The Accuracy of CT-Based Three-Dimensional Templating in Predicting Implant Sizes in Patients Undergoing Robot-Assisted Total Knee Arthroplasty.

Background: Computed tomography (CT) based three-dimensional templating is increasingly being used to predict implant sizes in total knee arthroplasty (TKA). However, the existing data is heterogeneous, and the majority of studies lack adequate statistical power. This study investigated whether preoperative CT-based planning in robot-assisted TKA (RA-TKA) helps in predicting the accurate size of implant used. Methods: This is a single-center retrospective study of 632 consecutive RA-TKA surgeries. All surgeries were performed using a fully automatic Cuvis RA-TKA system. Cohen's Kappa (κ) coefficient was used to measure the level of agreement between the predicted and the final implant sizes. Results: A total of 632 knees were operated on 384 patients. A total of 136 unilateral cases whereas 248 patients had both knees operated on. For the tibial component, in 21.7% cases a bigger implant size was used while in 11.8% cases a smaller size was used. For the femoral component, in 5.1% cases a bigger implant size was used while in 4.9% cases a smaller size was used. The agreement between the predicted and actual implant sizes was moderate for the tibial component [κ = 0.56 (95% CI: 0.51 to 0.61); p < 0.001] and almost perfect for the femoral component [κ = 0.87 (95% CI: 0.84 to 0.90); p < 0.001]. Conclusion: This study suggests that planning of RA-TKA using a CT-based model can be valuable to surgeons in accurately predicting the component size for femur and to a lesser degree for tibia. Future studies should investigate the potential predictors of discordance between the predicted and actual tibial implant sizes.

A Single-Center, Observational Study Assessing Functional Outcomes After Arthroscopic Anterior Cruciate Ligament Reconstruction Using Suspensory Tibial Fixation With a Polyether Ether Ketone (PEEK) Button.

Background Anterior cruciate ligament reconstruction (ACLR) is a crucial procedure in orthopedic surgery. This study evaluates the efficacy and safety of ACLR employing suspensory tibial fixation with a polyether ether ketone (PEEK) button. Methodology This retrospective observational study conducted at Sai Shree Hospital, Pune, India, between November 2023 and December 2023 enrolled 47 subjects aged 18-60 years who underwent arthroscopic ACLR utilizing the T-Button-A Adjustable Loop Ultra-High-Molecular-Weight Polyethylene Suture PEEK button. The functional outcomes and patient-reported outcomes were assessed using the International Knee Documentation Committee (IKDC) score, the Modified Cincinnati Rating System Questionnaire (MCRS), the Single Assessment Numeric Evaluation (SANE) score, the Tegner Activity Level (TAL) Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life subscale. Results Femoral fixation utilized 27 (57.4%) Proloop Ultra Adjustable Loop Button 60 mm, 19 (40.4%) Infiloop Fixed Loop Button 20 mm, and 1 (2.1%) Infiloop Fixed Loop Button 30 mm. Tibial fixation solely relied on T-Button A (PEEK Tibial Button With Adjustable Loop 90 mm). Postoperative evaluations revealed favorable IKDC (79.49 ± 12.67), MCRS (81.32 ± 11.57), SANE (77.83 ± 11.11), TAL Scale (3.87 ± 0.99) and KOOS quality of life subscale (83.81 ± 13.07) scores. Conclusions The findings affirm the efficacy and safety of arthroscopic ACLR utilizing suspensory tibial fixation with the PEEK button, supporting its use for improved patient outcomes.

Correlation Between Planned and Executed Bone Cuts Using Robotics in Total Knee Arthroplasty: A Prospective Study of 500 Patients.

Objective: This study evaluated the precision of robotic-arm-assisted total knee arthroplasty (RATKA) in performing bone resection, predicting component size, managing soft tissue tension, and determining postoperative range of motion (ROM). Methods: A total of 500 participants were enrolled in this prospective cohort research. The procedures were conducted at a single facility, with a uniform method and implant design. The Cuvis system, a fully automated robot, was utilized for the study. The precise removal of bone at both the tibial and femur sites, the positioning of the implant, and the release of soft tissue were documented and then compared to the preoperative plan. Results: The distal (medial and lateral) femoral cuts had a mean absolute deviation from the plan of 0.23 mm, while the posterior (medial and lateral) femoral cuts had a mean absolute difference of 1 mm and 1.4 mm, respectively. The absolute discrepancies in the medial and lateral tibial cuts are 0.93 mm and - 0.06 mm, respectively. Out of 1000 bone resections, 980 (98%) were within < 1 mm from the preoperative plan. The predictions for the sizes of the tibial and femoral components had accuracies of 100% and 98.9%, respectively. Conclusion: These findings collectively underscore the effectiveness of the fully automated Cuvis robotic system in achieving consistent and accurate results in bone resections and implant sizing, highlighting its potential as a valuable tool in orthopedic surgery.

Expert Consensus on Best Practices for Optimal Wound Closure in Total Knee Arthroplasty: A STRIDE Initiative for Orthopedic Surgeons of India.

Background: Wound closure in joint replacement surgeries is crucial for postoperative rehabilitation. Despite substantial advances in total knee arthroplasty (TKA), no guidelines/recommendation or consensus practice statement available internationally or nationally around the optimal method of wound closure. The study aimed to develop evidence-based consensus on current practices, and proposed adoption of advanced wound closure initiatives. Methods: From Nov 2020 to Jan 2021, a group of 12 leading orthopedic surgeons from India met virtually under the Success in Total joint replacement through Recommendation In wounD closure (STRIDE) initiative. Expert committee used Delphi method to evaluate definitional statements that were identified through a comprehensive review of the published literature. Over three rounds of iterative voting, revision, and exclusion, the expert panel provided recommendations based on their clinical expertise and scientific evidence. Statements that reached ≥ 80% agreement was considered as "consensus". A survey poll was conducted following each round to add or suggest changes to the statements. Results: General recommendations include marking the arthrotomy before incision, placing the knee in flexion (less than 90°) for re-approximation during arthrotomy closure. The barbed suture can be a good alternative to traditional sutures for providing water-tight capsule closure and topical skin adhesives (TSAs) to staples for minimizing hospital visits and improving patient satisfaction. Conclusion: This consensus provides interim guidance and practical references to orthopedic surgeons of India enabling easy access to evidence-based healthcare solutions for TKA wound closure. These recommendations need to be periodically reviewed in light of emerging evidence.

Polyalanine polymorphism in the signal peptide of Glutathione peroxidase 1 (GPX1) gene & its association with osteoporosis.

Background & objectives: Osteoporosis is a systemic skeletal disease, characterized by a low bone mass leading to increased bone fragility and hence, a greater susceptibility to the risk of fracture. Since age-related oxidative stress is one of the factors that has been implicated in developing low bone mineral density (BMD), leading to osteoporosis, this study wanted to explore the expression of antioxidant enzymes in individuals with osteoporosis. The present study focused on mapping polymorphism in an important antioxidant enzyme glutathione peroxidase 1 (GPx1) among osteoporosis and healthy Asian Indians. Methods: Dual-energy X-ray absorptiometry was used to assess BMD of individuals and was classified into normal (n=96) and osteoporotic (n=88) groups. Biochemical parameters such as vitamin D, total oxidant status (TOS), and GPx1 enzyme activity were estimated from plasma samples of recruited individuals. Quantitative real-time qRT-PCR was carried out using GAPDH as an endogenous control. Genomic DNA was isolated from whole blood, and polymorphisms were evaluated by sequencing. Results: The BMD was lower in osteoporotic individuals, and further analysis of biochemical parameters indicated significantly low 25-hydroxy vitamin D and GPx1 with higher TOS levels in osteoporotic as compared to healthy individuals. Furthermore, qRT-PCR revealed low expression of GPX1 in osteoporotic individuals. GPX1 sequence analysis of the promoter and two exons revealed the lower frequency of five alanine repeats in the osteoporotic individuals. Interpretation & conclusions: In this study, the in silico analysis revealed the lower frequency of five alanine repeats in exon 1 of GPX1 and high TOS to be associated with osteoporosis. However, no polymorphism was found in exon 2 of GPX1 among the two study groups.

Superoxide Dismutase 2 Polymorphisms and Osteoporosis in Asian Indians: A Genetic Association Analysis.

Oxidative stress plays an important role in the development of osteoporosis. The present cross-sectional study focuses on mapping single nucleotide polymorphisms (SNPs) in the mitochondrial manganese superoxide dismutase (SOD2) gene in Asian Indians. The bone mineral density (BMD) of study subjects was assessed by dual x-ray absorptiometry. Individuals were classified as normal (n = 82) or osteoporotic (n = 98). Biochemical parameters such as vitamin D, total oxidant status (TOS) and SOD2 enzyme activity were estimated from plasma samples. Semi-quantitative PCR was carried out using GAPDH as an endogenous control. Genomic DNA was isolated from whole blood and SNPs were evaluated by PCR sequencing. Thirteen SNPs are reported in the examined region of the SOD2 gene, out of which in our samples SNPs rs5746094 and rs4880 were found to be polymorphic. Allele G of rs5746094 (intronic) and allele C of rs4880 (exonic) are significantly higher in the osteoporotic individuals. Presence of allele C of rs4880 and increased level of TOS among osteoporotic individuals were found to be associated with disease risk.