Aims. Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%.
Aims. Implant waste during total hip arthroplasty (THA) represents a significant cost to the USA healthcare system. While studies have explored methods to improve THA cost-effectiveness, the literature comparing the proportions of implant waste by intraoperative technology used during THA is limited. The aims of this study were to: 1) examine whether the use of enabling technologies during THA results in a smaller proportion of wasted implants compared to navigation-guided and conventional manual THA; 2) determine the proportion of wasted implants by implant type; and 3) examine the effects of surgeon experience on rates of implant waste by technology used. Methods. We identified 104,420 implants either implanted or wasted during 18,329 primary THAs performed on 16,724 patients between January 2018 and June 2022 at our institution. THAs were separated by technology used:
Aims. No predictive model has been published to forecast operating time for total knee arthroplasty (TKA). The aims of this study were to design and validate a predictive model to estimate operating time for
Aims. Ideal component sizing may be difficult to achieve in unicompartmental knee arthroplasty (UKA). Anatomical variants, incremental implant size, and a reduced surgical exposure may lead to over- or under-sizing of the components. The purpose of this study was to compare the accuracy of UKA sizing with
Introduction.
Abstract.
Aims. The aim of this study was to report patient and clinical outcomes following
Introduction and Objective. In recent studies,
Introduction. Soft tissue releases are often required to correct deformity and achieve gap balance in total knee arthroplasty (TKA). However, the process of releasing soft tissues can be subjective and highly variable and is often perceived as an ‘art’ in TKA surgery. Releasing soft tissues also increases the risk of iatrogenic injury and may be detrimental to the mechanically sensitive afferent nerve fibers which participate in the regulation of knee joint stability. Measured resection TKA approaches typically rely on making bone cuts based off of generic alignment strategies and then releasing soft tissue afterwards to balance gaps. Conversely, gap-balancing techniques allow for pre-emptive adjustment of bone resections to achieve knee balance thereby potentially reducing the amount of ligament releases required. No study to our knowledge has compared the rates of soft tissue release in these two techniques, however. The objective of this study was, therefore, to compare the rates of soft tissue releases required to achieve a balanced knee in tibial-first gap-balancing versus femur-first measured-resection techniques in robotic assisted TKA, and to compare with release rates reported in the literature for conventional, measured resection TKA [1]. Methods. The number and type of soft tissue releases were documented and reviewed in 615
Objectives. The use of the haptically bounded saw blades in
Introduction.
Aims.
Aims. Osteoporosis can determine surgical strategy for total hip arthroplasty (THA), and perioperative fracture risk. The aims of this study were to use hip CT to measure femoral bone mineral density (BMD) using CT X-ray absorptiometry (CTXA), determine if systematic evaluation of preoperative femoral BMD with CTXA would improve identification of osteopenia and osteoporosis compared with available preoperative dual-energy X-ray absorptiometry (DXA) analysis, and determine if improved recognition of low BMD would affect the use of cemented stem fixation. Methods. Retrospective chart review of a single-surgeon database identified 78 patients with CTXA performed prior to
Introduction. There has been renewed interest in the use of unicompartmental knee arthroplasty (UKA) for patients with limited degenerative disease of the knee due to improved surgical techniques and prosthetic design, and the desire for minimally invasive surgery. However, patient satisfaction following UKA for lateral compartment disease have been suboptimal with increased revision rates.
Aims.
Introduction. Unicompartmental knee arthroplasty (UKA) has seen renewed interest in recent years due to improved surgical techniques and prosthetic design, and the desire for minimally invasive surgery. For patients with limited degenerative disease, UKA offers a viable alternative to total knee arthroplasty. Historically, the outcomes of lateral compartment UKA have been inferior to medial compartment UKA, with suboptimal patient satisfaction and increased revision rates.
INTRODUCTION. Successful clinical outcomes following unicompartmental knee arthroplasty (UKA) depend on component positioning, soft tissue balance and lower limb alignment, all of which can be difficult to achieve using manual instrumentation. A new robotic-guided technology has been shown to improve postoperative implant positioning and lower limb alignment in UKA but so far no studies have reported clinical results of
Aims. The aims of this study were: 1) to describe extended restricted kinematic alignment (E-rKA), a novel alignment strategy during
The objectives of our study were to compare patient reported outcome measures between manual and
Introduction. Unicompartmental knee arthroplasty (UKA) has seen renewed interest in recent years and is a viable option for patients with limited degenerative disease of the knee as an alternative to total knee arthroplasty. However, the minimally invasive UKA procedure is challenging, and accurate component alignment is vital to long-term survival.
Total knee arthroplasty is a successful procedure with good long-term results. Studies indicate that 15% – 25% of patients are dissatisfied with their total knee arthroplasty. In addition, return to sports activities is significantly lower than total hip arthroplasty with 34% – 42% of patients reporting decreased sports participation after their total knee arthroplasties. Poor outcomes and failures are often associated with technical errors. These include malalignment and poor ligament balancing. Malalignment has been reported in up to 25% of all revision knee arthroplasties, and instability is responsible for over 20% of failures. Most studies show that proper alignment within 3 degrees is obtained in only 70% – 80% of cases. Navigation has been shown in many studies to improve alignment. In 2015, Graves examined the Australian Joint Registry and found that computer navigated total knee arthroplasty was associated with a reduced revision rate in patients under 65 years of age. Navigation can improve alignment, but does not provide additional benefits of ligament balance.
Background. Robotic assistance is being increasingly utilised in the surgical field in an effort to minimise human error. In this study, we report minimum two-year outcomes and complications for
Introduction. There is increasing pressure on healthcare providers to demonstrate competitiveness in quality, patient outcomes and cost. Robotic and computer-assisted total knee arthroplasty (TKA) have been shown to be more accurate than conventional TKA, thereby potentially improving quality and outcomes, however these technologies are usually associated with longer procedural times and higher costs for hospitals. The aim of this study was to determine the surgical efficiency, learning curve and early patient satisfaction of
Introduction/Aim. The NAVIO
Total hip arthroplasty (THA) is an effective operation for patients with hip osteoarthritis; however, patients with hip dysplasia present a particular challenge. Our novel study examined the effect of
Introduction. Recently
Introduction. Bicompartmental knee replacement (BKR) may be an alternative to total knee arthroplasty (TKA) for degenerative disease limited to two knee compartments. Most commonly, BKA is a combination of medial compartment and patellofemoral compartment resurfacing. In contrast to TKA, BKA preserves the uninvolved compartment and cruciate ligaments possibly leading to advanced stability and more physiologic knee kinematics.
We sought to evaluate the early post-operative active range-of-motion (AROM) between
Patient-reported outcome measures (PROMs) have failed to highlight differences in function or outcome when comparing knee replacement designs and implantation techniques. Ankle-worn inertial measurement units (IMUs) can be used to remotely measure and monitor the bi-lateral impact load of patients, augmenting traditional PROMs with objective data. The aim of this study was to compare IMU-based impact loads with PROMs in patients who had undergone conventional total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and
Background. The JOURNEY™ II Cruciate-Retaining Total Knee System (JIICR) and the JOURNEY™ II Bi-Cruciate Stabilized Total Knee System (JIIBCS) (both, Smith & Nephew, Memphis, TN, USA) are used for the treatment of end-stage degenerative knee arthritis. Belonging to the JOURNEY family of knee implants, the relatively new devices are designed to provide guided motion. Studies suggest that long-term outcomes of
Introduction. Semi-active robots can improve the accuracy and precision of total knee arthroplasty (TKA). The surgical efficiency of the recently introduced NAVIO
Introduction. Total knee arthroplasty (TKA) is a well established treatment option for patients with end stage osteoarthritis. Conventional TKA with manual instruments has been shown to be a cost effective and time efficient surgery. While
Introduction. In total hip arthroplasty, the positioning of the acetabular cup, in particular, has been shown to play an important role in the survivorship of the prosthetic joint. The commonly accepted “safe zone” extends from 5–30° of anteversion to 30–50° of inclination. However, several studies have utilized a more restrictive safe zone of 5–25° of anteversion and 30–45° of inclination, a modification of the Lewinnek zone. Many attempts have been made to develop a more reliable method of positioning the acetabular component.
Introduction. Unicompartmental knee arthroplasty (UKA) has seen renewed interest in recent years and is a viable option for patients with limited degenerative disease of the knee as an alternative to total knee arthroplasty. However, the minimally invasive UKA procedure is challenging and accurate component alignment is vital to long-term survival.
Introduction.
Background. Component positioning in total hip arthroplasty (THA) is critical to achieve optimal patient outcomes. Recent literature has shown acetabular component positioning may be inaccurate using traditional techniques.
Introduction. In prosthetic knee surgery, the axis of the lower limb is often determined only by static radiographic analysis. However, it is relevant to determine if this axis varies during walking, as this may alter the stresses on the implants. The aim of this study was to determine whether pre-operative measurement of the mechanical femorotibial axis (mFTA) varies between static and dynamic analysis in isolated medial femorotibial osteoarthritis. Methods. Twenty patients scheduled for
Arthrofibrosis remains a dominant post-operative complication and reason for returning to the OR following total knee arthroplasty. Trauma induced by ligament releases during TKA soft tissue balancing and soft tissue imbalance are thought to be contributing factors to arthrofibrosis, which is commonly treated by manipulation under anesthesia (MUA). We hypothesized that a
Background. Several recent reports have documented high frequency of malpositioned acetabular components, even amongst high volume arthroplasty surgeons. Robotic assisted total hip arthroplasty (THA) has the potential to improve component positioning; however, to our knowledge there are no reports examining the learning curve during the adoption of robotic assisted THA. Purpose. The purpose of this study was to examine the learning curve of robotic assisted THA as measured by component position, operative time, intra-operative technical problems, and complications. Methods. The first 105
Introduction. Surgical outcome analysis has shifted from surgeon- to patient-reported outcome measures (PROM). High rates of dissatisfaction (13–20%) in PROM after TKA have persisted despite significant advances in pain-management, implant design and introduction of newer surgical techniques. The NAVIO
Unicompartmental knee arthroplasty is realizing a resurgence due to factors such as improved alignment and sizing of components during surgery. This study compares the early results of two implantation techniques –
The use of robotics in total joint arthroplasty is the latest in a long list of expensive technologies that promise multiple positive outcomes, but come with an expensive price tag. In the last decade alone we've seen the same claims for navigation and patient specific instruments and implants. There are various current systems available including a robotic arm, robotic-guided cutting jigs and robotic milling systems. For robotics to be widely adopted it will need to address the following concerns, which as of 2017 it has not. 1). Cost - Very clearly the robotic units come with a significant price tag. Perhaps over time, like other technologies, they will reduce, but at present they are prohibitive for most institutions. 2). Outcomes - One could perhaps justify the increased costs if there was compelling evidence that either outcomes were improved or revision rates reduced. Neither of these has been proved in any type of randomised trial or registry captured data. As with any new technology one must be wary of the claims superseding the results. In 2017 the jury is still out on the cost vs. benefit of
Introduction/Aim. Mid-flexion instability is a well-documented, but often poorly understood cause of failure of TKA. NAVIO
Introduction. Robotic systems have been used in TKA to add precision, although few studies have evaluated clinical outcomes. We report on early clinical results evaluating patient reported outcomes (PROs) on a series of
Introduction. Current CMS reimbursement policy for total joint replacement is aligned with more cost effective, higher quality care. Upon implementation of a standardized evidenced-based care pathway, we evaluated overall procedural costs and clinical outcomes over the 90-day episode of care period for patients undergoing TKA with either conventional (Conv.) or
The
Introduction. The advantages of UKA include bone stock preservation, physiologic kinematics, retention of main knee ligaments, improved proprioception, & better functional outcome. A semi-active robotic system using CT-based data combined with intraoperative registration & tactile feedback has the potential for more precise implant placement & alignment. This purpose of this study was to compare
Introduction. Component position and overall limb alignment following total knee arthroplasty (TKA) have been shown to influence prosthetic survivorship and clinical outcomes.
Unicompartmental knee arthroplasty (UKA) has been gaining popularity in recent years due to its perceived benefits over total knee arthroplasty (TKA), such as greater bone preservation, reduced operating-room time, better post-operative range of motion and improved gait. However there have been failures associated with UKA caused by misalignment of the implants that have lead to revisions. To improve the implant alignment a robotic guidance system called the RIO Robotic Arm has been developed by MAKO Surgical Corp (Ft. Lauderdale, FL), which is designed to give improved accuracy compared to traditional UKA using cutting jigs and other manual instrumentation. The University of Strathclyde in association with Glasgow Royal Infirmary has undertaken the first independent RCT trial of the MAKO system against the Oxford unicompartmental knee arthroplasty – a conventional UKA used in the UK. Motion analysis was used in order to obtain a quantitative assessment of their movement. The results from a total of 51 patients (23 MAKO, 28 Oxford) that underwent a one year post-operative biomechanical assessment were investigated. Motion analysis showed that during level walking the MAKO group achieved a higher knee excursion during the highest flexion portion of the weight bearing stage of the gait cycle (foot-strike to mid-stance) compared to the Oxford group (18.6° and 15.8° respectively). This difference was statistically significant (p-value = 0.03). Other knee excursion values that were compared were from mid-stance to terminal stance, and overall knee flexion. No statistically significant differences were seen in either of these measurements. A subsequent comparison of both MAKO and Oxford groups with a matched normal cohort (50 patients), demonstrated that there wasn't a statistically significant difference between the MAKO group and the normal knees during mean knee excursion from foot-strike to mid-stance (18.6° and 19.5° respectively, p-value 0.36). However the Oxford group, with a lower knee excursion was found to be significantly different to our normal control group (15.8° and 19.5° respectively, p-value < 0.001). This suggests that the
We introduce a novel active tensioning system that can be used for dynamic gap-based implant planning as well as for assessment of final soft tissue balance during implant trialing. We report on the concept development and preliminary findings observed during early feasibility testing in cadavers with two prototype systems. System description. The active spacer (fig 1) consists of a motorized actuator unit with integrated force sensors, independently actuated medial and lateral upper arms, and a set of modular attachments for replicating the range of tibial baseplate and insert trial sizes. The spacer can be controlled in either force or position (gap) control and is integrated into the OMNIBotics. TM.