Navigation v Conventional Techniques for Orthopaedic Surgery

Navigation v Conventional Techniques for Orthopaedic Surgery Bone Cutting, Soft Tissue Balancing; Cup Implant, Leg Length Discrepancy: Navigation vs. Conventional technique. Introduction In last decade, navigated implantation has become very popular and used in diverse areas of orthopaedic surgeries. This may be in total knee prosthesis, total hip arthroplasty and to restore leg discrepancies. All above surgeries require an accurate alignment of the implant, which is essential for implants long term survival. This is evident from the fact that in total knee replacement (TKR) surgeries proper bone cutting is necessary [1], total knee arthroplasty (TKA) requires correct soft tissue balancing [2], appropriate implantation of cup and stem in total hip arthroplasty (THA) [3], correcting leg discrepancies in total hip replacement (THR) [4]. Navigation system developed improves the reproducibility over conventional methods and assists surgeons with data for optimal position of implant to each individual patient. [2, 3] It was hypothesized that navigation assisted technique would result in achieving bone cut accuracy, better soft tissue balancing, good implant of cup and stem and enhanced joint reconstruction and control in leg length discrepancy as compared to conventionally used methods. Methods To test positioning time and bone cut accuracy in total knee replacement (TKR). Study involved 40 patients (23 females, 17 males) assigned randomly to TKR surgery using either conventional (n=20, mean patient age= 67.3 years) or Pivotal (n=20 mean patient age= 69.1 years) cutting blocks. Primary indication for surgical treatment was osteoarthritis (n=36), rheumatoid arthritis (n=3) and secondary posttraumatic gonarthrosis after tibial plateau fracture (n=1). All cases had posterior stabilized system with standard patellar component. The surgical approach used was medial parapatellar (n=8) or midvastus (n=32) approach. The implants used during the process were Scorpio PS (n=7), Scorpio Flex (n=20), Next Gen LPS (n=10) and LPS Flex Mobile bearing systems (n=4) fixed to bones by pins and screws. Accurate positioning was obtained by using navigation system. Block position was finalized by surgeon using this navigation system. Statistical differences in time and cut angles were measured by Mann-Whitney test (two-tailed; SPSS for Windows, Version 11.5). The significan ce level was set at p ≠¤0.05 for all analyses. [1] To test soft tissue balancing in total knee arthroplasty (TKA). The study included 120 patients [navigation assisted gap-balancing (n=60); conventional resection technique (n=60)], enrolled and randomized using computer-generated numbers. An inclusion criterion was substantial pain and loss of function due to osteoarthritis of knee, with any degree of genu varum deformity. An exclusion criterion was genu valgum deformity, earlier knee surgery that required removal of metallic implant, or revision of TKA. Four patients were lost to follow up and therefore excluded from study. All surgeries were done by single surgeon. Both patient groups showed no significant differences in terms of demographic characteristics, knee functions, preoperative hospital-for-special-surgery (HSS) scores and degree of preoperative deformity. Follow up period was minimum 24 months post-surgery (mean follow up = 28 months). Surgical technique was similar in all patients consisting of midline skin incision and a medial parapatellar approach. Gap measurement was done at full extension and at 90à ¡Ã‚ µÃ¢â‚¬â„¢ of flexion on medial and lateral sides of knee joint and defined as medial extension gap (MEG), medial flexion gap (MFG), lateral extension gap (LEG), and lateral flexion gap (LFG).Clinical outcome assessment was measured by HSS and ranges of motion (ROM) scores at latest follow up. All patients went through pre and post-operative (3months after surgery) standing radiographic assessment of AP and lateral views of entire lower limb. Student’s t-test or Mann–Whitney U tests was used for comparison of four variables in study, postoperative post-operative mechanical axes, HSS scores, and ROMs, between the two groups. The chi-square test was used for comparison of proportion of outliers (trapezoidal gaps) in symmetric gap and mechanical axis. [2] To Test good implant of cup and stem in Total Hip Arthroplasty (THA) The study involved 84 patients in two groups Navigated (42) Nonnavigated (42), with surgeries performed by investigator. Implant position was evaluated in post-operative anteroposterior radiography 2-3months after index surgery. Pelvic radiographs were taken in standing position of patient. Operated hip joints classified on basis of preoperative radiographs in three subgroups: Group 1: preoperative leg shortening (>5 mm); Group 2: preoperative leg length equality ( ±5 mm); Group 3: preoperative lengthening of the operated leg (>5 mm). Projected values for caput collum diaphysis (CCD) classified in three subgroups: 135 °. If any change in leg length was measured using distal line between teardrop figure and proximal corner of the lesser trochanter as an anatomical landmark. Scaling of pre and post-operative radiographs was distance between two teardrops and the head diameter of the hip replacement. Radiographic cup positions were measured for inclination with respect to teardrop line. All surgeries were done when patient was in 30 ° to 45 ° position. Any complication aroused during intraoperative and post operation was documented. General data (CCD angle, age, BMI) for both groups were compared as per Mann-Whitney U test for nonparametric values and chi-square test for distribution of operated leg, gender and indication. [3] To Test enhanced joint reconstruction and control in leg length discrepancy Retrospective study involved 44 patients divided in two groups A (n=22; navigation/computer assisted THR) B (n=22; conventional free hand THR). Inclusion criteria involved patients with BMI 2 cm), or a major deformity of the femoral head or neck were excluded from study. Each patient in group A was matched in group B. This matching was done on basis of age (max difference +3 years), sex, arthritis level, preoperative diagnosis, and preoperative limb length discrepancy (max difference. + 0.3 cm). The length of involved limbs was less than or equal to that of the contralateral limb in all cases. The two groups were also compared according to hip function and number of postoperative dislocations. The same posterolateral approach was made to the hip joint in both groups, and the same prosthesis was used in all cases. The duration of surgery was documented. Digital radiographs (as per standardised protocol using same magnification) were used for pre and post-operative measurements of li mb length discrepancy and femoral offset. Radiographs were repeated if any mistake detected and these radiographs were assessed by independent radiologist blinded to original procedure. All episodes of hip dislocation were documented. At minimum follow-up of 3 months clinical outcome was evaluated using Harris Hip score. Statistical analysis was carried out using SPSS for Windows Release 11.0. Differences between two groups were measured using independent Students t-test or Mann-Whitney nonparametric test depending on the data distribution of the continuous variables. [4] Results Pivotal block consumed approximately half the time to adjust saw blade and perform proximal tibial and anterior and femoral resections as compared to conventional block. Statistically significant difference was observed in Pivotal and conventional blocks with respect to angular difference between instrument slots and resultant bone cuts in frontal plane. Also, Pivotal blocks eliminated angular differences >1à ¡Ã‚ µÃ¢â‚¬â„¢. [1] The mean intraoperative gap in conventional resection technique group for MFG (medial flexion gap) was significantly greater (24  ± 3 mm) than navigation assisted (NA) gap-balancing (22  ± 3 mm) (p = 0.028), but other three gaps (LFG, MEG, and LEG) did not differ significantly between the two groups (p = 0.167, 0.693, and 0.471, respectively). Statistical significant difference was seen in terms of kind of gaps in both groups: NA group, 88% (53 knees) -rectangular gaps and 12% (7knees)-trapezoidal gaps. Whereas in conventional group 75% (42 knees) -rectangular gaps and 25% (14knees) had trapezoidal gaps. Greater difference in medial gap difference (MGD; MFG-MEG) outliers in conventional group (23%) than NA group (5%) (p = 0.025). No difference was noticed in average postoperative mechanical axis of lower limb between NA and conventional group (1à ¡Ã‚ µÃ¢â‚¬â„¢  ± 2à ¡Ã‚ µÃ¢â‚¬â„¢ vs. 1à ¡Ã‚ µÃ¢â‚¬â„¢  ± 3à ¡Ã‚ µÃ¢â‚¬â„¢; p=0.558). Greater number of outliers were seen in m echanical axis (>183à ¡Ã‚ µÃ¢â‚¬â„¢ or Statistical difference was noted in patient’s age at time THA, with p value slightly below 0.05. Significant difference was seen during radiologic analysis of cup position {Non-navigated: 53 °, SD 8.1; Navigated: 44 °, SD 5.6, p135 °. No implant related or navigation technology related complications and no joint dislocations in both groups were noted. [3] There was no statistically significant difference in patient demographics. In both groups preoperative limb length discrepancy, no significant differences were noted. (0.9 cm navigation/computer assisted THR vs. 1.1cm free hand/conventional THR). Mean surgical time was 102.6 min, comparatively longer in navigation/computer assisted THR than free hand/conventional THR (87.7 min) Statistically significant difference was seen in mean postoperative leg length discrepancy of 0.4 cm in navigation/computer assisted THR to that of 0.8 cm (free hand/conventional THR). There were no cases of postoperative cases with leg length discrepancy > 1.0 cm >2.0 cm for navigation/computer assisted THR. However, in 9% cases (2patients) postoperative cases with leg length discrepancy > 1.0 cm was noted and 3patients (13.6%) had postoperative over lengthening mean of 0.4 cm in Free hand/conventional THR group. Recreation of femoral offset better in navigation/computer assisted THR than free hand/conventio nal THR group. Preoperative and postoperative femoral offset difference less in navigation/computer assisted THR than free hand/conventional THR, which was statistically significant. No statistically significant differences in Harris Hip Score in both groups. [4] Discussion The comparison of patient groups in navigated and non-navigated techniques may be a possible method for obtaining useful information regarding various orthopaedic surgeries. In our studies long term survival of prosthesis can be improved by accurate positioning of implant. This can save time and improve accuracy of the procedure. Klima, 2008 showed pivotal blocks used during surgery improved bone cuts and reduced time for positioning and adjustment by nearly 50%. In addition, navigation technique used allowed initial positioning to be achieved in 5-10 seconds. Also, navigation system indicated that all patients were within 3à ¡Ã‚ µÃ¢â‚¬â„¢ in frontal plane angular bone cut deviations of ideal mechanical axis. Conventional blocks used were found to be associated with some degree of motion during insertion of pins, but this was not the case with pivotal blocks. [1] Lee. et al, 2010 showed, soft tissue balance can be achieved by having equal extension and flexion gaps after bone cutting and no inclination between medial and lateral bony surfaces. Any error in bone cutting can affect overall postoperative mechanical alignment and quickening of wear process. In study it was found that use of navigation guided gap balancing technique improved in creating accuracy of rectangular space between bones as compared to conventional measured resection technique. Only 12% (7 of 60 patients) in navigation TKAs had outliers of >3mm either medially or laterally in extension gap or 90à ¡Ã‚ µÃ¢â‚¬â„¢ flexion were seen as compared to conventional TKAs (25%) [14 of 56 patients]. As compared to earlier studies, this study had outliers of the medial and lateral compartments together. There was no significant gap differences (FGD, EGD, and LGD) in both navigation assisted and conventional groups, in spite of that navigation guided technique proved to be more reliabl e in attaining equal joint gaps as there were small proportion of outliers in that group. Significant difference was seen in medial gap difference (MGD) in two groups. There were limited outliers in MGD observed and moreover navigation technique can be easily reproduced as compared to conventional technique, so this prevents unnecessary any over release of medial soft tissue during TKA. In addition, navigation system helped surgeon in correcting any kind of deformed alignment. Clinical outcomes were similar to both groups even though navigation group showed more accurate gap balancing than conventional group. This can be attributed to the fact that relatively small amount of asymmetry in soft tissue balancing in conventional group. Also, both groups had relatively short term follow up and inaccurate scoring system. The study had several limitations: during gap measurement patella was in laterally everted position, which is not anatomically correct. Ligament balancing was not taken i n consideration. Gap measurements was done by surgeon who performed operation in the study, this may have led to bias. [2] In a study by Mainard, 2008 showed that comparing navigated and non-navigated techniques can lead to information about benefits and any improvement required for position of implant. In this study, there was a clear and significant improvement of acetabular cup positioning by use of THA navigation. In both methods average total limb lengthening of operated joint was below 10mm (9.2 mm Non-navigated, 8.5 mm Navigated ), i.e. below clinical relevance value and comparable to other studies (mean lengthening 7mm). Mean post-operative limb discrepancy is close to 5 mm (6.2mm Non-Navigated; 4.4mm Navigated) comparable to 3.9 mm in other study with patient pool of 420. This study however had several limitations: retrospective in nature; Measurements of implant position are less accurate than CT based measurements; Radiologic and ante-version taken in standing positions with anteroposterior radiographs (not to exceed deviation of 5 mm compared with CT); Limb length data of un-operated hip join t is small (+ 1.3 mm- navigated ; -1.3mm – nonnavigated); Cup position measurements unimproved as patients radiograph is not in standing position; No change in leg lengthening data using navigated or non-navigated technique. [3] In a study by Confalonieri, et al, 2008 showed that to resurface hip arthroplasty short stem prostheses is an attractive alternative option with same selected indications. In this study 22 patients in each group were match paired using same modular short stemmed femoral component. Strict criteria were adhered to achieve the match. At minimum follow up of 3 months after surgical intervention results showed computer navigation provided better results in correction of limb length discrepancy and restoring original offset. However, there were few limitations associated with the study: Retrospective; patients were not randomized; short follow up; small number of cases in each group (hence, no clinical difference detected and findings for improvement in dislocation risk). [4] Conclusion From above studies it can be concluded that given correct indications navigation guided technique is a minimally invasive surgical option and is significantly better than conventionally used technique in orthopaedic surgeries which proves our original hypothesis. Though it might take a little longer time but can give better and improved results in bone cutting, soft tissue balancing, acetabular implant and correction of limb length discrepancy and restoring original offset depending on patient anatomy. Further research in this area is still directed. References Klima S, Zeh A, Josten C; Comparison of operative time and accuracy using conventional fixed navigation cutting blocks and adjustable Pivotal TM cutting blocks; Computer Aided Surgery, July 2008; 13(4): 225–232. Lee DH; Park JH; Song DI; Padhy D; Jeong WK; Han SB; Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection; Knee Surg Sports Traumatol Arthrosc (2010) 18:381–387. Mainard D, Navigated and Nonnavigated Total Hip Arthroplasty: Results of Two Consecutive Series Using a Cementless Straight Hip Stem; Orthopedics; Oct 2008; 31 (10); 22-26. Confalonieri N; Manzotti A; Montironi F; Pullen C; Leg Length Discrepancy, Dislocation Rate, and Offset in Total Hip Replacement Using a Short Modular Stem: Navigation vs Conventional Free-hand; Orthopedics; Oct 2008; 31 (10); 35-39. 1

Briefly comment on the communication research report Essay

With rapid advancement of new communication technologies, people currently can freely and actively express their own opinions in the new media. For example, the Internet has dramatically changed the ways in which some individuals receive news and information, this is very big different from the traditional forms of communication. However, there are some correlation links between traditional mass communication ways and modern new technology ways(Kotcher,1992;Rubin, 1994). Roberts M, Wanta, W and Dzwo, T (2002) examined one aspect of the Internet: electronic bulletin boards (EBBs). The objective of this study is to investigate if traditional news media sources have an agenda-setting impact on the discussions taking place on the EBBs. In other words, the purpose of the study is to examine the agenda-setting process and the role it may play on the Internet. The report’s dominant methodology is quantitative. As we know, it is a critical issue that appropriate methodology should be taken depending on different research topic. Quantitative approach and qualitative approach have their respective advantages and disadvantages (Fowler, 1993). Quantitative research, through surveys, gathers data about people’s knowledge, opinions, attitudes and behavior. Quantitative research approach is used to generate new knowledge for evidence-based practice. Attention will be given to the advantages and disadvantages of Quantitative research designs for large group research, the principles of reliability and validity, the value of descriptive and inferential statistics and the importance of ethical research conduct. For the topic, it belongs to sociology category, so I think the researchers have used appropriate research approach (quantitative research approach) even though the approach has some disadvantages. This is because quantitative research approach for this topic has the following advantages: Large members of people can be studies; the method is relatively quick and relatively cheap; the results are reliable, and representative of a much wider population than that directly investigated, the personal influence of the research on the results is slight and the data can easily be expressed in statistical form. This enables comparisons to be made between different groups and populations. For this study, the researchers use Internet, its main advantages are low/moderate cost to design; low cost to send; quick to analyse data; easy for respondent to complete and can attach brochures, images, etc. However, Every survey methodology has its weaknesses, and online surveys are no exception. – Not sure who is answering the survey. Like mail studies, it is difficult to insure the desired person actually answers the survey. – Not representative of the population. The Internet population has a slight bias towards younger, more computer literate users, though this is changing all the time and becoming more representative of the population. – Long surveys are more difficult. The personalities of today’s online users makes it difficult to coerce respondents into completing long surveys. – Not a â€Å"mainstream† research methodology, yet. With more experience and comparative analyses of online surveys versus mail and telephone results, online surveys should reach the same level of acceptance as other methodologies. For this research, the researchers use EBBs which has the above weaknesses too. For the research’s method, the researchers use five steps (Roberts, 2002, P456-458): The first step imperative examines whether traditional news media sources have an agenda-setting impact on the discussions taking place on the EBBs. They ask † Do individuals take issue information gained from news media and pass information about this issue online to other electronic bulletin board users? † The second step is selecting the sample. The third step deals with defining categories, time frames, coding units, and context units. The fourth step is content analysis and the final and fifth step of content analysis process is to analyze and interpret the data. The five steps are typical research method that is used by many researchers (McMillan, 2000) and they are very similar with the quantities analysis approach (the Scientific Method) which includes seven steps: Defining the problem; Developing a Model; Acquiring Input Data; Developing a Solution; Testing the Solution; Analyzing the Results and Implementing the Results (Render, 1982). The researchers use an ARIMA model cross-correlational test showed EBB discussions of three issues—immigration, health care, and taxes-correlated with news media coverage, with time lags varying from 1 day to 7 days. In my opinion, the method is appropriate method for the topic. This investigation looks for a more powerful effect than previous agenda-setting researchers. Because of the Internet’s dynamic characteristic of transmitting information from senders to receivers, researchers currently assume that our traditional theories of mass communication can directly apply to online communication (Wimmer, 1994). The researches have an accurate research questions or hypothesis that are: how will the new online communication forms affect the agenda-setting process? Can we assume that the transfer of salience still follows the original hypothesis? How does the condensed and compressed environment of online communication affect what we know about time frame effects? All these questions are explored in their study. By quantitative research, the researchers concluded: † The results demonstrate the usefulness of examining the rule the Internet plays in the agenda-setting process. Media coverage apparently can provide individuals with information to use in their Internet discussions. As the Internet continues to become an important source of information, it also will become an important area for mass communication researchers. † (Roberts, 2002, P464). The report also recommended† future research should link other mass communication theoretical approaches with Internet usage†. Despite the research has some definite problems; online research has many more advantages than disadvantages. When surveying populations, which mimic the demographics of online users, online research can be a primary means of information collection. With other populations, online research can be effective as a supplement to more traditional survey approaches or as a quick impression of your customers (much like qualitative approaches are used). For outlook, as the Internet continues to grow in popularity, investigations of the content of information being sent online similarly will increase in importance. The study takes an important step in linking the Internet to a mainstream mass communication theory. References Kotcher, R. L. (1992). The technological revolution has transformed crisis communication. Public Relations Quarterly, 37(3), 19-21. Rubin, R. , P. Palmgreen, and H. Sypher (1994 eds. ), Communication Research Measures: A Sourcebook, New York: Guilford. Roberts, et al (2002), Agenda setting and issue salience online. Communication Research, Vol. 29 No. 4, August 452-465. Fowler, Floyd J. , Jr (1993). Survey Research Methods, 2nd ed. Newbury Park, CA: Sage Publications. McMillan, S. J. (2000). The microscope and the moving target: The challenge of applying content analysis to the World Wide Web. Journalism and Mass Communication Quarterly, 77, 80-98. Render, B and Stair, R. M (1982). Quantitative Analysis for Management ( The Second Edition). New York: Library of congress Cataloging in Publication Data. Wimmer, R. D. and J. R. Dominick (1994), Mass Media Research: An Introduction, 4th ed. Belmont, CA: Wadsworth.

Hiring a Plant Manager at Dynamo Industries Case Analysis Essay

As the plant is facing two major issues in terms of higher production cost and poor worker relations, the candidate should possess good interpersonal skills as well as knowledge on production processes and management techniques. It would definitely be an advantage if the candidate is promoted within the ranks as this sends good signal within the organization about opportunities for personal growth for the employees. My rank ordering of my top four choices for the Pittsburg job is George Martin, Kathy Joyce, Frank Hall and Jay Davis. George Martin is currently the plant manager for Dynamo. George well with handling stress and interpersonal skills but he did poorly on the ability to resolve conflict. Kathy Joyce is currently a plant manager for Dynamo. She has the experience in the job and the company. She scored well on all areas and in most they build her capability to meet the job description. She also scores well in approaching stress and ability to succeed as a manager. Her overal l interview ratings are good and her performance and her scores are not the highest. My third choice is Frank Hall. His scores on work samples were among the highest and he scored in the normal range for intelligence and high on handwriting. Frank’s interviewer skills were high. His personality profile concerns me because ability to manage stress is mandatory in management positions and he fall in the low area. Otherwise he is in the medium range for all other personality testing. He also has experience in the field and as a plant manager. My fourth choice would be Jay Davis who is an assistant plant manager and has experience in management through this position in both St. Paul and Atlanta. He scores well in most of the personality profiles but a major issue was interacting with others and it might be a problem for working with other work related conflicts. He scored highest in intelligence, which leads me to believe he can meet the standards of the job descriptions. He was the lowest in work sample scoring, but highest in promotability which is keeping him f rom being in the top position for the job. My changes would include dropping the handwriting. Another  suggestion is to explain what the purpose of the intelligence test is or stop using it. There should also be better explanation of the criteria of the interviews. The personality profile is excellent and putting more emphasis on this would be a good idea. Also, it would be better to have an idea why each of the people applied for the position and why they feel they can do the job. In Conclusion, Looking at the various rating and the interview scores, two candidates stand out on overall selection to be selected as Plant Manager George Martin and Kathy Joyce. However, I would prefer Kathy Joyce because other than the selection evaluation scores, she is an employee of the company already.

The Effect Of Stretching On Muscle Strength And Performance

Increased muscle strength and performance is sought after by athletes of almost every discipline, as well as others simply looking to increases their health and fitness. Stretch and flexibility is another area of fitness, one that is often neglected by most people. However, the effect of stretching on both muscle strength and performance is disputed by the relatively few studies that have actually been done on the topic. The results of the studies have ranged from concluding that stretching has a negative effect on strength on performance to concluding that it has no effect to even concluding that it can have a positive effect. Many factors play a role in muscle strength and performance so it is difficult to conclusively determine what is due to stretching and what is due to one of the other variable that come into play when exercising and training. Knowing the effect of stretching on muscle strength and performance would allow athletes and their trainers to develop more efficient an d productive training plans to help the athletes achieve a higher level of performance. Most people are under the impression that stretching lengthens muscles and that an increase in flexibility is due to an increase in the length of the muscle itself. This is not accurate. Flexibility is not achieved by having long muscles, but rather having to do with the length-tension relationship of the muscle (Magnusson 1998). 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