Abstract. Introduction. Mako robotic assisted knee arthroplasty requires a planning CT scan within 8 weeks of surgery according to the supplier's protocol. This is often impractical, therefore we evaluated whether CT scans remain valid for an extended period. Methodology. Patients undergoing Mako partial (PKA) and total (TKA) knee arthroplasty were identified from our hospital database. The hospital PACS system was used to define the time interval between the initial planning CT scan and surgery, and whether further imaging was required prior to surgery. Results. 443 consecutive Mako cases (225 TKA and 218 PKA) were undertaken between November 2019 and December 2021 (33 cases to March 2020, and 410 cases from August 2020). CT scans were done within 8 weeks of surgery in 229 patients (51.7%); between 8 and 24 weeks in 148 patients (33.4%); between 24 and 48 weeks in 53 patients (12.0%); and more than 48 weeks in 13 patients (2.9%). Repeat pre-operative radiographs were done in the first 43 patients with a delay to surgery of more than 8 weeks following their CT scan. No gross anatomical changes were identified, and this practice was therefore discontinued. No patients required a repeat CT scan. There were no intra-operative registration errors in any patient in this series. Conclusion.
Total joint arthroplasty (TJA) is one of the commonest and most successful orthopaedic procedures, used for the management of end-stage arthritis. With the recent introduction of robotic assisted joint replacement, Computed Tomography (CT) has become part of required pre-operative planning. The aim of this study is to quantify and characterise incidental CT findings, their clinical significance, and their effect on planned joint arthroplasty. All consecutive patients undergoing an elective TJR (hip or knee arthroplasty) were retrospectively identified, over a 3-year period (December 2019 and December 2022). Data documented and analysed included patient demographics, type of joint arthroplasty, CT findings, their clinical significance, as well as potential delays to the planned arthroplasty because of these findings and subsequent further investigation.Abstract
Introduction
Methodology
COVID-19 reduced availability of cross-sectional imaging, prompting the need to clinically justify pre-operative computed tomography (CT) in tibial plateau fractures (TPF). The study purpose was to establish to what extent does a CT alter the pre-operative plan in TPF compared to radiographs. There is a current paucity of evidence assessing its impact on surgical planning 50 consecutive TPF with preoperative CT were assessed by 4 consultant surgeons. Anonymised radiographs were assessed defining the column classification, planned setup, approach, and fixation technique. At a 1-month interval, randomised matched CT scans were assessed and the same data collected. A tibial plateau disruption score (TPDS) was derived for all 4 quadrants (no injury=0,split=1,split/depression=2 and depression=3). Radiograph and CT TPDS were assessed using an unpaired T-test.Abstract
INTRODUCTION
METHODOLOGY
Our purpose is to analyze the true costs associated with preoperative CT scans performed for robotic assisted TKA planning and also to determine the value of a formal radiologist reading of these studies. We reviewed 194 CT scans of 176 sequential patients who underwent primary RTKA by a single surgeon at a suburban teaching hospital. CT radiology reports were reviewed for the presence of incidental findings that might result in change of care to the patient. Actual payments for technical and professional components of the CT scans were retrieved for 170 of the 176 patients. Any patient payments for the CT scan were also recorded.Introduction
Methods
Pulmonary embolism is a serious complication after arthroscopy of the knee, about which there is limited information. We have identified the incidence and risk factors for symptomatic pulmonary embolism after arthroscopic procedures on outpatients. The New York State Department of Health Statewide
Obtaining solid implant fixation is crucial in revision total knee arthroplasty (rTKA) to avoid aseptic loosening, a major reason for re-revision. This study aims to validate a novel grading system that quantifies implant fixation across three anatomical zones (epiphysis, metaphysis, diaphysis). Based on pre-, intra-, and postoperative assessments, the novel grading system allocates a quantitative score (0, 0.5, or 1 point) for the quality of fixation achieved in each anatomical zone. The criteria used by the algorithm to assign the score include the bone quality, the size of the bone defect, and the type of fixation used. A consecutive cohort of 245 patients undergoing rTKA from 2012 to 2018 were evaluated using the current novel scoring system and followed prospectively. In addition, 100 first-time revision cases were assessed radiologically from the original cohort and graded by three observers to evaluate the intra- and inter-rater reliability of the novel radiological grading system.Aims
Methods
The aims of this study were: 1) to describe extended restricted kinematic alignment (E-rKA), a novel alignment strategy during robotic-assisted total knee arthroplasty (RA-TKA); 2) to compare residual medial compartment tightness following virtual surgical planning during RA-TKA using mechanical alignment (MA) and E-rKA, in the same set of osteoarthritic varus knees; 3) to assess the requirement of soft-tissue releases during RA-TKA using E-rKA; and 4) to compare the accuracy of surgical plan execution between knees managed with adjustments in component positioning alone, and those which require additional soft-tissue releases. Patients who underwent RA-TKA between January and December 2022 for primary varus osteoarthritis were included. Safe boundaries for E-rKA were defined. Residual medial compartment tightness was compared following virtual surgical planning using E-rKA and MA, in the same set of knees. Soft-tissue releases were documented. Errors in postoperative alignment in relation to planned alignment were compared between patients who did (group A) and did not (group B) require soft-tissue releases.Aims
Methods
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 robotic-assisted techniques versus a conventional surgical technique. Three groups of 93 medial UKAs were assessed. The first group was performed by a conventional technique, the second group with an image-free robotic-assisted system (Image-Free group), and the last group with an image-based robotic arm-assisted system, using a preoperative CT scan (Image-Based group). There were no demographic differences between groups. We compared six parameters on postoperative radiographs to assess UKA sizing. Incorrect sizing was defined by an over- or under-sizing greater than 3 mm.Aims
Methods
