Operating room efficiency after the implementation of MAKO robotic-assisted total knee arthroplasty.

INTRODUCTION: The aim of this study was to examine if robotic-assisted total knee arthroplasty (RATKA) is cost- and time-effective in terms of implant stock and perioperative parameters, as optimizing perioperative efficiency may contribute to value-based care. MATERIALS AND METHODS: Four hundred thirty-two consecutive patients who received primary total knee arthroplasties (TKAs) from May 2017 to March 2020 in a regional hospital were included in this study. Operating room time (OR time), surgical time, number of trays, insert thickness, and length of stay (LOS) were assessed and compared for a cohort group with navigation-assisted procedures to a group with robotic-assisted procedures (MAKO, Stryker, USA). Prediction of implant size was assessed for the robotic-assisted group. The Mann-Whitney U test was used for comparisons between groups when the normality assumption was not met. Categorical variables were assessed using the Fisher's exact test. p < 0.05 was considered statistically significant. RESULTS: In the RATKA group, we noticed a significant mean reduction of 11 min in total OR time (p < 0.001), the use of thinner insert (p < 0.001), and a shorter mean length of stay of 1 day (p < 0.001). Compared to the navigation group, surgical time was not significantly longer, nor clinically relevant (0.238). In 76.9% of the robotic-assisted cases, the estimated implant size was equal to the final size and in all other cases, the preoperative implant size was oversized. CONCLUSION: The introduction of the MAKO robotic-assisted total knee arthroplasty resulted in a gain in operating room time, a thinner and more predictable insert thickness, a shorter length of stay in hospital, and less instrumentation compared to navigation-assisted procedures. Level of evidence Level III, Retrospective cohort study.

Correlations in radiographic and MAKO Total Knee Robotic-Assisted Surgery intraoperative limb coronal alignment.

Robotic-assisted arthroplasty has become increasingly established in recent years. The aim of the study is to determine if intraoperative coronal alignment during robotic-assisted total knee arthroplasty correlates with radiographic alignment. We prospectively compared the pre- and postoperative limb alignment values measured on long leg standing radiographs with intraoperative robotic-assisted measurements for 100 patients who underwent primary total knee arthroplasty. Two-tailed bivariate Pearson correla- tions were performed to evaluate the strength of the association between radiographic and robotic- assisted alignment. The intraclass correlation coeffi- cient (ICC) was used to estimate interrater reliability. There was a male/female ratio of 1.16 and the mean age was 67 years (range 42-88). Robotic-assisted measurements slightly overestimated the degree of varus relative to radiographs. Radiographic and robotic-assisted measurements were strongly correlated (r = 0.915, p < 0.001) preoperatively, with a difference of 1.6 ± 3.2°. The average measure ICC was 0.996 with a 95% confidence interval from 0.995 to 0.997 (p < 0.001). Postoperatively a bigger difference was measured (3.1° ± 1.9°), comparing radiographic and MAKO alignment. A moderate correlation was observed between the postoperative radiographic and MAKO outcome alignment (r = 0.604, p < 0.001). The average measure ICC was 0.977 with a 95% confidence interval from 0.967 to 0.984 (p < 0.001). There is a strong correlation in the preoperative set- ting between radiographic and robotic-assisted lower limb alignment and a moderate correlation in the post-operative setting. The values measured by the MAKO Total Knee application were considerably more in varus.

Outcomes of reverse total shoulder arthroplasty with postoperative scapular fracture. A systematic review.

Postoperative scapular fractures are infrequent complications of reverse total shoulder arthroplasty (RTSA). The aim of this study is to discuss the functional outcome, clinical outcome and pain scores of these fractures and to analyze these outcome results based on fracture location. A systematic review in accordance with the PRISMA guidelines was conducted. Pubmed, EMBASE, Web of Science, Cochrane library and Ovid have been screened. A total of 78 RTSA in 12 articles were retained for qualitative analysis. The average minimum follow- up was 33.3 ± 14.4 months (range 12-60 months) and the mean age was 74.4 ± 5.6 years (range 63-85 years) with a mean female percentage of 90.9%. Overall, the mean DASH score was 39.8 ± 9.4 points (range 29.5- 48.0 points), ASES score 53.4 ± 23.3 points (range 13.3-95.0 points), SST 3.2 ± 2.2 points (range 0.0- 5.1 points), the only OSS 28.0 points and Constant- Murley shoulder score 50.5 ± 20.0 points (range 31.5- 69.0). The mean anterior elevation was 91.5° ± 30.7° (range 46.0°-160.0°), abduction 87.8° ± 21.8° (range 55.0°-125.0°), external rotation 33.2° ± 22.2° (range 9.0°-85°) and the only internal rotation was 60.0°. The VAS score averaged of 3.8 ± 2.8 points (range 0.8-9.0 points). A subgroup analysis of acromial and scapular spine fractures was performed. Acromial and scapular spine fractures have an undeniable effect on RTSA outcomes, however patients still improve compared to their preoperative state. We advise to consider acromial and scapular fractures as different problems, as prognosis is worse for more medial fractures.

Accuracy of malaria diagnosis by clinical laboratories in Belgium.

BACKGROUND: The Belgian Reference Laboratory for Plasmodium offers a free-of-charge reference testing of malaria-positive or doubtful samples to clinical laboratories. METHODS: The final malaria diagnosis from the Reference Laboratory (microscopy, rapid diagnostic tests (RDTs) and Plasmodium species-specific PCR) were compared with the final diagnosis from peripheral Belgian laboratories. The Reference Laboratory reports were analysed for all samples submitted between 2013 and 2017. Criteria assessed included the diagnosis of malaria, Plasmodium species identification including mixed infections, and in case of Plasmodium falciparum, the parasite density and the presence of sexual and asexual stages. RESULTS: A total of 947 non-duplicate samples were included. Reference testing confirmed 96.3% (893/927) and 90.0% (18/20) samples submitted as positive and negative, respectively, the two missed diagnoses were samples with Plasmodium ovale and Plasmodium malariae. Submitting laboratories had correctly identified P. falciparum in 95.1% (508/534) samples with P. falciparum single infection. They had correctly diagnosed the species in 62.9% (95/151) single non-falciparum samples and had reported 'non-falciparum' in another 26 (17.2%) samples; most errors occurred among P. malariae (n = 8/21, 38.1%) and P. ovale (n = 14/51, 27.5%). Only one of the 21 mixed Plasmodium species infections had been diagnosed as such by the submitting laboratories; in three of them, P. falciparum had been overlooked. Taken single and mixed infections together, P. falciparum was diagnosed in 98.6% (546/554) samples. Among 471 single P. falciparum samples available for comparison, laboratories had correctly reported parasite densities above 2% in 87.5% (70/80) samples; they had incorrectly reported parasite densities > 2% in an extra 52 (8.9%) samples. Laboratories had correctly reported P. falciparum schizonts and gametocytes in 25.6% (11/43) and 56.7% (17/30) samples, respectively. CONCLUSION: Diagnostic laboratories in a malaria non-endemic setting provided excellent diagnosis of malaria and P. falciparum, reasonably good diagnosis of non-falciparum infections and acceptable calculation of P. falciparum parasite density.

Posterior tibial tendon dysfunction alters the midfoot mechanics and energetics during gait.

A comprehensive insight into the in vivo foot kinetics of patients with posterior tibial tendon dysfunction (PTTD) is lacking to support clinical decision making. Our goal was to study how PTTD alters the kinetic and kinematic characteristics of the foot and ankle with a special focus on the midfoot joints. Multisegment foot joint kinetics and kinematics were compared based on the Rizzoli Foot Model and inversed dynamics between a control group (n = 25), patients with PTTD Stage II (n = 21) and PTTD Stage III (n = 4) over the entire stance phase. Compared to controls, a mean decrease in power generation of 1.3 W/kg was found in the Ankle joint in PTTD II patients (p < 0.001) and PTTD III patients of 1.5 W/kg (p < 0.001). In the Chopart joint, there was a mean increase in power absorption of 0.4 W/kg in the PTTD III patients (p = 0.014) and a mean decrease in power generation of 0.6 W/kg (p < 0.001) in the PTTD II patients. The distribution of total negative work showed a shift from the Ankle and first metatarsal phalangeal joint towards the Chopart joint in both PTTD compared with the control subjects. A significant reduction in range of motion was observed among both PTTD groups. The outcome of this study will enable the possibility to customize the conservative and surgical treatment of each patient with PTTD, to improve or even restore the kinetic features. This will prevent the natural deterioration of function seen in this pathology.