Differences in Infection Rates by Surgical Approach in Total Hip Arthroplasty and Patient Sex: A Systematic Review.

Background: There exists conflicting data that patient sex may influence complication and revision rates when undergoing total hip arthroplasty (THA), specifically when comparing different surgical approaches. Differences in body fat or muscular distribution are proposed mechanisms, but these are poorly understood and not well described in current literature. Methods: A systematic review of the literature was conducted from PubMed, Embase, and Web of Science from inception of the database through September 15, 2020. Studies were included if they included patients undergoing primary elective unilateral THA, delineated infections by surgical approach, and delineated infections by patient sex. Basic science, cadaveric, and animal studies were excluded as were case reports. Two authors screened abstracts and then extracted data from the full text article. Results: Three studies, including 1,694 patients undergoing 1,811 THA were included. 80 infections were included. No study reported a statistically significant difference in infection risk by patient sex or surgical approach, though there was substantial heterogeneity in study design, approach, and analysis. Conclusion: Limited data suggests no relationship between sexes across surgical approaches for infection rates. However, poor reporting and small sample sizes preclude definitive conclusions from being drawn. Future studies should emphasize reporting differences in outcomes by patient sex to better elucidate differences, if any, in adverse outcomes between sexes following THA across surgical approaches. Level of Evidence: IV.

The trends in robotic-assisted knee arthroplasty: A statewide database study.

OBJECTIVE: Recent technological advancements have led to the utilization of robotic-assisted knee arthroplasty (raKA) in the operating room. METHODS: All patients who underwent knee arthroplasty from 2009 to 2013 in NYS SPARCS were reviewed. raKAs and non-raKAs were compared for utilization and institutional trends. RESULTS: Robotic-assistance increased by 500%. 80% of raKAs were performed in teaching hospitals. The trend increase was greater in teaching hospitals. Blood transfusion rates differed between raKA and non-raKA (6.6% vs. 10.9%, p < 0.001). CONCLUSION: raKA utilization increased in NYS, moreso within teaching hospitals. raKA transfusion rates were lower but higher in teaching hospitals, potentially related to learning curve.

Making the transition from traditional to robotic-arm assisted TKA: What to expect? A single-surgeon comparative-analysis of the first-40 consecutive cases.

OBJECTIVE/METHODS: We compared short-term outcomes following 40 traditional, cemented total knee arthroplasty (TKA) to the first 40 cemented robotic-arm assisted TKA (raTKA) and analyzed the learning curve for raTKA. RESULTS: LOS was longer for traditional TKA compared to raTKA (1.92 vs. 1.27days, p < 0.0001). There was no difference in surgical time between the second 20 raTKA and all traditional TKA cases (81.1 vs. 78.3 mins, p = 0.254). raTKA patients had improved 90-day ROM (+3.8° vs. -8.7°, p < 0.05) but comparable complications rates, Knee Society Scores, and patient-reported outcomes at all timepoints. CONCLUSION: Despite comparable outcomes, the learning curve for raTKA appeared to progress rapidly.

Robotic-Assisted and Computer-Navigated Unicompartmental Knee Arthroplasties: A Systematic Review.

INTRODUCTION: Unicompartmental knee arthroplasty (UKA) effectively improves pain and function associated with isolated compartmental knee arthritis. The developments of computer-navigated and robotic-assisted UKA are among the most significant changes that have improved patient outcomes. This study aimed to systematically review the literature to identify differences between computer-navigated and robotic-assisted UKAs. MATERIALS AND METHODS: Twenty total articles were identified. Data pertaining to demographics, outcomes, and complications/failures were extracted from each study. Reoperation/revision rates, indications for reoperation/revision, type of procedure, and number of patients who underwent conversion to TKA (when available) were recorded. RESULTS: Nine studies reported 451 computer-navigated medial UKAs, with 19 (3.9%) reportedly requiring reoperation: primary revision (n=8; 42.1%), conversion to TKA (n=6), and manipulation under anesthesia (n=5). Eleven studies reported 2,311 robotic-assisted UKAs (74 lateral UKAs), with 106 (5.0%) requiring reoperation: conversion to TKA (n=46; 43.4%), primary revision (n=43), reoperations without component-removal (n=15), subchondroplasty, and partial meniscectomy/synovectomy (both n=1). Reoperation rate discrepancy between computer-navigated and robotic-assisted UKA was not statistically significant (p=0.495); age and BMI differed between both groups (p<0.0001). DISCUSSION: This study represents the first known comparison of revision rates of computer-navigated and robotic-assisted UKA, suggesting that these methods can benefit orthopaedic surgeons, especially those new to UKA or in a low-volume practice.

Outcomes of isolated glenoid labral injuries in professional baseball pitchers.

BACKGROUND: Major League Baseball (MLB) pitchers who return to competition after labral surgery show a decline in their pitching performance. DESIGN: Retrospective cohort. SETTING: Tertiary institution. PATIENTS: MLB starting or relief pitchers with isolated glenoid labral injuries. INTERVENTIONS: Open or arthroscopic surgical repair of isolated glenoid labral injuries. MAIN OUTCOME MEASUREMENTS: Individual statistics were reviewed for 42 MLB pitchers who underwent surgical repair of isolated glenoid labral injuries of their throwing shoulder between 1998 and 2003. Pertinent statistical data, including earned run average (ERA), innings pitched (IP), and walks plus hits per inning pitched (WHIP), were obtained for all players and compared before and after surgery. These statistics were evaluated for an association with demographic factors, pitching role, and rehabilitation time. RESULTS: A total of 42 MLB pitchers (26 starters, 16 relievers) were included in the study with an average age of 27.5 years for starters and 29.9 years for relievers at injury time. There were 30 right-handed pitchers and 12 left-handed pitchers. In all, 69% of pitchers returned postoperatively to MLB for at least one season; 29% pitched for three seasons or more. For both relievers and starters, there was no statistically significant postoperative change in ERA or WHIP at 1 and 3 years. Starters had significantly decreased IP at 1 year, but not at 3 years. Relievers had no significant change in IP at 1 year postoperatively, but IP were significantly decreased at 3 years. Relievers missed less time after surgery than did starters (11.4 vs. 18.4 months). CONCLUSIONS: Most pitchers who were able to return to competition after surgery showed insignificant changes in ERA and WHIP and significant decreases in IP. Age, MLB experience, and pitching role as a reliever were the most significant factors related to a successful return after surgery.

An aneurysmal bone cyst in the cervical spine of a 10-year-old girl: a case report.

STUDY DESIGN: An aneurysmal bone cyst in the neural arch of the fourth cervical vertebra of a 10-year-old girl is reported, along with a brief review of the literature on the topic. OBJECTIVE: To report the presentation and diagnosis of this disorder along with a discussion of the major pitfalls of treatment. SUMMARY OF BACKGROUND DATA: An aneurysmal bone cyst occurs commonly in the second decade, with a predilection for the lumbar spine. With occurrence in the neural arch of a cervical vertebra, the potential for instability following surgical excision is high. METHODS: A 10-year-old white female presented with neck pain of 3 months' duration. Diagnostic imaging revealed an expansile lytic lesion in the spinous process and lamina of the fourth cervical vertebra. Surgical treatment consisted of excisional biopsy and a segmental instrumented posterior fusion from C3-C5. The histopathology was consistent with an aneurysmal bone cyst. RESULTS: Surgical excision consisting of laminectomy and instrumented segmental fusion provided a good clinical result, and minimized the risk and degree of the 2 most common complications: recurrence of the tumor; and postlaminectomy kyphosis, a frequent occurrence in the pediatric population. CONCLUSIONS: In pediatric patients who develop a bone tumor of the posterior elements of the cervical spine, careful clinical and radiologic evaluation is necessary to narrow the differential diagnosis. In most cases, a complete excision should be performed if possible. The risk of postlaminectomy kyphosis is high in the pediatric age population. As such, a fusion should be considered whenever a laminectomy is performed in the immature cervical spine. Risk factors for kyphosis include a high cervical level, multiple laminectomy levels, and postoperative irradiation.