Computed tomography based three-dimensional surgical preoperative planning (3D-planning) has been expanded to achieve more precise placement of knee and hip arthroplasties. However, few reports have addressed the utility of 3D-planning for the total elbow arthroplasty (TEA). The purpose of this study was to assess the reliability and precision of 3D planning in unlinked TEA. Between April 2012 and April 2014, 17 joints in 17 patients (male 4, female 13) were included in this study. Sixteen patients were rheumatoid arthritis and one was osteoarthritis and the average age at the time of the procedure was 61 years (range 28–88). Unlinked K-NOW total elbow system (Teijin-Nakashima Medical. Co. Ltd.) was used in all cases and 3D planning was performed by Zed View (Lexi.Co.). After the appropriate size and position of the prosthesis were decided on the 3D images [Figure 1], the position of the bone tunnel made for the insertion of humeral and ulnar stem was recorded on axial, sagittal, and coronal plane (4 point measurements for humerus, and 6 points for ulna, See Figure 2). After the elbow was exposed via a posterior approach, bone resection and reaming was performed according to the 3D planning. The surgeon took an appropriate adjustment to align the prosthesis properly during the surgery. The final position of the stem insertion was recorded immediately prior to set the prostheses. We analyzed the accuracy of stem size prediction, the correlation between preoperative and final measurements, and postoperative complications.Objective
Methods
Between 1974 and 1998, 34 patients with primary bone tumors and 28 with soft tissue tumors, all located in the foot, were surgically treated at our institutions. Of the 34 patients with a bone tumor, 27 (79%) had chondrogenic tumors: exostoses, 17; enchondromas, 7; benign chondroblastomas, 2 and chondrosarcoma, 1. This chondrosarcoma was misdiagnosed as a benign chondroblastoma at the initial biopsy. Five months after the initial curettage and bone grrafting, the tumor was recurred as a chondrosarcoma. This patient died with pulmonary metastasis another five months after the below the knee (BK) amputation. The differential diagnosis between benign chondrogenic tumors and low grade chondrosarcoma is very difficult as proposed by Mirra. Whereas the malignant tumor is very rare in the foot, the diagnosis of chondrogenic tumor should be made carefully. Of the 28 soft tissue tumors, diagnoses were giant cell tumor of tendon sheath or pigmented villonodular synovitis, 8; angioleiomyoma, 4; ganglion, 4; hemangioma, 2; miscellaneous benign tumors, 7 and soft tissue sarcomas (STS), 3. All patients with a STS were treated by a BK amputation, a partial foot amputation or a marginal resection, and died with pulmonary metastasis. However the function of the operated limb and the emotional acceptance were better in a patient with the less abrasion surgery.
