First molecular identification and phylogenetic illustration of Sarcocystis species infection in Red Sea shortfin mako shark (Isurus oxyrinchus Rafinesque, 1810).

BACKGROUND: members of the genus Sarcocystis are intracellular obligate protozoan parasites classified within the phylum Apicomplexa and have an obligate heteroxenous life cycle involving two hosts. A more comprehensive understanding of the prevalence and geographic range of different Sarcocystis species in marine ecosystems is needed globally and nationally. Hence, the objective of this study was to document the incidence of Sarcocystis infection in sharks within the aquarium ecosystem of Egypt and to identify the species through the characterization of the SSU rDNA gene. METHODS: All organs of the mako shark specimen underwent macroscopic screening to detect the existence of a Sarcocystis cyst. Ten cysts were collected from the intestine and processed separately to extract the genomic DNA. The polymerase chain reaction (PCR) was accomplished by amplifying a specific 18S ribosomal RNA (rRNA) gene fragment. Subsequently, the resulting amplicons were subjected to purification and sequencing processes. RESULTS: Macroscopic examination of the mako shark intestinal wall sample revealed the presence of Sarcocystis cysts of various sizes and shapes, and sequencing of the amplicons from Sarcocystis DNA revealed a 100% nucleotide identity with the sequence of Sarcocystis tenella recorded from sheep in Iran; The mako shark sequence has been deposited in the GeneBank with the accession number OQ721979. This study presents the first scientific evidence demonstrating the presence of the Sarcocystis parasite in sharks, thereby documenting this specific marine species as a novel intermediate host in the Sarcocystis life cycle. CONCLUSIONS: This is the first identification of Sarcocystis infection in sharks, and we anticipate it will be an essential study for future screenings and establishing effective management measures for this disease in aquatic ecosystems.

High three-dimensional accuracy of component placement and lower limb alignment using a robotic arm-assisted system and gap-balancing instrument in total knee arthroplasty.

PURPOSE: It was hypothesized that robotic arm-assisted total knee arthroplasty (RA-TKA) using additionally a gap-balancing instrumentation will show high accuracy in executing the planning in femoral and tibial component placement throughout the range of knee motion (ROM) during TKA surgery. METHODS: Prospectively collected data were analysed for patients undergoing RA-TKA. A cruciate retaining cemented design was implanted using the MAKO® robotic system. Lower limb alignment at 0°, 30°, 45°, 60° and 90° of flexion was recorded at the beginning of surgery and finally after implantation of the components. A ligament tensioner was inserted after tibial precut to measure the extension and flexion gap, and final component placement was planned based on 3D CT images. Femoral and tibial component placement was measured in all three planes. RESULTS: A total of 104 patients were included (mean age 69.4 ± 9 years; 44 male, 60 female). The difference in component placement after planning and final implantation showed less valgus of 0.7° ± 1.4° (p < 0.001), less external rotation of 0.6° ± 1.9° (p = 0.001) and less flexion of 0.9° ± 1.8° (p < 0.001) for the femoral component. The tibial component was placed in more varus of 0.2° ± 0.9° (p = 0.056) and more posterior slope of 0.5° ± 0.9° (p < 0.001). The lower limb alignment in extension was 4.4° ± 5.2° of varus of the native knee and changed to 1.2° ± 1.9° of varus after TKA (p < 0.01). CONCLUSION: Robotic-assisted TKA helps to achieve the target of alignment and component placement very close to the planning. It allows optimal component placement of off-the-shelf implants respecting patient's specific anatomy. LEVEL OF EVIDENCE: Level II.

Comparison of the efficacy and safety of MAKO robot-assisted total knee arthroplasty versus conventional manual total knee arthroplasty in uncomplicated unilateral total knee arthroplasty a single-centre retrospective analysis.

PURPOSE: To compare the efficacy and safety of MAKO robot-assisted total knee arthroplasty (MA-TKA) with conventional manual total knee arthroplasty (CM-TKA) in patients with end-stage knee osteoarthritis (KOA) during the early postoperative period. METHOD: A retrospective analysis was conducted on 22 patients with KOA who underwent MA-TKA and 26 patients who underwent CM-TKA from April 2023 to July 2023. Hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), American Knee Society Score (AKSS), Forgotten Joint Score-12 (FJS-12), visual analogue scale (VAS), and postoperative complications were recorded and compared between the two groups. RESULT: Both groups successfully completed the surgeries. In terms of radiographic parameters, postoperative one month LDFA and HKA in the MA-TKA group were significantly lower than those in the CM-TKA group (P < 0.05). At the one month follow-up, 19 patients (86.4%) in the MA-TKA group had an HKA less than 3°, compared to 20 patients (76.9%) in the CM-TKA group. Clinically, VAS scores at 24 h, 48 h, and 72 h postoperatively were lower in the MA-TKA group both at rest and during activity. At one month and three months postoperatively, AKSS Function Scores and FJS-12 scores in the MA-TKA group were significantly higher than those in the CM-TKA group (P < 0.05). Regarding postoperative complications, no complications occurred in the MA-TKA group, while one patient in the CM-TKA group experienced postoperative knee stiffness, which resolved after physical therapy, with no statistically significant difference (P > 0.05). CONCLUSION: Compared with conventional manual total knee arthroplasty, MAKO robot-assisted TKA demonstrates better short-term clinical efficacy, achieves better alignment planning, and maintains good safety.

Direct anterior approach with conventional instruments versus robotic posterolateral approach in elective total hip replacement for primary osteoarthritis: a case-control study.

BACKGROUND: The purpose of this study is to compare peri-operative and short-term outcomes in patients who underwent elective total hip replacement (THA) for primary osteoarthritis (OA) with direct anterior approach (DAA) versus a pair-matched cohort of patients who underwent robotic-assisted THA with posterolateral approach. MATERIALS AND METHODS: Data from consecutive patients who underwent elective hip replacement from 2021 to 2023 for primary OA were retrospectively retrieved and divided into two groups: the DAA group, who underwent THA with the DAA approach using conventional instruments, and the robotic posterolateral (R-PL group), who underwent robot arm-assisted THA with the posterolateral approach. Comparative assessed outcomes were: operative time, radiographical implant positioning, intake of rescue analgesics, blood loss, transfusion rate, leg length discrepancy and functional outcomes (Harris hip score and forgotten joint score). RESULTS: A total of 100 pair-matched patients were retrieved with a mean age of 66.7 ± 10.7 (range: 32-85) years and a mean follow-up of 12.8 ± 3.6 (range: 7-24) months. No differences in patients' characteristics were detected. Patients in the R-PL group required less rescue tramadol (p > 0.001), ketorolac (p = 0.028) and acetaminophen (p < 0.001). There was no significant difference in the operative time between (MD = 5.0 min; p = 0.071). Patients in the DAA group had significantly lower Hb levels at day 1 (p = 0.002) without significant differences in transfusion rate (p = 0.283). Patients in the R-PL group had shorter length of stay (LOS) with a mean difference of 1.8 days [p < 0.001; 95% confidence interval (CI) 1.4-2.3]. No difference in clinical outcomes was found [leg length discrepancy (LLD), p = 0.572; HHS, p = 0.558; forgotten joint score (FJS), p = 0.629]. No radiographical differences were measured in cup inclination (MD = 2.0°, p = 0.069), malpositioning [odd ratio (OR) = 0.2; p = 0.141], stem alignment (OR = 0.3; p = 0.485) and stem sizing (OR = 1.5; p = 1.000). There was no difference in complication rate except for lateral femoral cutaneous nerve damage, which was higher in DAA group (p < 0.001). CONCLUSIONS: R-PL and DAA THA had comparable short-term clinical and radiological outcomes along with similar complication rates. The R-PL group showed significantly lower Hb drop, rescue analgesic consumption and shorter LOS. This is a preliminary study and no strong recommendation can be provided. Further prospective randomized trials are requested to further investigate the cost-effectiveness of robotic surgery in THA. LEVEL OF EVIDENCE: Level IV, case-control study.

Postoperative full leg radiographs exhibit less residual coronal varus deformity compared to intraoperative measurements in robotic arm-assisted total knee arthroplasty with the MAKO™ system.

PURPOSE: Robotic arm-assisted total knee arthroplasty (raTKA), currently a major trend in knee arthroplasty, aims to improve the accuracy of implant positioning and limb alignment. However, it is unclear whether and to what extent manual radiographic and navigation measurements with the MAKO™ system correlate. Nonetheless, a high agreement would be crucial to reliably achieve the desired limb alignment. METHODS: Thirty-six consecutive patients with osteoarthritis and a slight-to-moderate varus deformity undergoing raTKA were prospectively included in this study. Prior to surgery and at follow-up, a full leg radiograph (FLR) under weight-bearing conditions was performed. In addition, a computed tomography (CT) scan was conducted for preoperative planning. The hip-knee-ankle angle (HKA), mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and joint line convergence angle (JLCA) were measured in the preoperative and follow-up FLR as well as in the CT scout (without weight-bearing) by three independent raters. Furthermore, the HKA was intraoperatively assessed with the MAKO™ system before and after raTKA. RESULTS: Significantly higher HKA values were identified for intraoperative deformity assessment using the MAKO system compared to the preoperative FLR and CT scouts (p = 0.006; p = 0.05). Intraoperative assessment of the HKA with final implants showed a mean residual varus deformity of 3.2° ± 1.9°, whereas a significantly lower residual varus deformity of 1.4° ± 1.9° was identified in the postoperative FLR (p < 0.001). The mMPTA was significantly higher in the preoperative FLR than in the CT scouts (p < 0.001). Intraoperatively, the mMPTA was adjusted to a mean of 87.5° ± 0.9° with final implants, while significantly higher values were measured in postoperative FLRs (p < 0.001). Concerning the mLDFA, no significant differences could be identified. CONCLUSION: The clinical importance of this study lies in the finding that there is a difference between residual varus deformity measured intraoperatively with the MAKO™ system and those measured in postoperative FLRs. This has implications for preoperative planning as well as intraoperative fine-tuning of the implant position during raTKA to avoid overcorrection of knees with slight-to-moderate varus osteoarthritis. LEVEL OF EVIDENCE: Level IV.

Is Robotic-Assisted Technology Still Accurate in Total Hip Arthroplasty for Fibrous-Fused Hips?

BACKGROUND: Total hip arthroplasty (THA) for fibrous-fused hips is technically demanding. This study aimed to evaluate the precision and accuracy, as well as the rate of conversion of robotic-assisted THA in such difficult patients. METHODS: We retrospectively analyzed 67 patients (84 hips) who underwent THA with fibrous-fused hips between August 2018 and June 2021 at our institution. Demographics, acetabular cup positioning, leg-length discrepancies, and postoperative Harris hip scores were recorded for all patients. Thirty-six patients (44 hips) who underwent robotic-assisted THA and 31 patients (40 hips) who underwent manual THA were enrolled in this study. RESULTS: The robot accurately executed the preoperative plan, and there were no statistically significant differences between the preoperative planned anteversion, inclination, and postoperative measurements. In the robotic group, the percentage of acetabular cups in the safe zone was significantly higher than in the manual group (87.2 versus 55%, respectively, P = .042). The rate of conversion to manual THA for various reasons in the robotic-assisted THA group was 11.4% (5/44). Compared with manual THA, the mean increase in operative time for conversion from robotic-assisted to manual THA was 24 min (P < .001). CONCLUSION: In patients who have fibrous-fused hips, preoperative planning can be accurately executed by robotic-assisted technology. Compared with manual THA, robotic-assisted THA had a remarkable advantage in improving the frequency of achieving cup positioning within the target zone. Overall, robotic-assisted technology was helpful in such difficult cases, and the approximately 11.4% of cases converted to manual THA are reminders that surgeons should be thoroughly prepared preoperatively.

How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? A comparison of two robotic platforms.

PURPOSE: This study aimed to compare the effect of an image-based (MAKO) system using a gap-balancing technique with an imageless (OMNIbot) robotic tool utilising a femur-first measured resection technique. METHODS: A retrospective cohort study was performed on patients undergoing primary TKA with a functional alignment philosophy performed by a single surgeon using either the MAKO or OMNIbot robotic systems. In all cases, the surgeon's goal was to create a balanced knee and correct sagittal deformity (eliminate any fixed flexion deformity). Intra-operative data and patient-reported outcomes (PROMS) were compared. RESULTS: A total of 207 MAKO TKA and 298 OMNIbot TKAs were analysed. MAKO TKA patients were younger (67 vs 69, p=0.002) than OMNIbot patients. There were no other demographic or pre-operative alignment differences. Regarding implant positioning, in MAKO TKAs the femoral component was more externally rotated in relation to the posterior condylar axis (2.3° vs 0.1°, p<0.001), had less valgus femoral cuts (1.6° vs 2.7° valgus, p<0.001) and more varus tibial cuts (2.4° vs 1.9° varus, p<0.001), and had more bone resected compared to OMNIbot TKAs. OMNIbot cases were more likely to require tibial re-cuts than MAKO (15% vs 2%, p<0.001). There were no differences in femur recut rates, soft tissue releases, or rate of achieving target coronal and sagittal leg alignment between robotic systems. A subgroup analysis of 100 MAKO and 100 OMNIbot propensity-matched TKAs with 12-month follow-up showed no significant difference in OKS (42 vs 43, p=0.7) or OKS PASS scores (83% vs 91%, p=0.1). MAKO TKAs reported significantly better symptoms according to their KOOS symptoms score than patients that had OMNIbot TKAs (87 vs 82, p=0.02) with a higher proportion of KOOS PASS rates, at a slightly longer follow-up time (20 months vs 14 months, p<0.001). There were no other differences in PROMS. CONCLUSION: A gap-balanced technique with an image-based robotic system (MAKO) results in different implant positioning and bone resection and reduces tibial recuts compared to a femur-first measured resection technique with an imageless robotic system (OMNIbot). Both systems achieve equal coronal and sagittal deformity correction and good patient outcomes at short-term follow-ups irrespective of these differences.

Acetabular cup placement and offset control in robotic total hip arthroplasty performed through the modified anterolateral approach.

PURPOSE: The modified anterolateral approach (Röttinger) for total hip arthroplasty (THA) offers great advantages over conventional approaches, especially concerning early postoperative symptoms, which are mild and well tolerated by patients. Robotic-assisted implantation might facilitate rapid adoption of the modified anterolateral approach without exposing surgeons to risks encountered during the learning curve. This study posits that the use of robotic assistance in conjunction with the modified anterolateral approach for total hip arthroplasty (THA) can provide a substantial enhancement in the accuracy of cup placement in comparison to manual surgery. METHODS: Thirty-two robotic-assisted THAs met the inclusion criteria and were matched to 32 conventional cases. Acetabular cup inclination, anteversion, limb-length discrepancy, and acetabular offset were assessed using certified planning software by two independent observers using pre- and postoperative anterior-posterior radiographs. Data was analyzed for normal distribution. Chi2 test was used to determine whether implanted acetabular cups that were within Lewinnek's safe zones were influenced by type of implantation. Effect size estimates and statistical power analysis were also performed to appreciate the appropriateness of the chosen sample size. RESULTS: Robotic-assisted implantation was found to significantly improve acetabular cup placement in terms of inclination (p < 0.001) but not anteversion (p = 0.783). Although mean postoperative limb-length discrepancy and mean acetabular offset did not differ between groups, a significantly smaller variance was found in the robotic-assisted group (p < 0.001) and (p = 0.04), respectively. There were no significant differences between the two groups in terms of consistently implanting the acetabular cup within the Lewinnek safe zones p = 0.641 for anteversion and p = 0.230 for inclination, respectively. CONCLUSIONS: Our results show that although robotic-assisted acetabular cup implantation performed through the modified anterolateral approach did not significantly differ from conventional implantation, it did offer increased accuracy in cup positioning, acetabular bone preservation, and limb-length restoration.

Re-estimation of juvenile Isurus oxyrinchus growth in the Mexican Pacific through a multimodel inference approach and verification of growth band periodicity.

An update of the age and growth for juveniles of the short fin mako shark (I. oxyrinchus) from the Mexican Pacific is presented, based on the analysis of growth band counts from dorsal vertebrae of 198 individuals [110 females, 74-231 cm of total length (TL) and 88 males, 72-231 cm TL) caught during 2008-2018. New available information on vertebral growth band periodicity (biannual deposition in juveniles) and the convenience of using vertebrae form the dorsal region over the cervical region to count growth bands, as well as a multimodel approach, were used. The von Bertalanffy (VB) growth model, Gompertz, logistic and two parameters of VB (2-VB) were fitted to the length-at-age. Only ages ≤6 years were used for the fitting of the models and their performance was compared with the small-sample bias-corrected form of the Akaike information criterion (AICc), their differences ( ∆ i ) and weights ( w i ). Following a multimodel inference approach, the model averaged asymptotic length ( L ¯ inf ), length-at-age 0 ( L ¯ 0 ) and their unconditional standard error ( SE ¯ ), were estimated for each sex scenario using the three-parameter version of each model. The precision of growth band counts was acceptable for the different methods used and by two different readers. The centrum edge analysis (CEA) and marginal increment analysis (MIA) did not support the hypothesis of biannual band pair formation for juveniles, likewise for adults the periodicity could not be verified due to the small sample of large animals. Age was estimated assuming the formation of two pairs of growth bands per year during the first 5 years and one pair of bands per year afterwards considering direct validation information. The estimated ages in years ranged from 0-14 for females and 0-6 for males. The Kimura likelihood ratio test showed no differences in the growth curves of juveniles by sex (P > 0.05). According to the AICc, the 2-VB model better fitted the length-at-age data for combined sexes (Linf = 386.4 cm, k = 0.12 years-1 , L0 = 70 cm). The model averaged L ¯ inf and L ¯ 0 were 378.3 cm ( SE ¯ = 64.5 ) and 69.5 cm ( SE ¯ = 6.3 ), respectively. The growth parameters determined for juveniles of I. oxyrinchus are similar to those estimated in other regions, showing relatively fast growth rate as previously reported, medium longevity in comparison to other shark species and natural mortality close to that reported in the last stock assessment for the North Pacific Ocean. These life-history parameters should be considered to evaluate the population in the region and to develop better fishery management and conservation measures.

Comparison of Postoperative Instability and Acetabular Cup Positioning in Robotic-Assisted Versus Traditional Total Hip Arthroplasty.

BACKGROUND: Robotic-assisted total hip arthroplasty (R-THA) affords precision yet uncertain clinical benefits. This study compares dislocation rates and related revisions between R-THA and manual total hip arthroplasty (M-THA). Secondarily we evaluated cup position, patient-reported outcome measures (PROMs), and postoperative complications. METHODS: A three-surgeon cohort study was conducted on 2247 consecutive patients (1724 M-THA and 523 R-THA) who received a primary THA between January 2014 and June 2020 at a single hospital. Demographics, PROMs, emergency department visits, readmissions, and 90-day complications were collected via the Michigan Arthroplasty Registry Collaborative Quality Initiative. Chart review yielded instability occurrence with an average follow-up of 4 years. Multivariate regression analysis was performed, and a sample of 368 radiographs, including all dislocations, were assessed. RESULTS: There were significantly lower rates of dislocation in R-THA (0.6%) vs M-THA (2.5%; Multivariate odds ratio 3.74, P < .046). All cases of unstable R-THA were successfully treated conservatively, whereas 46% of unstable M-THA were revised for recurrent instability. Cup anteversion (25.6° ± 5.4° R-THA vs 20.6° ± 7.6° M-THA) was greater, and cup inclination (42.5° ± 5.3° R-THA vs 47.0° ± 6.7° M-THA) was lower in the R-THA group (P < .05). No significant differences were noted for demographics, PROMs, or other complications (P > .05). CONCLUSION: R-THA resulted in less than one-fourth the dislocation rate compared to M-THA and no revision for instability. It was associated with no difference in PROMs or other early complications. The influence of R-THA on stability goes beyond simply cup positioning and deserves further study.

MAKO CT-based robotic arm-assisted system is a reliable procedure for total knee arthroplasty: a systematic review.

PURPOSE: The aim of this study was to investigate the clinical and radiological results of the MAKO CT-based robotic-assisted system for total knee arthroplasty (TKA). METHODS: A PRISMA systematic review was conducted using four databases (MEDLINE, EMBASE, Pubmed, GOOGLE SCHOLAR) to identify all clinical and radiological studies reporting information regarding the use and results of the CT-based robotic-assisted system to perform TKA between 2016 and 2020. The main investigated outcome criteria were postoperative pain, analgesia requirements, clinical scores, knee range of motion, implant positioning and the revision rate. The ROBINS-I tool (Risk Of Bias In Non-randomized Studies of Interventions) was used to evaluate the quality of included studies and the risk of bias. RESULTS: A total of 36 studies were identified, of which 26 met inclusion criteria. Of these 26 studies, 14 were comparative. The follow-up varied from 30 days to 17 months. This CT-based, saw cutting Robotic TKA is associated with a significantly lower postoperative pain score (2.6 versus 4.5) and with significantly reduced time to hospital discharge (77 h versus 105), compared with conventional TKA. The two comparative studies assessing functional outcomes at 1 year reported significantly better functional scores with CT-based robotic TKA compared with conventional TKA (WOMAC score: 6 ± 6 versus 9 ± 8 (p < 0.05); KSS function score: 80 versus 73 (p = 0.005)). Only three comparative studies assessed implant positioning, and these reported better implant positioning with CT-based robotic-assisted TKA. CONCLUSION: The CT-based robotic-assisted system for TKA reduced postoperative pain and improved implant positioning with equal or slightly superior improvement of the functional outcomes at one year, compared to conventional TKA. LEVEL OF EVIDENCE: Systematic review level IV.

Joint line is restored in robotic-arm-assisted total knee arthroplasty performed with a tibia-based functional alignment.

INTRODUCTION: Functional alignment (FA) in total knee arthroplasty (TKA) has been introduced to restore the native joint line obliquity, respect the joint line height and minimize the need of soft tissue releases. The purpose of this study was to assess the intraoperative joint line alignment and compare it with the preoperative epiphyseal orientation of the femur and tibia in patients undergoing robotic-arm-assisted (RA)-TKA using FA. MATERIALS AND METHODS: This retrospective study included a consecutive series of patients undergoing RA-TKA between February 2019 and February 2021. The joint line orientation of the femur and tibia in the three-dimensions was calculated and classified on preoperative CT-scans and compared with the intraoperative implant alignment. The tibial cut was performed according to the tibial preoperative anatomy. The femoral cuts were fine-tuned based on tensioned soft tissues, aiming for balanced medial and lateral gaps in flexion and extension. RESULTS: A total of 115 RA-TKAs were assessed. On average, the tibial component was placed at 1.8° varus (SD 1.3), while the femur was placed at 0.8° valgus (SD 2.2) and 0.6° external rotation (SD 2.6) relative to the surgical transepicondylar axis. Moderate to strong, statistically significant relationships were described between preoperative tibial coronal alignment and tibial cut orientation (r = 0.7, p < 0.0001), preoperative femoral orientation in the coronal and axial planes and intraoperative femoral cuts alignment (r = 0.7, p < 0.0001 and r = 0.5, p < 0.0001, respectively). One case (0.9%) of slight tibial component varus subsidence was reported 45-days post-operatively, but implant revision was not necessary. CONCLUSIONS: The proposed robotic-assisted functional technique for TKA alignment, with a restricted tibial component coronal alignment, based on the preoperative phenotype and femoral component positioning as dictated by the soft tissues, provided joint line respecting resections. Further studies are needed to assess long-term implant survivorship, patient satisfaction and alignment-related failures.

Blood transfusion, hospital stay and learning curve in robotic assisted total hip arthroplasty.

Total Hip Arthroplasty (THA) has been defined the surgical procedure of the century considering its outcome and cost-benefit ratio (1). Both standard and robotic assisted procedures are increasing, thus, comparison between standard and robotic surgery become useful to understand the cost-benefit of the latter. The prerequisites of the robotic assisted arthroplasty are precision, accuracy, limitation of errors and safety but, on the other hand, its cost is the main drawback. The primary endpoint of our research was to evaluate differences in terms of blood transfusion rates between standard manual and robotic arm assisted THA. All the robotic procedures have been managed using semi active Robotic Arm interactive orthopaedic System (RIO® MAKO Stryker surgical corporation) in a group of patients who underwent primary uncemented total hip arthroplasty (THA) for osteoarthritis or avascular necrosis. Secondary endpoints were the evaluation of length of hospital stay (LOS), age category, gender and the impact of the learning curve on surgical time in the robotic surgery sample. Our retrospective cohort study was conducted between July 2014 and December 2018. Data have been collected from the Tuscany regional hospital discharge register, extracting the relative Hospital Discharge Forms (SDO). During the period of the study, 1537 patients underwent uncemented total hip arthroplasty for osteoarthritis or avascular necrosis. The sample was divided in two subgroups: 1142 patients (74.3%) operated on with standard manual technique and 395 patients (25.7%) operated on with Mako- Stryker Robotic System. In the descriptive analysis, the average values of age and days of hospitalization with 95% CI were calculated. Mean significance was assessed by the T student test. The association between surgical modality and gender was assessed with the chi-square test. The multivariate logistic regression model was used to evaluate the risk of transfusion (outcome variable), between conventional and robotic surgical techniques. The significance threshold was set up at p <0.05. During the period of the study we observed a decrease in standard surgery and an increase in robotic surgery; an increasing number of women per year underwent total uncemented total hip arthroplasty. We found a statistical significance in favor of robotic procedures in terms of transfusion percentage (OR 6.10, 95% CI 2.96-12.59, p<0,001), highlighting the greatest risk in women (OR 1.90, 95%CI 1.30-2.78, p=0.001 ), length of hospital stay (Mr=4.24, SD=2.04, 95% CI 4.04-4.44) (Ms=8.04, SD=2.84, 95%CI 7.88-8.21), (p<0.01). Operative time in the robotic sample decreased substantially with the rise of surgical experience (106.75±13.4 mins in 2014; 82.79±15.95 mins in 2018) (p<0.01). Since the Robotic procedure is a technologically demanding process, an adequate surgical learning curve is mandatory. Our paper, comparing conventional vs robotic assisted THA, showed in favor of the robotic one, a statistically significant reduction of number of transfusions (p<0.001) and length of hospital stay (p<0.01).

Outcomes of robotic-arm-assisted medial unicompartmental knee arthroplasty: minimum 3-year follow-up.

The purpose of this study was to determine implant survivorship, complications, and re-operation rates, after robotic arm-assisted unicompartmental knee arthroplasty (UKA) at intermediate follow-up. Patient satisfaction and clinical outcome were further investigated, in addition to an analysis of restoration of knee alignment. Fifty-one patients, who received a robotic arm-assisted medial UKA, were prospectively studied, and followed for a minimum of 3 years (mean 51.4 ± 4.5 months). Survival of implants, complications, reoperations, and patients' overall satisfaction were evaluated. WOMAC scores, as well as knee flexion, varus deformity and flexion contracture were further analyzed, before and after surgery. No implant failure or implant-related complication was recorded, and no revision surgery was performed at the last follow-up in any patient. Overall satisfaction was excellent; 96.1% of patients, at the latest follow-up, was satisfied or very satisfied, while none was dissatisfied or very dissatisfied. Total WOMAC score and each score's component was significantly improved after surgery. Knee alignment was significantly improved, as flexion increased, varus decreased, and flexion contracture also decreased. In conclusion, robotic-arm-assisted UKA, through accurate implant positioning, significantly improves range of motion and coronal plane alignment, in appropriately selected patients. Excellent overall satisfaction rates and clinical outcomes can be expected, at intermediate follow-up, along with excellent survival of implants and minimal to none surgery-related morbidity.

Satellite telemetry reveals higher fishing mortality rates than previously estimated, suggesting overfishing of an apex marine predator.

Overfishing is a primary cause of population declines for many shark species of conservation concern. However, means of obtaining information on fishery interactions and mortality, necessary for the development of successful conservation strategies, are often fisheries-dependent and of questionable quality for many species of commercially exploited pelagic sharks. We used satellite telemetry as a fisheries-independent tool to document fisheries interactions, and quantify fishing mortality of the highly migratory shortfin mako shark (Isurus oxyrinchus) in the western North Atlantic Ocean. Forty satellite-tagged shortfin mako sharks tracked over 3 years entered the Exclusive Economic Zones of 19 countries and were harvested in fisheries of five countries, with 30% of tagged sharks harvested. Our tagging-derived estimates of instantaneous fishing mortality rates (F = 0.19-0.56) were 10-fold higher than previous estimates from fisheries-dependent data (approx. 0.015-0.024), suggesting data used in stock assessments may considerably underestimate fishing mortality. Additionally, our estimates of F were greater than those associated with maximum sustainable yield, suggesting a state of overfishing. This information has direct application to evaluations of stock status and for effective management of populations, and thus satellite tagging studies have potential to provide more accurate estimates of fishing mortality and survival than traditional fisheries-dependent methodology.

Virtual reconstruction of the skeletal labyrinth of two lamnid sharks (Elasmobranchii, Lamniformes).

The first virtual reconstruction of the skeletal labyrinth of the porbeagle shark Lamna nasus and the shortfin mako shark Isurus oxyrinchus is presented here using high-resolution micro-computed tomography. The results, in comparison with previously published information, suggest relationships between skeletal labyrinth morphology and locomotion mode in chondrichthyans, but also show that further studies are required to establish such connections. Nevertheless, this study adds to the knowledge of the skeletal labyrinth morphology in two apex elasmobranch species.

Robotics in Arthroplasty: A Comprehensive Review.

Robotic-assisted orthopedic surgery has been available clinically in some form for over 2 decades, claiming to improve total joint arthroplasty by enhancing the surgeon's ability to reproduce alignment and therefore better restore normal kinematics. Various current systems include a robotic arm, robotic-guided cutting jigs, and robotic milling systems with a diversity of different navigation strategies using active, semiactive, or passive control systems. Semiactive systems have become dominant, providing a haptic window through which the surgeon is able to consistently prepare an arthroplasty based on preoperative planning. A review of previous designs and clinical studies demonstrate that these robotic systems decrease variability and increase precision, primarily focusing on component positioning and alignment. Some early clinical results indicate decreased revision rates and improved patient satisfaction with robotic-assisted arthroplasty. The future design objectives include precise planning and even further improved consistent intraoperative execution. Despite this cautious optimism, many still wonder whether robotics will ultimately increase cost and operative time without objectively improving outcomes. Over the long term, every industry that has seen robotic technology be introduced, ultimately has shown an increase in production capacity, improved accuracy and precision, and lower cost. A new generation of robotic systems is now being introduced into the arthroplasty arena, and early results with unicompartmental knee arthroplasty and total hip arthroplasty have demonstrated improved accuracy of placement, improved satisfaction, and reduced complications. Further studies are needed to confirm the cost effectiveness of these technologies.

Precision of robotic guided instrumentation for acetabular component positioning.

Robotic computerized instrumentation that guides bone preparation and cup implantation in total hip arthroplasty was studied. In 38 patients (43 hips) intraoperative cup inclination and anteversion were validated by postoperative CT scans. Planned inclination was 39.9°±0.8° and with robotic instrumentation was 38. 0°±1.6° with no outliers of 5°; on the postoperative CT scan there were 5 outliers (12%). Planned anteversion was 21.2°±2.4° and intraoperatively was 20.7°±2.4° with no outlier of 5°; on the CT there were 7 outliers (16%). The center of rotation (COR) was superior by a mean 0.9±4.2 mm and medial by 2.7±2.9 mm. This robotic instrumentation achieved precision of inclination in 88%, anteversion in 84% and COR in 81.5%.

Identifying subgroups of patients that may benefit from robotic arm-assisted total knee arthroplasty: Secondary analysis of data from a randomised controlled trial.

BACKGROUND: The aims were to assess whether a specific subgroup(s) of patients had a clinically significant benefit in their knee specific outcome or health-related quality of life (HRQoL) when undergoing robotic total knee arthroplasty (rTKA) when compared to manually performed TKA (mTKA). METHODS: One hundred patients were randomised to either rTKA or mTKA, 50 to each group, of which 46 and 41 were available for functional review at 6-months, respectively. Subgroup analysis was undertaken for sex, age (<67-years versus ≥ 67-years), preoperative WOMAC score (<40 versus ≥ 40) and EQ-5D utility (<0.604 versus ≥ 0.604). RESULTS: Male patients undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (mean difference (MD) 16.3, p = 0.011) at 2-months, function (MD 12.6, p = 0.032) and total score (MD 12.7, p = 0.030), and OKS (MD 6.0, p = 0.030) at 6-months. Patients < 67-years old undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 10.3, p = 0.039) at 2-months, and function (MD 12.9, p = 0.040) and total (MD 13.1, p = 0.038) scores at 6-months. Patients with a preoperative WOMAC total score of < 40 points undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 14.6, p = 0.044) at 6-months. Patients with a preoperative EQ-5D utility of <0.604 undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 15.5, p = 0.011) at 2-months. CONCLUSION: Patients of male sex, younger age, worse preoperative knee specific function and HRQoL had a clinically significantly better early functional outcome with rTKA when compared to mTKA.

Does inverse kinematic alignment coupled with robot-assisted TKA optimize patellofemoral clinical and radiological results?

INTRODUCTION: With a satisfaction rate of 80%, total knee arthroplasty (TKA) surgery has seen significant improvements in recent decades. The 20% of poor results may be explained by the alignment technique used for implant placement, which can influence patellofemoral kinematics. The objective of this study was to demonstrate that the use of inverse kinematic alignment makes it possible to obtain satisfactory clinical and radiological patellar scores in robotic TKA. HYPOTHESIS: The inverse kinematic alignment technique coupled with robotic surgery makes it possible to restore the native kinematics of the patella. MATERIALS AND METHODS: This prospective study including 100 TKAs with a primary TKA performed using the Stryker Mako™ robotic surgery system, and the inverse kinematic alignment technique. Patients who underwent patella resurfacing were excluded. Clinical and radiological scores were recorded preoperatively and 1 year postoperatively. RESULTS: At one year, the specific patellar clinical scores were excellent with an average Kujala score of 85.69 and an average HSS Patellar score 88.15. The average patellar lateralization index was 0.15 and the average patellar tilt was 5.1°, showing no significant difference compared to preoperation (p=0.45 and p=0.18). The average external rotation of the femoral implant was 0.47±0.6° [-1.9; 2.1]. DISCUSSION: The patellofemoral clinical results were excellent. The use of the robotic arm coupled with this alignment technique makes it possible to obtain a controlled external rotation of the femoral implant as well as an optimized orientation of the tibial component, favoring good restitution of the alignment of the extensor apparatus. This study did not demonstrate any radiological correction of patellar tilt and lateralization. CONCLUSION: The combined use of robotic surgery with the inverse kinematic alignment technique seems effective on specific clinical results of the patellofemoral joint. LEVEL OF EVIDENCE: II; prospective cohort.