outcomes after total knee arthroplasty,” Anesthesiology, Vol.113, pp. 1144-62, 2010.
  47. [47] T. Tennent, N. Birch, M. Holmes, R. Birch, and N. Goddard, “Knee pain and the infrapatellar branch of the saphenous nerve,” J. of the Royal Society of Medicine, Vol.91, No.11, p. 573, 1998.
  48. [48] J.-H. Yoo, S.-H. Park, C.-D. Han, H.-C. Oh, J.-Y. Park, and S.-J. Choi, “Radiologic Outcomes According to Varus Deformity in Minimally Invasive Surgery Total Knee Arthroplasty,” Yonsei Medical J., Vol.57, No.1, pp. 225-231, 2016.
  49. [49] B. R. Smith, A. H. Deakin, J. Baines, and F. Picard, “Computer navigated total knee arthroplasty: the learning curve,” Computer Aided Surgery, Vol.15, No.1-3, pp. 40-48, 2010.
  50. [50] Y. Tashiro, H. Miura, S. Matsuda, K. Okazaki, and Y. Iwamoto, “Minimally invasive versus standard approach in total knee arthroplasty,” Clinical orthopaedics and related research, Vol.463, pp. 144-150, 2007.
  51. [51] I. Han, S. C. Seong, S. Lee, J. H. Yoo, and M. C. Lee, “Simultaneous bilateral MIS-TKA results in faster functional recovery,” Clinical orthopaedics and related research, Vol.466, No.6, pp. 1449-1453, 2008.
Cite this article as:
Yosuke Uozumi and Kouki Nagamune, “Interactive Surgery System with 3D Electromagnetic Motion Tracker for Training Surgeons in Skin Cutting Skills Needed in Total Knee Arthroplasty,” J. Adv. Comput. Intell. Intell. Inform., Vol.21, No.7, pp. 1180-1188, 2017
Yosuke Uozumi and Kouki Nagamune, J. Adv. Comput. Intell. Intell. Inform., Vol.21, No.7, pp. 1180-1188, 2017

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Last updated on May. 19, 2018