Robotic-assisted unicompartmental knee arthroplasty is associated with earlier discharge from physiotherapy and reduced length-of-stay compared to conventional navigated techniques.

INTRODUCTION: Computer-assisted surgery (CAS) has been used to improve intraoperative accuracy to restore patient's anatomy and joint kinematics. It is not yet known whether robotic systems provide significant benefits over established navigation techniques. MATERIALS AND METHODS: Thirty-one patients underwent robotic-assisted UKA (RA-UKA) over a 14-month period. Length of operation, transfusion requirements, time to discharge, range-of-motion and analgesia requirements were compared to a similar cohort of 31 patients who had received UKA using computer-assisted surgery (CAS-UKA). RESULTS: All patients in the RA-UKA and CAS-UKA groups underwent surgery without conversion to conventional techniques. Both cohorts were similar apart from mean BMI (RA-UKA-group 28.5 vs 32.2; p < 0.05). There was a higher percentage of females in the CAS-UKA group (68% vs 45%, p = 0.12). Minor complication rates were the same in both groups (4/31, 12.9%). Mean operating time was longer in the RA-UKA group (104.8 vs 85.6 min; p < 0.001). No patients required post-operative transfusion in either group and there was no significant difference in haemoglobin level drop or analgesia requirements at any time point. Patients in the RA-UKA group achieved straight leg raise without lag sooner (23 vs 37.5 h; p = 0.004) and demonstrated increased range-of-motion on discharge (81.4° vs 64.5°; p < 0.001). Patients in the RA-UKA group were discharged from physiotherapy services earlier than the CAS-UKA group (42.5 vs 49 h; p = 0.02) and discharged from hospital significantly sooner (46 vs 74 h; p = 0.005). CONCLUSIONS: RA-UKA is safe and reproducible, comparable to traditional navigation. Patients undergoing RA-UKA achieve straight leg raise and discharge from physiotherapy sooner than with navigation alone. LEVEL OF EVIDENCE: III (Therapeutic) Retrospective Cohort Study.

Excellent medium-term survival of an all-inside tensionable knotted suture device justifies repair of most meniscal tears encountered during reconstructive knee ligament surgery.

PURPOSE: All-inside meniscal repair devices have evolved to allow surgeons to undertake complex repairs in a timely and efficient manner. This is advantageous in active patients, where meniscus preservation is critical in preserving joint function and stability. The aim of the study was to evaluate the failure rate of all-inside meniscal repair performed in patients undergoing reconstructive ligament surgery using a particular meniscal repair device. METHODS: Patients were identified using a single-site prospectively maintained patient registry. Primary outcome was failure, defined as return to surgery with documented failure of repair. Complication rates and functional scores were also recorded. Patients in whom meniscal repair failure was identified were further assessed, to identify any common features. RESULTS: Over an 8-year period, 323 patients underwent meniscal repair at the time of ligament reconstruction, compared to 244 meniscectomies. Of these, 286 patients underwent repair using an all-inside suture device. One-hundred and twenty-seven repairs were to the medial meniscus only, 124 were lateral, and in 35 patients both menisci were repaired. Follow-up was to a median of 51.5 months. There were 31 (9.7%) failures reported at a median of 22 months post-operatively (IQR 13.5-41.5). Medial repair failures were seen more frequently than lateral (13.6% versus 5.6% OR 2.62 95% CI 1.17-5.88 p = 0.022). Failure of ACL reconstruction was associated with meniscal repair failure (OR 5.83 95% CI 1.55-21.95 p = 0.0039). Multi-ligament reconstruction was undertaken in 70/286 patients receiving meniscal repair and was not associated with failure (OR 1.3 95% CI 0.57-2.98 p = 0.51). Mode number of all-inside sutures used was 3 in both medial and lateral repairs (Range 1-9 lateral; 1-7 medial). CONCLUSIONS: All-inside repair is a safe and versatile technique which can be used in the majority of meniscal tears encountered during ligament reconstruction with excellent mid-term success. Failure is seen more commonly in medial sided repairs and with failure of ACL reconstruction. LEVEL OF EVIDENCE: IV.

Effect of flow rate, humidifier dome and water volume on maximising heated, humidified gas use for neonatal resuscitation.

AIM: Dry, cold gas is used for neonatal resuscitation, contributing to low admission temperatures and exacerbation of lung injury. Recently, a method of heating and humidifying neonatal resuscitation gases has become available. We aimed to determine the optimal flow rate, humidifier chamber and water volume needed to reach 36°C, and near 100% humidity at the patient T-piece in the shortest possible time. METHOD: A T-piece resuscitator was connected via a heated patient circuit to a humidifier chamber. Trials were performed using different gas flow rates (6, 8 and 10L/min), humidification chambers (MR290, MR225) and water volumes (30g, 108g). Temperature was recorded at the humidifier chamber (T1), distal temperature probe (T2) and the T-piece (T3) over a 20min period at 30s intervals. A test lung was added during one trial. RESULTS: No significant difference existed between flow rates 8L/min and 10L/min (p=0.091, p=0.631). T3 reached 36°C and remained stable at 360s (8L/min, MR225, 30mL); near 100% RH was reached at 107s (10L/min, MR225, 30mL). T3 and humidity reached and remained stable at 480s (10L/min, MR290, 30mL). Target temperature and humidity was not reached with the test lung. CONCLUSIONS: It is possible to deliver heated, humidified gases in neonatal resuscitation in a clinically acceptable timeframe. We suggest the set-up to achieve optimal temperature and humidity for resuscitation purposes is 10L/min of gas flow, a MR290 humidification chamber, and 30mL of water.

Routine neonatal postextubation chest physiotherapy: a randomized controlled trial.

OBJECTIVE: To test the effects of a neonatal postextubation programme on the incidence of postextubation collapse and adverse outcomes. METHODS: A randomized controlled trial was carried out at the Mater Mothers' Hospital, Brisbane. Mechanically ventilated infants were randomized into one of two groups, physiotherapy group--which involved a regimen of chest wall percussion and oropharyngeal suctioning and control group - which involved suctioning without the percussion unless indicated. Chest X-rays were taken at 6 h and at 24 h postextubation. The primary outcome measure was postextubation collapse as determined by a paediatric radiologist blinded to the group allocation. RESULTS: One hundred and seventy-seven neonates were enrolled in the trial between 1997 and 1999. After an interim analysis, the trial was stopped early. No statistically significant difference was shown in the rate of postextubation collapse (15 of 87 (17.2%) physiotherapy group and 17 of 86 (19.8%) control group (P = 0.85)). No differences were shown between the groups in the number of apnoeic or bradycardic events, duration of requirement for supplemental oxygen or the need for re-intubation within 24 h postextubation. CONCLUSION: The results of this trial suggest that a routine neonatal postextubation chest physiotherapy programme for all infants is not indicated. There was no evidence that chest physiotherapy is associated with any adverse outcomes.