OBJECTIVE: Accurately predicting the implant size in total knee arthroplasties could increase the efficiency of the operation, decrease the costs associated with the procedure and result in improved patient outcomes. To substantiate its continued use, digital templating must demonstrate itself to be an accurate tool in predicting component size in order for surgeons to confidently use it to optimize the procedure.
METHODS: A systematic literature review was performed and identified 16 studies within the Pubmed, Ebsco and Ovid-Embase databases, with 1189 TKR prostheses included for analysis. A quality of evidence assessment was performed on each study depending on the study design. A random effects meta-analysis model was used to pool overall implant accuracy and the reported inter-rater agreement when performing digital templating and displayed in a forest plot. Meta-regression was used analyze potential factors that may affect the accuracy of digital templating.
RESULTS: The pooled proportion of accurate templates with 0 margin of error was found to be 56% (52-61, 95CI), which increases to 96% (0.94-0.98, 95CI) when allowing for a 1 size margin of error. Subgroup analysis between femoral and tibial components concluded no statistically significant difference.
CONCLUSIONS: This study supports the continued use of digital templating for planning total knee arthroplasties and recommends further subgroup analysis of patient age, body mass index and sex against accuracy. This review was registered in the International Prospective Register of Systematic Reviews Database under ID: CRD420222367461. No funding was provided for the completion of this systematic review.
BACKGROUND: Templating in the preoperative planning of total knee arthroplasties is a vital step in ensuring maximum operative efficiency. A method that can accurately predict the required implant size within 1 size could improve theatre turnover, decrease costs and benefit patient outcomes. The current literature on the accuracy of digital templating in total knee arthroplasties lacks a systematic review calculating the overall accuracy of the process, this study aims to address this gap.

Prosthetic alignment is a highly subjective process that is still based on clinical judgments. Thus, researchers have aimed their effort to quantify prosthetic alignment by providing an objective method that can assist and guide prosthetists in achieving transtibial (TT) prosthetic alignment. This systematic review aimed to examine the current literature on TT prosthetic alignment to scope the qualitative and quantitative methods designed to guide prosthetists throughout the TT prosthetic alignment process as well as evaluate the reported instruments and devices that are used to align TT prostheses and their clinical feasibility. A literature search, completed in June 2022, was performed using the following databases: Web of Science (Clarivate), SCOPUS (Elsevier), and Pub Med (Medline) with searching terms focusing on TT, prosthesis, prosthetist, prosthetic alignment, and questionnaires, resulting in 2790 studies being screened. Twenty-four studies have used quantitative methodologies, where sensor technologies were found to be the most frequently proposed technology combined with gait analysis tools and/or subjective assessments. A qualitative method that assists prosthetists throughout the alignment process was not found. In this systematic review, we presented diverse methods for guiding and assisting clinical decision-making regarding TT prosthetic alignment. However, most of these methods considered varied parameters, and there is a need for elaboration toward standardized methods, which would improve the prosthetic alignment clinical outcome.

OBJECTIVE: This systematic review aimed to investigate the reliability of AI predictive models of intraoperative implant sizing in total knee arthroplasty (TKA).
METHODS: Four databases were searched from inception till July 2023 for original studies that studied the reliability of AI prediction in TKA. The primary outcome was the accuracy ± 1 size. This review was conducted per PRISMA guidelines, and the risk of bias was assessed using the MINORS criteria.
RESULTS: A total of four observational studies comprised of at least 34,547 patients were included in this review. A mean MINORS score of 11 out of 16 was assigned to the review. All included studies were published between 2021 and 2022, with a total of nine different AI algorithms reported. Among these AI models, the accuracy of TKA femoral component sizing prediction ranged from 88.3 to 99.7% within a deviation of one size, while tibial component sizing exhibited an accuracy ranging from 90 to 99.9% ± 1 size.
CONCLUSIONS: This study demonstrated the potential of AI as a valuable complement for planning TKA, exhibiting a satisfactory level of reliability in predicting TKA implant sizes. This predictive accuracy is comparable to that of the manual and digital templating techniques currently documented in the literature. However, future research is imperative to assess the impact of AI on patient care and cost-effectiveness.
METHODS: PROSPERO registration number: CRD42023446868.

OBJECTIVE: To evaluate the efficacy and safety of contact lenses (CL) as a therapeutic option for patients affected by a corneal disease and to determinate which is the best lens modality for each disease.
METHODS: A literature review using PubMed was performed. All relevant articles published during the last 15 years have been included.
RESULTS: Various studies point to CL as the best therapeutic option for some corneal diseases and even as an alternative to surgery in some cases. After fitting, patients show an improvement in their functional vision and quality of life, in some cases being able to drive or work again.
CONCLUSIONS: There is a lack of scientific evidence to determine which lens modality is suitable for each corneal pathology. Currently, according to this review, the reason for choosing between the different options depends on the severity of symptoms, and it is worth mentioning that scleral lenses seem to be the best option in advanced stages of disease. However, the expertise of professionals is also an important factor at the time of choosing a particular CL modality. Standardized criteria are still necessary for correct selection of lens modality for a correct management of the disease.

BACKGROUND: Fit and alignment are observable objectives of the prosthesis rendering process for individuals with lower limb amputation. Nevertheless, there is a dearth of validated measures to directly assess the quality of this clinical procedure.
OBJECTIVE: The objectives of this scoping review are to evaluate existing measurement parameters and clinical outcomes used in investigations of transtibial socket fit or prosthetic alignment and to identify gaps in the literature regarding tools for evaluation of prosthetic fitting.
METHODS: Scoping literature review.
METHODS: A comprehensive search was conducted in the following databases: MEDLINE (through PubMed), Embase (through Elsevier), Scopus (through Elsevier), and Engineering Village (through Elsevier), resulting in 6107 studies to be screened.
RESULTS: Sixty-three studies were included in the review. When measuring fit, studies most frequently reported on patient-reported comfort (n = 22) and socket size compared with the residual limb volume (n = 9). Alignment was most frequently measured by the prosthetists\' judgment and/or use of an alignment jig (n = 34). The measurement parameters used to determine alignment or fit varied greatly among the included studies.
CONCLUSIONS: This review demonstrated that most measures of socket fit rely on a patient\'s self-report and may vary with biopsychosocial factors unrelated to the socket fitting process. Meanwhile, alignment is determined mostly by the prosthetist\'s judgment, paired with objective measurements, such as alignment jigs and gait analysis. Efforts to standardize and validate measures of these parameters of prosthetic fitting are vital to improving clinical practice and reporting outcomes.

Total knee arthroplasty is an effective treatment for end-stage knee osteoarthritis. The tibial platform osteotomy must take full account of the coronal plane, the sagittal plane, and the rotational alignment of the tibial prosthesis. During surgery, individual differences in the coronal alignment of the tibia need to be taken into account as poor alignment after surgery can lead to rapid wear of the tibial platform, reducing the longevity of the prosthesis and adversely affecting quality of life. Intraoperative tibial osteotomies are often performed using extramedullary alignment. When an extramedullary alignment approach is used, the proximal tibial osteotomy guide is usually placed in the medial third of the tibial tuberosity. There is no consensus on the most reliable anatomical landmarks or axes for achieving distal tibial coronary alignment. Anatomical points or reference axes that are highly reproducible and precise need to be identified. From available data it appears that most surgeons use the extensor hallucis longus tendon, the second metatarsal, and the anterior tibial cortex to determine the distal localization point. However, its accuracy has not been confirmed in clinical and radiographic data, and the alignment concept and preoperative planning for total knee arthroplasty has paid more attention to rotational alignment, but there are few studies on the coronal alignment of the tibia. This article reviews the recent use of the distal tibial coronal osteotomy reference point in total knee arthroplasty. However, due to there being only a small number of studies available, the evidence collected is insufficient to prove that a certain reference axis has obvious advantages and a combination of different reference points is needed to achieve the ideal lower extremity force line angle.

The success of total knee arthroplasty (TKA) depends on restoration of the stability and biomechanical efficiency of the native knee. The emergence of robotic surgical technologies has greatly increased the precision and reproducibility. We discuss contemporary robotic TKA systems by reviewing the features of the individual platforms, their accuracy, and the clinical outcomes. While early results suggest significant gains in patient outcomes, long-term evidence is still awaited from multicenter prospective clinical trials. Moreover, advances in this technology are needed to address knee laxity while individualizing the functional performance of each patient\'s new joint.

UNASSIGNED: In persons with a hip or knee flexion contracture ≥25°, fitting a prosthesis is said to be difficult. This systematic review aims to assess the evidence for fitting of a prosthesis in persons with a severe contracture (≥25°) after a lower limb amputation.
UNASSIGNED: PubMed, Embase, Scopus, CINAHL, and Orthotics & Prosthetics Virtual Library databases were searched from inception to December 2019, using database specific search terms related to amputation, prosthesis, and contracture. Reference lists of included studies were checked for relevant studies. Quality of the included studies was assessed using the critical appraisal checklist for case reports (Joanna Briggs Institute).
UNASSIGNED: In total, 13 case studies provided evidence for fitting of a prosthesis in more than 63 persons with a transtibial amputation and three with a transfemoral amputation, all of whom had a hip or knee flexion contracture ≥25°. Some studies found a reduction in contractures after prosthesis use.
UNASSIGNED: Several techniques for fitting a prosthesis in case of a flexion contracture ≥25° were found. Contracture reduction occurred in some cases and was possibly related to prosthesis use. Fitting a transtibial or transfemoral prosthesis in persons with a lower limb amputation with a severe flexion contracture is possible.IMPLICATIONS FOR REHABILITATIONThis study provides information on prosthesis prescriptions and adaptations for persons with a transfemoral and transtibial amputation with a flexion contracture ≥25°.The fitting of bent prostheses is not limited by prosthetic components and techniques.Parallel to the use of bent prostheses, it is also important to treat the contracture.

Most major lower limb amputations are related to peripheral artery disease (PAD) or diabetes. Just 40% of patients who undergo major lower limb amputation will use a prosthesis yet measures of surgical success commonly focus on prosthesis use. Patient reported outcome measures (PROMs) are valuable to comprehensively evaluate health related quality of life (HRQL) after surgery. This systematic review aimed to identify and describe PROMs available to assess HRQL in patients after amputation for PAD or diabetes.
A search was conducted based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) for systematic reviews of PROMs. Ovid MEDLINE, Ovid EMBASE, PsycINFO, CINAHL, and Cochrane CENTRAL were also searched from inception until August 2019. Included were articles describing the development, measurement properties, or evaluation of HRQL via a PROM in adult patients after amputation for PAD or diabetes. Studies of amputation exclusively for trauma or malignancy were excluded. Data were collected on study characteristics, PROM characteristics (generic/disease specific), and properties of amputation specific PROMs.
Of 3 317 abstracts screened, 111 full text articles were assessed for eligibility and 64 included. Fifty-six studies evaluated HRQL, with 23 (46%) of these using an amputation specific PROM to do so. Eleven different amputation specific PROMs were identified, 10 (91%) of which were developed only for prosthesis users. One measure was suitable for use in all patients after amputation. This \"Amputee single item mobility measure\" includes a single item evaluating mobility. Nine studies reported some psychometric testing of an amputation specific PROM.
A well tested, multidimensional PROM applicable to wheelchair and prosthetic users after amputation is lacking and urgently needed for studies in this field. Future work to develop an appropriate measure is required.

To describe outcomes using impression based-scleral devices for the management of anterior segment disease.
Retrospective chart review identified all patients who were fitted with impression-based scleral devices between January 1, 2013 and June 30, 2019 at three specialty contact lens practices. Patient demographic data, indication for device use, visual and physiological outcomes, as well as details of the fitting process and survival of device use were determined.
Forty-four patients (70 eyes) were included in the study. Primary indications for device use included corneal irregularity (28 patients, 44 eyes) and ocular surface disease (16 patients, 26 eyes). Fifty-four percent of patients had more than one ocular surface condition, and 39 % of patients had undergone at least one anterior segment surgical procedure. Twenty-nine patients had unsuccessfully attempted to wear standard scleral lenses prior to being fit with impression-based devices. Visual acuity improved significantly with impression-based devices compared to habitual correction (p < 0.001). Completion of the fitting process (including visit to acquire the impression and post-fitting assessments) required an average of 4 [1.5] visits.Ideal haptic alignment was achieved with 74 % and complete limbal clearance was achieved in 83 % of fits. Device use was discontinued due to complications in two eyes.
Patients with complex eye disease who are unable to successfully wear standard scleral lenses successfully may achieve visual and therapeutic success with impression-based devices.