Robotic and Navigation Systems in Orthopaedic Surgery: How Much Do Our Patients Understand?

BACKGROUND: Technology in orthopaedic surgery has become more widespread in the past 20 years, with emerging evidence of its benefits in arthroplasty. Although patients are aware of benefits of conventional joint replacement, little is known on patients' knowledge of the prevalence, benefits or drawbacks of surgery involving navigation or robotic systems. METHODS: In an outpatient arthroplasty clinic, 100 consecutive patients were approached and given questionnaires to assess their knowledge of navigation and robotics in orthopaedic surgery. Participation in the survey was voluntary. RESULTS: Ninety-eight patients volunteered to participate in the survey, mean age 56.2 years (range, 19 to 88 years; 52 female, 46 male). Forty percent of patients thought more than 30% of National Health Service (NHS) orthopaedic operations involved navigation or robotics; 80% believed this was the same level or less than the private sector. One-third believed most of an operation could be performed independently by a robotic/navigation system. Amongst perceived benefits of navigation/robotic surgery was more accurate surgery (47%), quicker surgery (50%), and making the surgeon's job easier (52%). Sixty-nine percent believed navigation/robotics was more expensive and 20% believed it held no benefit against conventional surgery, with only 9% believing it led to longer surgery. Almost 50% would not mind at least some of their operation being performed with use of robotics/navigation. CONCLUSIONS: Although few patients were familiar with this new technology, there appeared to be a strong consensus it was quicker and more accurate than conventional surgery. Many patients appear to believe navigation and robotics in orthopaedic surgery is largely the preserve of the private sector. This study demonstrates public knowledge of such new technologies is limited and a need to inform patients of the relative merits and drawbacks of such surgery prior to their more widespread implementation.

Effect of 2 % pilocarpine eye drops on the field of vision

A clinical study of the effect of 2% pilocarpine drops on the visual field in six normotensive nearly emmetropic eyes and ten wide-angle glaucomatous eyes was done. It was found that in 83% of the normotensive cases, the field was concentrically contracted after pilocarpine. In medically controlled glaucomatous eyes, after the use of pilocarpine 60% of the cases had enlargement of the field, 30% had concentric contraction and in 10% there was no field changes. Thus in our cases pilocarpine had a varied effect on the visual field. Possible explanations for these results were discussed