Introduction

Peak incidence of pulmonary embolism (PE) typically occurs weeks after total hip (THA) or knee (TKA) arthroplasty, long after hospital discharge. We investigated risk factors for acute PE occurring during index hospitalisation.

Functional Ultrasound Elastography (FUSE) of Tendo Achilles is an ultrasound technique utilising controlled, measurable movement of the foot to non-invasively evaluate TA elastic and load-deformation properties. The study purpose is to assess Achilles tendons, paratenon and bursa mechanical properties in healthy volunteers and establish a clinical outcome tool for TA treatment.

We studied 40 Achilles tendons in healthy volunteers using our novel Elastography method, which we developed in the University of Oxford. US scan device (Z.one, Zonare Medical System Inc., USA, 8.5 MHz) with and without the Oxford isometric dynamic foot and ankle mover were used. Tendon insertion, midportion and musculotendinous junction were examined during lateral movement and axial compression/decompression modes. B mode and elasticity images were derived from the raw ultrasound radio frequency data. The anatomical structures mechanical properties were evaluated by a semi-quantitative score of different colours representing stiff tissue (blue) to more soft tissue (green, yellow, red).

The Achilles tendons showed mainly a hard structured pattern on sonoelastography. Compression/decompression modes are best used to demonstrate axial softening, while longitudinal displacement is best used to assess load transfer. The average strain along the tendon was 2% (range 0-6%). The overall correlation (?) between real-time sonoelastography and ultrasound findings was < 0.3. However, the correlation (?) between FUSE UEI and US findings was 1.0

Our findings show that FUSE seems to be a sensitive method for assessment of TA mechanical properties. The B mode and elasticity images must be viewed simultaneously. Elasticity and stiffness measurement may offer an invaluable tool to guide TA rupture and tendonopathy treatment and rehabilitation protocol.

Robots have been used in surgery since the late 1980s. Orthopaedic surgery began to incorporate robotic technology in 1992, with the introduction of ROBODOC, for the planning and performance of total hip replacement. The use of robotic systems has subsequently increased, with promising short-term radiological outcomes when compared with traditional orthopaedic procedures. Robotic systems can be classified into two categories: autonomous and haptic (or surgeon-guided). Passive surgery systems, which represent a third type of technology, have also been adopted recently by orthopaedic surgeons.

While autonomous systems have fallen out of favour, tactile systems with technological improvements have become widely used. Specifically, the use of tactile and passive robotic systems in unicompartmental knee replacement (UKR) has addressed some of the historical mechanisms of failure of non-robotic UKR. These systems assist with increasing the accuracy of the alignment of the components and produce more consistent ligament balance. Short-term improvements in clinical and radiological outcomes have increased the popularity of robot-assisted UKR.

Robot-assisted orthopaedic surgery has the potential for improving surgical outcomes. We discuss the different types of robotic systems available for use in orthopaedics and consider the indication, contraindications and limitations of these technologies.