Technology and Health Care - Volume 32, issue 5

Authors: DeClaire, Jeffrey H. | Wakelin, Edgar A. | Chattinger, Kayla | Plaskos, Christopher

Article Type: Research Article

Abstract: BACKGROUND: Early complications in total knee arthroplasty (TKA) associated with modern robotics platforms integrated with digital balancing technology have not been investigated. OBJECTIVE: The objective was to compare 90-day complication rates between a manual technique and a modern robotic-assisted ligament balancing TKA platform. METHODS: 895 primary TKA procedures from a single surgeon were retrospectively reviewed (614 manual TKA, 281 using a modern robotics platform with an integrated digitally controlled ligament balancing device). Post-operative complications within the 90-day episode of care were recorded by the Michigan Arthroplasty Registry Collaborative Quality Initiative. Differences in complication …rates between techniques were further divided into inpatient hospital, outpatient hospital, and ambulatory surgery center (ASC) cohorts. RESULTS: In the pooled hospital cohort and inpatient hospital cohort, ‘Return to OR’ was significantly lower for the robotic assisted group (1.3% vs 5.2% and 0% vs 4.9%, respectively, p < 0.0370). Specifically, the need for manipulation under anesthesia (MUA) was reduced for the robotics group (0.0% vs 2.5%, p = 0.0352). No differences in overall complication rate or cause of complication was found between manual and robotics cases for the hospital outpatient and ASC cohorts (p ⩾ 0.68). CONCLUSION: Within the hospital setting, robotic assisted ligament balancing technology was associated with reduced 90-day postoperative complications for ‘Return to OR’ and MUA. Show more

Keywords: Total knee arthroplasty, robotics, soft tissue, complications, hospital, ambulatory surgical center, ASC

DOI: 10.3233/THC-231198

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3713-3725, 2024

Authors: Orsi, Alexander D. | Mathew, Manu | Plaskos, Christopher | Wakelin, Edgar A. | Slotkin, Eric M. | Coffey, Simon | Ponder, Corey E. | Keggi, John K. | McMahon, Stephen J.

Article Type: Research Article

Abstract: BACKGROUND: Passive smartphone-based apps are becoming more common for measuring patient progress after total hip arthroplasty (THA). Optimum activity levels during early THA recovery have not been well documented. OBJECTIVES: Correlations between step-count and patient reported outcome measures (PROMs) during early recovery were explored. This study also investigated how demographics impact step-count during early post-operative recovery. METHODS: Smartphone captured step-count data from 666 THA patients was retrospectively reviewed. Mean age was 64 ± 11 years. 55% were female. Mean BMI was 29 ± 8kg/m2 . Mean daily …step-count was calculated for each patient over four time-windows: 60 days prior to surgery (preop), 42–49 days postop (6 weeks), 91–98 days postop (3 months), and 183–197 days postop (6 months). Spearman correlation coefficients and linear regression were used to assess the association between PROMs (HOOS-12, HOOS-Jr, and UCLA) and step-count. Patients were separated into three step-count levels: low (< 2500 steps/day), medium (2500–5500 steps/day), and high (> 5500 steps/day). Age > 65 years, BMI > 35 kg/m2 , and sex were used for demographic comparisons. Post hoc analyses were performed using Welch’s unequal variances t -tests, or Wilcoxon rank-sum tests, both with Bonferroni corrections, where appropriate when comparing between groups. Chi-squared analyses were also used when comparing categorical variables. RESULTS: UCLA correlated with step-count at all time-windows (p < 0.001). HOOS12-Function correlated with step-count preoperatively, at 6 weeks, and at 3 months (p < 0.001). High step-count individuals had improved UCLA scores compared to low step-count individuals preoperatively (Δ 1.5, p < 0.001), at 6 weeks (Δ 0.9, p < 0.001), at 3 months (Δ 1.4, p < 0.001), and at 6 months (Δ 1.4, p < 0.001). High step-count individuals had improved HOOS12-Function scores compared to low step-count individuals preoperatively (Δ 9.6, p < 0.001), at 6 weeks (Δ 5.3, p < 0.001), and at 3 months (Δ 6.1, p < 0.001). Males had greater step-count at all time points (p < 0.001). Younger patients and low BMI patients had greater step-count across all time points (p < 0.001). CONCLUSION: High step-count improved PROMs scores compared to low step-count. Early post-operative step-count was significantly impacted by age, sex, and BMI. Generic recovery profiles may not be appropriate across diverse populations. Show more

Keywords: Total hip arthroplasty, smartphone, step-count, PROMs, remote patient monitoring

DOI: 10.3233/THC-231203

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3727-3736, 2024

Authors: Rossi, Stefano Marco Paolo | Sangaletti, Rudy | Andriollo, Luca | Matascioli, Luca | Benazzo, Francesco

Article Type: Research Article

Abstract: BACKGROUND: Robotic-assisted total knee arthroplasty (TKA) have shown promising results in recent years with improved clinical outcomes using standard primary implants. OBJECTIVE: The purpose of this study was to assess the experience of a single center in correcting severe coronal deformities with the use of a robotic-assisted TKA system and an increased constrained implant. METHODS: Between July 2020 and December 2022, 30 knees in 28 patients with a major deformity and an associated ligament laxity requiring an increased constrained implant treated using an imageless robotic-assisted TKA were prospectively enrolled. Patients included in the …study showed a minimum 15 degrees varus or 10 degrees valgus deviation. RESULTS: 20 cases were varus knees and 10 cases were valgus knees. Postoperative neutral alignment was defined as 0∘ ± 2.5∘ . A CCK implant was used in 20 cases while a Constrained Posterior Stabilized implant was used in 10 cases. A neutral alignment was achieved in all patients. At a minimum 6 months follow up (f-u 6–30 months) clinical outcomes including ROM, KSS, HSS, OKS and WOMAC showed significant improvement and no major complications were registered. CONCLUSIONS: The robotic system showed the achievement of a mechanical alignment with reliable radiographic outcomes and clinical results in the treatment of major deformities of the lower limb with the use of higher constrained implants at short term follow up. Further follow up and studies are necessary to confirm and verify these promising outcomes. Show more

Keywords: Robotics, knee, major deformities, varus, valgus, constaint, computer-aided surgical planning, orthopedic surgery

DOI: 10.3233/THC-231261

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3737-3746, 2024

Authors: Rullán, Pedro J. | Oyem, Precious C. | Pumo, Thomas J. | Khan, Shujaa T. | Pasqualini, Ignacio | Klika, Alison K. | Barsoum, Wael K. | Molloy, Robert M. | Piuzzi, Nicolas S.

Article Type: Research Article

Abstract: BACKGROUND: It is crucial to understand weight trends in patients undergoing total hip arthroplasty (THA). OBJECTIVE: To evaluate preoperative and postoperative weight trends for patients undergoing primary THA and factors associated with clinically significant weight change. METHODS: A prospective cohort who underwent primary unilateral THA (n = 3,011) at a tertiary healthcare system (January 2016 to December 2019) were included in the study. The primary outcomes were clinically significant weight change (> 5% change in body mass index [BMI]) during the one-year preoperative and one-year …postoperative periods. RESULTS: Preoperatively, 66.6% maintained a stable weight, 16.0% gained and 17.4% lost weight, respectively. Postoperatively, 64.0% maintained a stable weight, while 22.6% gained and 13.4% lost weight, respectively. Female sex, Black race, obesity, higher Charlson Comorbidity Index (CCI) scores, and older age were associated with preoperative weight loss. Female sex, obesity, higher CCI scores, and Medicare insurance were associated with postoperative weight loss. Preoperative weight loss was associated with postoperative weight gain (OR = 3.37 [CI: 2.67 to 4.25]; p < 0.001), and preoperative weight gain was associated with postoperative weight loss (OR = 1.74 [CI: 1.30 to 2.3]; p < 0.001). CONCLUSION: Most patients maintained a stable BMI one-year before and one-year after THA. Several factors are associated with weight loss before and after THA. Preoperative weight changes were associated with a reciprocal rebound in BMI post-operatively. Show more

Keywords: THA, BMI, weight change, trends, predictors

DOI: 10.3233/THC-231404

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3747-3760, 2024

Authors: Barberis, Luca | Sabatini, Luigi | Pellegrino, Andrea | Galletta, Claudia | Risitano, Salvatore | Capella, Marcello | Massè, Alessandro | Schiraldi, Marco | Indelli, Pier Francesco

Article Type: Research Article

Abstract: BACKGROUND: Bicruciate-retaining (BCR) total knee arthroplasty (TKA) has seen renewed interest due to the potential for more natural knee kinematics with anterior cruciate ligament (ACL) retention. OBJECTIVE: The present study attempts to determine differences in the 2-year survivorship and patient-reported outcomes between two surgical strategies (traditional instrumentation versus robotics) applied to the extensive use of a modern, 2nd generation BCR TKA design. METHODS: We performed a retrospective study with prospectively collected data of 113 patients who underwent primary TKA between 2018 and 2020 using a 2nd generation BCR TKA implant. Patient …demographics, PROMS, and intra/post-operative complications were collected. Patients were also evaluated according to the use or not of robotics. A Kaplan-Meier analysis was used to evaluate revision-free survival at follow up. RESULTS: 102 patients were enrolled: 90 received traditional surgery and 12 robotic-assisted surgery. The mean age was 68 years (SD 7.76) with an average BMI of 29.6 kg/m2 (SD 3.56). The mean follow up (FU) was 32.4 ± 6.2 months (range 24–45 months). Survivorship at 2 years was 98% (95% CI: 92.4–99.5). Revisions/reoperations were performed for anterior cruciate ligament (ACL) tear (1/4), pain (1/4), arthrofibrosis (1/4) and acute periprosthetic joint infection (PJI) (1/4). At final FU, 92 patients (90.2%) considered themselves satisfied, showing a mean OKS of 40.6 (SD 5.1) and a mean FKS of 76.7 (SD 11.8). No differences in the outcome were found between traditional and robotic-assisted procedures. CONCLUSION: The modern BCR design evaluated in this study achieved excellent results in terms of implant survivorship, low rate of reoperation and clinical results, independently from the use of enabling technologies. Show more

Keywords: Arthroplasty, replacement, knee, anterior cruciate ligament, TKA, BCR, instability

DOI: 10.3233/THC-231608

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3761-3768, 2024

Authors: Rogers, Nathan | Rullán, Pedro J. | Pasqualini, Ignacio | Khan, Shujaa T. | Klika, Alison K. | Surace, Peter A. | Molloy, Robert M. | Piuzzi, Nicolas S. | Bloomfield, Michael

Article Type: Research Article

Abstract: BACKGROUND: The value of robotic-assisted total hip arthroplasty (rTHA) has yet to be determined compared to conventional manual THA (mTHA). OBJECTIVE: Evaluate 90-day inpatient readmission rates, rates of reoperation, and clinically significant improvement of patient-reported outcome measures (PROMs) at 1-year in a cohort of patients who underwent mTHA or rTHA through a direct anterior (DA) approach. METHODS: A single-surgeon, prospective institutional cohort of 362 patients who underwent primary THA for osteoarthritis via the DA approach between February 2019 and November 2020 were included. Patient demographics, surgical time, discharge disposition, length of stay, acetabular …cup size, 90-day inpatient readmission, 1-year reoperation, and 1-year PROMs were collected for 148 manual and 214 robotic THAs, respectively. RESULTS: Patients undergoing rTHA had lower 90-day readmission (3.74% vs 9.46%, p = 0.04) and lower 1-year reoperation (0.93% vs 4.73% mTHA, p = 0.04). rTHA acetabular cup sizes were smaller (rTHA median 52, interquartile range [IQR] 50; 54, mTHA median 54, IQR 52; 58, p < 0.001). Surgical time was longer for rTHA (114 minutes vs 101 minutes, p < 0.001). At 1-year post-operatively, there was no difference in any of the PROMs evaluated. CONCLUSION: Robotic THA demonstrated lower 90-day readmissions and 1-year reoperation rates than manual THA via the DA approach. PROMs were not significantly different between the two groups at one year. Show more

Keywords: THA, direct anterior approach, HOOS, satisfaction, value of robotics

DOI: 10.3233/THC-231646

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3769-3781, 2024

Authors: Álvarez Valdivielso, Ainhoa | Akkaya, Mustafa | Mau, Hans | Luo, T. David | Gehrke, Thorsten | Citak, Mustafa

Article Type: Research Article

Abstract: BACKGROUND: Surgeons still face difficulties when performing aseptic acetabular revision on patients with extensive defects. Advances in three-dimensional printing technology (3DP) have afforded to the surgeons to create a patient-specific implant matching the morphology and topography of the defect. OBJECTIVE: The aim of the current research was to determine the survivorship in the treatment of acetabular bone defects with pelvic discontinuity (PD). METHODS: In order to reconstruct Paprosky type III defects with PD, twenty-three patients underwent revision total hip arthroplasty (THA) utilizing 3D-printed implants (Mobelife). The primary outcomes were the implant-associated failure rate …correlated with survivorship. As secondary variables, complications and the effect of age, sex, comorbidities, history of infections and the presence of other lower limb arthroplasties on a new revision were analyzed. RESULTS: Patients were followed out to a mean of 67.22 ± 39.44 months (range, 0.9–127 months). Mobelife implant mean survival was 102.57 ± 9.90 months (95% CI 83.17–121.96). The cohort’s implant one-year survival rate was 87%; at ten years, it dropped to 78.3%. There were four revisions: three due to periprosthetic joint infection (PJI) and one case due to aseptic loosening. Cox regression analysis did not identify any variable as predictor of failure. CONCLUSION: The use of 3DP patient-specific acetabular components has shown encouraging results and it is a viable treatment option for addressing acetabular defects with combined PD in aseptic THA revision. Show more

Keywords: Acetabular bone loss, Paprosky type III bone defect, pelvic discontinuity, patient-specific implants, 3D printing

DOI: 10.3233/THC-231647

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3783-3792, 2024

Authors: Ciloglu, Osman | Karaali, Evren | Yilmaz, Ahmet | Çetinkaya, Pelin Duru | Unlu, Nurdan | Kaya, Hatice | Unal, Nevzat | Keklikcioglu, Burak

Article Type: Research Article

Abstract: BACKGROUND: It has not yet been fully established that there is coronavirus disease 2019 (COVID-19) involvement in the synovial fluid and it remains a topic of debate. OBJECTIVE: The aim of this study was to evaluate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in knee joint synovial fluid of patients with COVID-19. METHODS: This retrospective study was conducted with an initial screening of patients who were admitted to a tertiary pandemic hospital due to COVID-19 symptoms, and underwent treatment for COVID-19 between March and June 2020. RESULTS: …A total of 2476 patients were hospitalized or received treatment for a possible diagnosis of COVID-19. While the RT-PCR test was positive in 318 patients (12.8%), 2158 (87.2%) were computed tomography positive but reverse transcription-polymerase chain reaction (RT-PCR) negative. Twelve patients were consulted due to acute joint effusion. Of five patients with knee joint effusion and a positive RT-PCR test, the synovial tissue RT-PCR test was positive in only one patient. CONCLUSION: This paper is the first to show the presence of SARS-CoV-2 in synovial fluid. This can be considered of importance for the determination and elimination of the route of transmission, thereby preventing further development and spread of the disease. Show more

Keywords: Coronavirus, COVID-19, SARS-CoV-2, knee arthritis

DOI: 10.3233/THC-240317

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3793-3800, 2024