Retrospective analysis of robotic unicompartmental and total knee arthroplasties: patient demographics and outcomes.

CONTEXT: With the growing number of robotic knee arthroplasties being performed, new outcomes must be analyzed to provide a database for comparing robotic and nonrobotic surgeries. These results can be utilized in the future to properly assess the significance of utilizing robotic technology in the operating room regarding patient outcomes and cost. OBJECTIVES: The aims of this study are to: (1) analyze adverse outcomes from robotic-assisted knee arthroplasty and its relation to sex, body mass index (BMI), and age; and (2) explore any possible differences in outcomes among robotic-assisted unicompartmental knee arthroplasty (UKA) and robotic-assisted total knee arthroplasty (TKA). It is hypothesized that sex, BMI, and age will play a role in adverse events experienced among robotic-assisted knee arthroplasty. It is hypothesized that adverse outcomes will differ in robotic-assisted TKA v UKA. METHODS: A retrospective analysis was performed utilizing 1,300 patient cases from a single surgeon that underwent robotic-assisted UKA or TKA utilizing a robotic surgical system. Demographics were sorted by age, sex, and BMI. Outcomes were sorted by the type of adverse event. The most common adverse event was further statistically analyzed by age, sex, and BMI and then compared to the total cohort. The most common adverse event was also broken down by TKA vs. UKA. RESULTS: The average age of the individuals undergoing this procedure was 63.6 years, with 52.3 % being female. The average BMI was 32.2. Of the 87 patients who experienced adverse events, 111 total events were documented. Manipulation under anesthesia (MUA) was the highest experienced adverse event. Among the MUA events, 79.5 % had a BMI over 30 (p=0.067), 72.8 % were female (p=0.014), and the average age was 59 years (p=0.019). Among the MUA adverse events, 76.9 % (n=30) were following a TKA and 23.1 % were following a UKA. When considering the entire sample (n=1,300), there was a statistically significant 12.6 times greater odds that an MUA occurred among those who had a TKA vs. UKA (p<0.001). Similar results were discovered when only considering those who had experienced an adverse event (n=87) because the odds of an MUA occurring among those who underwent a TKA was 4.67 times greater than those who underwent a UKA (p<0.001). CONCLUSIONS: MUA was the most common adverse event in this cohort of robotic-assisted knee arthroplasties. The other adverse events did not yield large enough cohort sizes to analyze statistically in relation to specific patient demographics. Younger patients and females were at significantly greater odds of needing MUA. A BMI over 30 was not found to have a statistically significant risk of needing an MUA after robotic-assisted knee arthroplasty. Among the total cohort, those who underwent a TKA were at a 12.6 times greater odds of needing an MUA than those who received a UKA.

Analysis of alternate material Onyx™ for total knee arthroplasty instrumentation sets.

CONTEXT: A 25-pound weight limit is currently set on containerized instrumentation sets by the Association of periOperative Registered Nurses (AORN) and the Association for the Advancement of Medical Instrumentation (AAMI), in order to reduce strain on the staff and ensure that the sets are not too crowded in order to preserve sterilization and drying of the instruments. This is pushing companies to reduce the weight and number of instrumentation sets for the operating room. One solution has been to explore the viability of new, lighter materials such as Onyx. OBJECTIVES: The goal of this study is to evaluate the novel material Onyx as a viable material utilized in reusable total knee arthroplasty (TKA) instrumentation sets utilizing traditional steam sterilization as the sterilization method. METHODS: Mechanical and biocompatibility tests according to the American Society for Testing Materials (ASTM) and International Organization for Standardization (ISO) 10,993 were run to evaluate the Onyx Material to see if it would be a viable alternative to the stainless and martensitic steel that is currently being utilized. RESULTS: Gross warping and cracking after 10 rounds of sterilization was observed. This was qualitatively worse in the Onyx without a carbon fiber component. The Onyx material did not meet biocompatibility standards for its application. CONCLUSIONS: Onyx was determined to not be a viable material for TKA instruments regarding multiple high-pressure and -temperature sterilizations and cytotoxic cell testing.

Clinical, Radiographic, and Patient-Reported Outcomes Associated with a Handheld Image-free Robotic-Assisted Surgical System in Total Knee Arthroplasty.

One of the primary aims of total knee arthroplasty (TKA) is restoration of the mechanical axis of the lower limb. Maintenance of the mechanical axis within 3° of neutral has been shown to result in improved clinical results and implant longevity. Handheld image-free robotic-assisted total knee arthroplasty (HI-TKA) is a novel way of performing TKA in the era of modern robotic-assisted TKA. The aim of this study is to assess the accuracy of achieving targeted alignment, component placement, clinical outcomes, as well as patient satisfaction after HI-TKA.

Arthroscopic removal of a bullet embedded in the acetabulum.

A unique case is described involving the arthroscopic removal of a bullet in the wall of the acetabulum from a low-velocity gunshot wound. The projectile entered the abdomen anteriorly and penetrated the urinary bladder and the inner wall of the acetabulum before becoming embedded intra-articularly in the subchondral bone of the hip joint. After surgical repair of the viscus, the bullet was retrieved from the hip joint using standard arthroscopic portals and a fracture table. Postoperatively, the patient immediately resumed full weightbearing with minimal discomfort and no formal rehabilitation. No complications were encountered. Arthroscopy allowed adequate inspection of the articular surface, irrigation of the joint, and removal of the foreign body while avoiding an invasive arthrotomy with its associated morbidity and soft tissue disruption.

Preoperative magnetic resonance imaging diagnosis of the floating anterior inferior glenohumeral ligament.

Approximately a century ago, labral avulsion from the glenoid was described as a source of recurrent anterior shoulder dislocation. Since then, the significance of other origins of shoulder instability has been a controversial issue. Cadaveric dissection, biomechanical evaluation, and surgical observation have led to the discovery of additional pathologic conditions associated with glenohumeral instability that must be properly identified and addressed for operative success. Recently, several authors have emphasized the importance of lesions of the glenohumeral ligament as a cause of post-traumatic shoulder instability. One such condition is bipolar avulsion of the anterior inferior glenohumeral ligament (AIGHL), or floating AIGHL. In previous reports, this finding has only been identified during surgery. We present a case of traumatic anterior shoulder dislocation in which a preoperative diagnosis of floating AIGHL was made by magnetic resonance imaging. Recognition of this rare lesion before surgical intervention is advantageous for appropriate preoperative planning and management of patients with posttraumatic anterior glenohumeral instability.