Robotic-assisted burring in total hip replacement: A new surgical technique to optimise acetabular preparation.

BACKGROUND: In Total Hip replacement (THR) surgery, a critical step is to cut an accurate hemisphere into the acetabulum so that the component can be fitted accurately and obtain early stability. This study aims to determine whether burring rather than reaming the acetabulum can achieve greater accuracy in the creation of this hemisphere. METHODS: A preliminary robotic system was developed to demonstrate the feasibility of burring the acetabulum using the Universal Robot (UR10). The study will describe mechanical design, robot trajectory optimisation, control algorithm development, and results from phantom experiments compared with both robotic reaming and conventional reaming. The system was also tested in a cadaver experiment. RESULTS: The proposed robotic burring system can produce a surface in 2 min with an average error of 0.1 and 0.18 mm, when cutting polyurethane bone block #15 and #30, respectively. The performance was better than robotic reaming and conventional hand reaming. CONCLUSION: The proposed robotic burring system outperformed robotic and conventional reaming methods to produce an accurate acetabular cavity. The findings show the potential usage of a robotic-assisted burring in THR for acetabular preparation.

Compliance to clinical pathways in the management of suspected pulmonary embolus: are there cost implications?

This study investigated the cost implications of poor compliance to established guidelines for management of suspected pulmonary embolism (PE) in two NSW public hospitals. A retrospective audit showed that the prevalence of PE overall was 9.9% (4.3% in the low-risk groups) in 436 patients. An estimated total of $32 454 (14%) was spent on unnecessary tests.