Does robotic-assisted computer navigation improve acetabular cup positioning in total hip arthroplasty for Crowe III/IV hip dysplasia? A propensity score case-match analysis.

AIMS: Total hip arthroplasty (THA) in patients with hip-dislocation dysplasia remains challenging. This study aims to evaluate whether these patients may benefit from robotic-assisted techniques. METHODS: We reviewed 135 THAs (108 conventional THAs and 27 robotic-assisted THAs) for Crowe type III or IV from January 2017 to August 2019 in our institution. Robotic-assisted THAs were matched with conventional THAs at a 1:1 ratio (27 hips each group) using propensity score matching. The accuracy of cup positioning and clinical outcomes were compared between groups. RESULTS: The inclination of the cup for conventional THAs and robotic THAs was 42.1 ± 5.7 and 41.3 ± 4.6 (p = 0.574), respectively. The anteversion of the cup for conventional THAs was significantly greater than that of robotic THAs (29.5 ± 8.1 and 18.0 ± 4.6; p < 0.001), respectively. The ratio of the acetabular cup in the Lewinnek safe zone was 37% (10/27) in conventional THAs and 96.3% (26/27) in robotic THAs (p < 0.001). Robotic THAs did not achieve better leg length discrepancy than that of conventional THAs (- 0.4 ± 10.9 mm vs. 0.4 ± 8.8 mm, p = 0.774). There was no difference in Harris Hip Score and WOMAC Osteoarthritis index between groups at the 2-year follow-up. No dislocation occurred in all cases at the final follow-up. CONCLUSION: Robotic-assisted THA for patients with high dislocation improves the accuracy of the implantation of the acetabular component with respect to safe zone.

Correcting severe flexion contracture with fusiform capsulectomy of posterior capsule during total knee arthroplasty.

PURPOSE: This study aimed to evaluate the safety and efficacy of fusiform capsulectomy of posterior capsule in correcting severe flexion contracture during total knee arthroplasty (TKA). METHODS: A retrospective analysis was performed in the patients who had preoperative severe flexion contracture (> 30 degrees) prior to TKA and received fusiform capsulectomy of posterior capsule during TKA between December 2013 and November 2018. Range of motion (ROM), knee functional score, forgotten joint score (FJS), post-operative complications, and radiographic results were collected and evaluated. RESULT: Twenty patients (32 knees) were enrolled in this study. The mean duration of follow-up was 27.19 ± 15.92 months. The flexion contracture improved from pre-operative 37.69 ± 11.79° to post-operative 5.78 ± 4.44° (p < 0.001), and ROM increased from pre-operative 63.50 ± 21.74° to post-operative 97.88 ± 13.20° (p < 0.001). KSS clinical score increased from pre-operative 32.94 ± 11.03 to post-operative 82.34 ± 10.73 (p < 0.001), and KSS function score increased from pre-operative 28.97 ± 18.43 to post-operative 68.75 ± 15.96 (p < 0.001). The post-operative FJS was 76.08 ± 2.14. There was no implant loosening, infection, obvious haematoma formation, resultant instability, neurovascular complications, or revision for any reasons in the cohort until the last follow-up. CONCLUSIONS: The technique of fusiform capsulectomy of posterior capsule to correct the severe flexion contracture during primary TKA is safe and effective and could provide good short-term results.

Use of Robotic-Arm Assisted Technique in Complex Primary Total Hip Arthroplasty.

BACKGROUND: There is a lack of data concerning the use of robotic devices in more complex total hip arthroplasty (THA) cases, such as hip dysplasia, ankylosing spondylolysis, and post-traumatic arthritis. CASE PRESENTATION: This case study presented three cases in which the Mako robotic device was used to help accurately implement the surgical plan. The operations went smoothly. The position and angle of the acetabular shells were placed as planned without any complications related to the operation. Postoperative Harris Hip Scores were good in two patients and poor in the patient with ankylosing spondylitis. Robotic-arm assisted surgery may be considered for complex THA cases in order to optimize the accuracy of the reconstruction, especially in the absence of conventional boney landmarks.

Strategy and management of cardiopulmonary bypass with cardiac surgery for pregnant women / 局解手术学杂志

Objective To evaluate the strategy and management of cardiopulmonary bypass ( CPB) with cardiac surgery for pregnant women.Methods The clinical data of 4 pregnant women with severe cardiac diseases ,who received cardiac surgery with CPB in our hospital form January 2016 to June 2017 were retrospectively analyzed ,meanwhile the maternal and neonatal outcomes were reviewed also .Results Among 4 patient s,there were 1 case of subacute bacterial endocarditis ,2 cases of congenital heart disease complicated with subacute bacterial endocarditis,1 case of rheumatic heart disease.The New York Heart Association(NYHA) functional classification:there were 2 cases with class Ⅲand 2 cases with classⅣ.Operations included 2 mitral valve replacement and tricuspid valve plasty ,1 right coronary artery fistula re-pair and aortic valve replacement ,1 patent ductus arteriosus closure and mitral valve repalcement ,aortic valve replacememnt ,pulmonary valve replacement,tricuspid valve plasty.The CPB time ranged from 85 to 287 minutes(median 135 minutes),the aortic cross clamp time ranged from 52 to 178 minutes (median 89 minutes),the gestational age of pateints received cardia surgery ranged from 25 to 32 weeks(median 29 weeks).All patients were followed up for 1 to 16months(median 6 months),with no death;4 neonatal outcomes included 3 of full-term labor with cesarean section ,all of the 3 newborns were alive and no malformation ,1 of death in the uterus and spontaneous abortion at 2 days post-operative .Conclusion Cardiac surgery can be performed with relative safety during pregnancy .According to the physiological characteristics of pregnancy ,a reasonable CPB plan should be formulated pre-operative ,better maternal and fetal survival rates may be achieved by optimized management of CPB and used fetal mornitoring perioperative ,reduce the incidence of complications .