Lower Perioperative Complication Rates and Shorter Lengths of Hospital Stay Associated With Technology-Assisted Total Knee Arthroplasty Versus Conventional Instrumentation in Primary Total Knee Arthroplasty.

BACKGROUND: The use of technology allows increased precision in component positioning in total knee arthroplasty (TKA). The objectives of this study were to compare (1) perioperative complications and (2) resource utilization between robotic-assisted (RA) and computer-navigated (CN) versus conventional (CI) TKA. METHODS: A retrospective cohort study was performed using a national database to identify patients undergoing unilateral, primary elective TKA from January 2016 to December 2019. A total of 2,174,685 patients were identified and included RA (69,445), CN (112,225), or CI (1,993,015) TKA. Demographics, complications, lengths of stay, dispositions, and costs were compared between the cohorts. Binary logistic regression analysis was performed. RESULTS: The RA TKA cohort had lower rates of intraoperative fracture (0.05 versus 0.08%, P < .05), respiratory complications (0.6 versus 1.1%, P < .05), renal failure (1.3 versus 1.7%, P < .05), delirium (0.1 versus 0.2%, P < .05), gastrointestinal complications (0.04 versus 0.09%, P < .05), postoperative anemia (8.9 versus 13.9%, P < .05), blood transfusion (0.4 versus 0.9%, P < .05), pulmonary embolism, and deep vein thrombosis (0.1 versus 0.2%, P < .05), and mortality (0.01 versus 0.02%, P < .05) compared to conventional TKA, though the cohort did have higher rates of myocardial infarction (0.09 versus 0.07%, P < .05). The CN cohort had lower rates of myocardial infarction (0.02 versus 0.07%, P < .05), respiratory complications (0.8 versus 1.1%, P < .05), renal failure (1.5 versus 1.7%, P < .05), blood transfusion (0.8 versus 0.9%, P < .05), pulmonary embolism (0.08 versus 0.2%, P < .05), and deep vein thrombosis (0.2 versus 0.2%, P < .05) over CI TKA. Total cost was increased in RA (16,190 versus $15,133, P < .05) and CN (17,448 versus $15,133, P < .05). However, the length of hospital stay was decreased in both RA (1.8 versus 2.2 days, P < .05) and CN (2.1 versus 2.2 days, P < .05). CONCLUSIONS: Technology-assisted TKA was associated with lower perioperative complication rates and faster recovery.

Varying Complication Rates and Increased Costs in Technology-Assisted Total Hip Arthroplasty Versus Conventional Instrumentation in 1,372,300 Primary Total Hips.

BACKGROUND: The use of technology allows surgeons increased precision in component positioning in total hip arthroplasty (THA). The objective of this study was to compare (1) perioperative complications and (2) resource utilizations between robotic-assisted (RA) and computer-navigated (CN) versus conventional instrumenttaion (CI) THA. METHODS: A retrospective cohort study was performed using a large national database to identify patients undergoing unilateral, primary elective THA from January 1, 2016 to December 31, 2019 using RA, CN, or CI. There were 1,372,300 total patients identified and included RA (29,735), CN (28,480), and CI (1,314,085) THA. Demographics, complications, lengths of stay, dispositions, and costs were compared between the cohorts. Binary logistic regression analyses were performed. RESULTS: The use of RA THA led to lower rates of intraoperative fracture (0.22% versus 0.39%), delirium (0.1% versus 0.2%), postoperative anemia (14.4% versus 16.7%), higher myocardial infarction (0.13% versus 0.08%), renal failure (1.7% versus 1.6%), blood transfusion (2.0% versus 1.9%), and wound dehiscence (0.02% versus 0.01%) compared to CI THA. The use of CN led to lower rates of respiratory complication (0.5% versus 0.8%), renal failure (1.1% versus 1.6%), blood transfusion (1.3% versus 1.9%), and pulmonary embolism (0.02% versus 0.1%) compared to CI THA. Total costs were increased in RA ($17,729 versus $15,977) and CN ($22,529 versus $15,977). Lengths of hospital stay were decreased in RA (1.8 versus 1.9 days) and CN (1.7 versus 1.9 days). CONCLUSIONS: Perioperative complication rates vary in technology-assisted THA, with higher rates in RA THA and lower rates in CN THA, relative to CI THA. Both RA THA and CN THA were associated with more costs, shorter postoperative hospital stays, and higher rates of discharge home compared to CI THA.

Characteristics and Trends of the Most Cited Knee Surgery, Sports Traumatology, Arthroscopy Articles.

Purpose: To compile and analyze the top 50 most frequently cited articles published in the Knee Surgery, Sports Traumatology, Arthroscopy journal. Methods: Guidelines set by the Preferred Reporting Items for Systematic Reviews were used as the foundation for data collection and analysis. Scopus database was used to acquire the metric analyzed in the study. Once collected, the data was exported to an excel sheet in order to be organized, sorted, and analyzed in accordance with the metrics of interest. Results: The United States was the most contributory nation with 14 publications, followed by Sweden with13 publications and Germany with eight publications. The most contributory institution was Umeå University in Vasterbottens, Sweden (8) followed by National Institute for Working Life in Stockholm, Sweden (7) and The University of Pittsburgh (5). Most publications were either Level II (19) or Level III (19) in terms of Level of Evidence. There was only one publication that was classified as a Level I paper. Conclusion: The Journal of Knee Surgery, Sports Traumatology, and Arthroscopy has published very influential research papers as noted by the number of citations amassed by its most popular articles. KSSTA's top cited publications hail largely from major European and United States institutions and are composed of high-quality reports of mostly Level 2 and Level 3 evidence classifications. Level of Evidence: 3.

Characteristics and trends of the most cited papers in robotic assisted arthroplasty.

Purpose: To compile and analyze the top 50 most frequently cited articles published on robotic-assisted arthroplasty, allowing clinicians to effectively identify the most influential literature pertaining to this topic. Methods: Guidelines set by the Preferred Reporting Items for Systematic Reviews were used as the foundation for data collection and analysis. All papers pertaining to robotic-assisted arthroplasty were retrieved using the Scopus database. Data including: manuscript title, authors, total citation count, level of evidence, journal, publication year, and country of publication was extracted from a final list of articles. Results: The top 50 publications regarding robotic assisted arthroplasty were cited a total of 4530 times (including self-citations), with an average total of 91. The years with the most publications in the top 50 were: 2017, 2018, and 2019, producing 7, 6, and 5 papers, respectively. Only 4 papers in the top 50 were published prior to the year 2003. The most common level of evidence was level V, and the most common category was Clinical Outcomes (74%). The United States contributed half of the 50 articles, and Princess Grace Hospital and University of London were the most contributory institutions, each with 6 of the top 50 articles. Conclusion: This analysis provides a comprehensive review of the most cited and influential papers in robotic-assisted arthroplasty. Understanding these trends in the literature will ultimately pave the way for physicians and researchers to continue to innovate and research in a targeted manner as they gain an understanding of what has been studied and what remains inadequately explored. Level of evidence: 3.

Time-Driven Activity-Based Costing in Preoperative Tasks for Total Hip and Knee Arthroplasty.

BACKGROUND: Substantial work in the preoperative phase of total hip arthroplasty (THA) and total knee arthroplasty (TKA) is unaccounted for in current Relative Value Scale Update Committee methodology. A Time-Driven Activity-Based Costing (TDABC) analysis allows for an accurate assessment of the preoperative costs associated with total joint replacement surgery. METHODS: The mean time that clinical staff members spent on preoperative tasks per patient was multiplied by the hourly salary. Clinical staff members included orthopedic surgeons, nurse practitioners or physician assistants, nurses, medical assistants, and surgical coordinators. Mean time spent on preoperative tasks was obtained from the most recent literature. Salaries were obtained from the nationwide database provided by Glassdoor Inc. RESULTS: Total time spent among clinical staff involved in preoperative tasks for each arthroplasty patient was 8.45 hours (2.96-13.94). Total TDABC was calculated to be $348.17 (132.46-562.64). Accounting for preoperative tasks, the TDABC for TKA/THA increases from $13321.5 to $13669.67. Preoperative tasks are composed of 2.6% of total TKA/THA TDABC. In 2020, an estimated $544,189,710 of preoperative TKA/THA work was completed. CONCLUSION: Surgeons, providers, and ancillary staff involved in THA/TKA spend a cumulative preoperative work time of approximately 8.5 hours per patient, which equates to $348.17 that is currently unaccounted for in Relative Value Scale Update Committee methodology.

Outcomes Following Isolated Posterior Interosseous Nerve Neurectomy: A Systematic Review.

BACKGROUND: Posterior interosseous nerve neurectomies (PINN) are an option in the treatment of chronic dorsal wrist pain. However, the literature describing PINN consists primarily of small case series, and the procedure is typically done as an adjunct treatment; therefore, the outcomes of the PINN itself are not well known. We performed a systematic review of the literature to provide characteristics of patients following a PINN. METHODS: A systematic review of the literature was performed. Papers published in the PubMed database in English on isolated PINN were included. Articles in which a PINN was performed as an adjunct were excluded. Primary outcomes were return to work, patient satisfaction, pain/function scores, wrist range of motion, complications, and pain recurrence. Weighted averages were used to calculate continuous data, whereas categorical data were noted in percentages. RESULTS: The search yielded 427 articles including 6 studies and 135 patients (136 cases). The average age was 43.6 years (range, 17-75), and most patients were female (54.1%). At an average final follow-up of 51 months, 88.9% of patients were able to return to work. After initial improvement, a recurrence of pain occurred in 25.5% of patients at an average of 12.3 months. Excluding recurrence of pain, the complication rate was 0.9%, including 1 reflex sympathetic dystrophy. Overall, 88.4% of patients experienced a subjective improvement and were satisfied with the procedure. CONCLUSIONS: Isolated PINN have shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up. PINN can provide relief in patient's chronic wrist pain.