Postoperative outcomes and trends in computer-navigated and robotic-assisted total hip arthroplasty.

INTRODUCTION: As the volume of technology-assisted total hip arthroplasty (THA) increases, there is a need to characterise the outcomes of robotic-assisted (RA) and computer-navigated (CN) THA. The goal of this study was to assess outcomes and opioid consumption following CN-THA and RA-THA compared to conventionally-instrumented (CON) THA. METHODS: The Premier Database was queried for all patients who underwent primary, elective THA from 2015-2020. Patients were divided into 3 groups: CN, RA, or CON-THA. Yearly usage trends were assessed. Univariate and multivariate analyses were performed to assess the 90-day risk of postoperative complications. Opioid consumption was reported in morphine milligram equivalents (MME) for postoperative days (POD) 0 and 1. RESULTS: Overall, 474,707 elective THAs were identified (95.7% CON, 2.1% CN, 2.2% RA. After accounting for confounders, CN-THA patients were at decreased risk for periprosthetic joint infection (PJI) (aOR: 0.55, p < 0.001) and dislocation (aOR 0.45, p < 0.001), but increased risk for blood transfusion (aOR 1.97, <0.001) compared to CON-THA. RA-THA patients were at decreased risk of dislocation (aOR:0.66, p < 0.001) but increased risk for transfusion (aOR 1.20, p < 0.001), prosthesis breakage (aOR 3.88, p < 0.001), and periprosthetic fracture (aOR 1.72, p < 0.001). Opioid consumption for CN-THA patients was lower on POD1 and lower for RA-THA patients POD0 and 2 compared to CON-THA. DISCUSSION: CN-THA was associated with reduced rates of PJI and dislocation, but increased rates of blood transfusion while RA-THA was associated with decreased rates of dislocation, but increased rates of blood transfusion, prosthesis complications, and periprosthetic fracture compared to CON-THA. Technology-assisted THA was associated with lower postoperative opioid consumption.

Impact of Insertion Speed, Depth, and Robotic Assistance on Cochlear Implant Insertion Forces and Intracochlear Pressure: A Scoping Review.

Cochlear implants are crucial for addressing severe-to-profound hearing loss, with the success of the procedure requiring careful electrode placement. This scoping review synthesizes the findings from 125 studies examining the factors influencing insertion forces (IFs) and intracochlear pressure (IP), which are crucial for optimizing implantation techniques and enhancing patient outcomes. The review highlights the impact of variables, including insertion depth, speed, and the use of robotic assistance on IFs and IP. Results indicate that higher insertion speeds generally increase IFs and IP in artificial models, a pattern not consistently observed in cadaveric studies due to variations in methodology and sample size. The study also explores the observed minimal impact of robotic assistance on reducing IFs compared to manual methods. Importantly, this review underscores the need for a standardized approach in cochlear implant research to address inconsistencies and improve clinical practices aimed at preserving hearing during implantation.

Biomechanical considerations for optimising subretinal injections.

Subretinal injection is the preferred delivery technique for various novel ocular therapies and is widely used because of its precision and efficient delivery of gene and cell therapies; however, choosing an injection point and defining delivery parameters to target a specified retinal location and area is an inexact science. We provide an overview of the key factors that play important roles during subretinal injections to refine the technique, enhance patient outcomes, and minimise risks. We describe the role of anatomical and physical variables that affect subretinal bleb propagation and shape and their impact on retinal integrity. We highlight the risks associated with subretinal injections and consider strategies to mitigate reflux and retinal trauma. Finally, we explore the emerging field of robotic assistance in improving intraocular manouvrability and precision to facilitate the injection procedure.

3D human pose data augmentation using Generative Adversarial Networks for robotic-assisted movement quality assessment.

In the realm of human motion recognition systems, the augmentation of 3D human pose data plays a pivotal role in enriching and enhancing the quality of original datasets through the generation of synthetic data. This augmentation is vital for addressing the current research gaps in diversity and complexity, particularly when dealing with rare or complex human movements. Our study introduces a groundbreaking approach employing Generative Adversarial Networks (GANs), coupled with Support Vector Machine (SVM) and DenseNet, further enhanced by robot-assisted technology to improve the precision and efficiency of data collection. The GANs in our model are responsible for generating highly realistic and diverse 3D human motion data, while SVM aids in the effective classification of this data. DenseNet is utilized for the extraction of key features, facilitating a comprehensive and integrated approach that significantly elevates both the data augmentation process and the model's ability to process and analyze complex human movements. The experimental outcomes underscore our model's exceptional performance in motion quality assessment, showcasing a substantial improvement over traditional methods in terms of classification accuracy and data processing efficiency. These results validate the effectiveness of our integrated network model, setting a solid foundation for future advancements in the field. Our research not only introduces innovative methodologies for 3D human pose data enhancement but also provides substantial technical support for practical applications across various domains, including sports science, rehabilitation medicine, and virtual reality. By combining advanced algorithmic strategies with robotic technologies, our work addresses key challenges in data augmentation and motion quality assessment, paving the way for new research and development opportunities in these critical areas.

Contemporary analysis of the learning curve for robotic-assisted total hip arthroplasty emerging technologies.

Robotic assisted (RA) total hip arthroplasty (THA) offers improved acetabular component placement and radiographic outcomes, but inconsistent assessment methods of its learning curves render the evaluation of adopting novel platforms challenging. Therefore, we conducted a systematic review to assess the learning curve associated with RA-THA, both tracking a surgeon's performance across initial cases and comparing their performance to manual THA (M-THA). PubMed, MEDLINE, EBSCOhost, and Google Scholar were searched on June 16, 2023, to identify studies published between January 1, 2000 and June 16, 2023 (PROSPERO registration: CRD42023437339). The query yielded 655 unique articles, which were screened for eligibility. The final analysis included 11 articles, evaluating 1351 THA procedures. Risk of bias was assessed via the Methodological Index for Nonrandomized Studies (MINORS) tool. The mean MINORS score was 21.3 ± 0.9. RA-THA provided immediate improvements in acetabular component placement accuracy and radiographic outcomes compared to M-THA, with little to no experience required to achieve peak proficiency. A modest learning curve (12-17 cases) was associated with operative time, which was elevated compared to M-THA (+ 9-13 min). RA-THA offers immediate advantages to M-THA for component placement accuracy and radiographic outcomes. Surgeons should expect to experience increased operative times, which become less pronounced or equivalent to M-THA after a modest caseload.

Does Approach Matter in Robotic-Assisted Total Hip Arthroplasty? A Comparison of Early Reoperations Between Direct Anterior and Postero-Lateral Approach.

BACKGROUND: There is no consensus on whether direct anterior approach (DAA) or postero-lateral approach (PLA) total hip arthroplasty (THA) confers a lower risk of postoperative complications. Robotic assistance in THA results in a more consistently accurate component position compared to manual THA. The objective of this study was to compare rates of dislocation, reoperation, revision, and patient-reported outcome measures between patients undergoing DAA and PLA robotic-assisted primary THA. METHODS: We identified 2,040 consecutive robotic-assisted primary THAs performed for primary osteoarthritis, using DAA (n = 497) or PLA (n = 1,542) between 2017 and 2020. The mean follow-up was 18 months. Kaplan-Meier analysis estimated survivorship free of dislocation, reoperation, and revision. Achievement of patient acceptable symptom state and minimum clinically important difference were used to compare changes in the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) and Visual Analog Scale. RESULTS: Dislocation was rare in this series (14 in 2,040, 0.7%), including 1 of 497 (0.2%) in the DAA cohort and 13 of 1,542 (0.8%) in the PLA cohort (P = .210). There was no difference in 2-year reoperation-free survivorship (97.8 versus 98.6%, P = .59) or revision-free survivorship (98.8 versus 99.0%, P = .87) at any time point. After controlling for age, sex, and body mass index, there was no difference in dislocation, reoperation, or revision. At 6-week follow-up, after controlling for age, sex, and body mass index, patients in the DAA cohort had higher odds of achieving HOOS JR minimum clinically important difference (odds ratio = 2.01, P = .012) and HOOS JR patient acceptable symptom state (odds ratio = 1.72, P = .028). There were no differences in patient-reported outcome measures by 3 months. CONCLUSIONS: For robotic-assisted primary THA, DAA may confer enhanced early (<6 weeks) functional recovery compared to the PLA, but there was no significant difference in postoperative dislocation, reoperation, or revision rates.

Robotic mirror therapy for stroke rehabilitation through virtual activities of daily living.

Mirror therapy is a standard technique of rehabilitation for recovering motor and vision abilities of stroke patients, especially in the case of asymmetric limb function. To enhance traditional mirror therapy, robotic mirror therapy (RMT) has been proposed over the past decade, allowing for assisted bimanual coordination of paretic (affected) and contralateral (healthy) limbs. However, state-of-the-art RMT platforms predominantly target mirrored motions of trajectories, largely limited to 2-D motions. In this paper, an RMT platform is proposed, which can facilitate the patient to practice virtual activities of daily living (ADL) and thus enhance their independence. Two similar (but mirrored) 3D virtual environments are created in which the patients operate robots with both their limbs to complete ADL (such as writing and eating) with the assistance of the therapist. The recovery level of the patient is continuously assessed by monitoring their ability to track assigned trajectories. The patient's robots are programmed to assist the patient in following these trajectories based on this recovery level. In this paper, the framework to dynamically monitor recovery level and accordingly provide assistance is developed along with the nonlinear controller design to ensure position tracking, force control, and stability. Proof-of-concept studies are conducted with both 3D trajectory tracking and ADL. The results demonstrate the potential use of the proposed system to enhance the recovery of the patients.

Minimally invasive sacrocolpopexy: efficiency of robotic assistance compared to standard laparoscopy.

Minimally invasive abdominal sacrocolpopexy (SC) is the treatment of choice for symptomatic, high-grade, apical or multi-compartmental pelvic organ prolapse (POP), in terms of anatomical correction and treatment durability. Robot-assisted sacrocolpopexy (RASC) could be an attractive alternative to the gold standard laparoscopic sacrocolpopexy (LSC), for its ergonomic advantages in such a technically demanding procedure. However, it has not yet proven its superiority, consequently raising cost-effectiveness issues. Our primary objective was to assess if RASC can achieve better overall operative time (OOT) over LSC, with at least equivalent perioperative results. This was a single-center retrospective study including 100 patients (58 consecutive RASC cases and 42 LSC within the same time-period), with primary endpoint the OOT in both groups. Secondary results included complication rate, hospital stay, short-term anatomic results and OOT within and beyond the RASC learning curve. A multivariate linear regression was carried out for our primary outcome. The groups had comparable characteristics, except for BMI, which was lower in RASC group. The mean OOT was significantly lower in the RASC group (188 vs. 217 min, p ≤ 0.01), even after adjusting for possible confounders. Short-term anatomic results, complication rate, and blood loss were similar in the two groups. Mean hospital stay was significantly longer in the RASC group. Average RASC OOT was significantly shorter after the first 20 cases realized. This study demonstrated a significant reduction of OOT for RASC compared to LSC, with similar perioperative results, encouraging further use of the robotic technology for this indication.

Robotic-Assisted Versus Fluoroscopic-Guided Surgery on the Accuracy of Spine Pedicle Screw Placement: A Systematic Review and Meta-Analysis.

Spinal fusion is a common method by which surgeons decrease instability and deformity of the spinal segment targeted. Pedicle screws are vital tools in fusion surgeries and advancements in technology have introduced several modalities of screw placement. Our objective was to evaluate the accuracy of pedicle screw placement in robot-assisted (RA) versus fluoroscopic-guided (FG) techniques. The PubMed and Cochrane Library databases were systematically reviewed from January 2007 through to August 8, 2022, to identify relevant studies. The accuracy of pedicle screw placement was determined using the Gertzbein-Robbins (GR) classification system. Facet joint violation (FJV), total case radiation dosage, total case radiation time, total operating room (OR) time, and total case blood loss were collected. Twenty-one articles fulfilled the inclusion criteria. Successful screw accuracy (GR Grade A or B) was found to be 1.02 (95% confidence interval: 1.01 - 1.04) times more likely with the RA technique. In defining accuracy solely based on the GR Grade A criteria, screws placed with RA were 1.10 (95% confidence interval: 1.06 - 1.15) times more likely to be accurate. There was no significant difference between the two techniques with respect to blood loss (Hedges' g: 1.16, 95% confidence interval: -0.75 to 3.06) or case radiation time (Hedges' g: -0.34, 95% CI: -1.22 to 0.53). FG techniques were associated with shorter operating room times (Hedges' g: -1.03, 95% confidence interval: -1.76 to -0.31), and higher case radiation dosage (Hedges' g: 1.61, 95% confidence interval: 1.11 to 2.10). This review suggests that RA may slightly increase pedicle screw accuracy and decrease per-case radiation dosage compared to FG techniques. However, total operating times for RA cases are greater than those for FG cases.

Robotic-assisted versus manual Uro Dyna-CT-guided puncture in an ex-vivo kidney phantom.

INTRODUCTION AND OBJECTIVES: Challenging percutaneous renal punctures to gain access to the kidney requiring guidance by cross-sectional imaging. To test the feasibility of robotic-assisted CT-guided punctures (RP) and compare them with manual laser-guided punctures (MP) with Uro Dyna-CT (Siemens Healthcare Solutions, Erlangen, Germany). MATERIAL AND METHODS: The silicon kidney phantom contained target lesions of three sizes. RP were performed using a robotic assistance system (guidoo, BEC GmbH, Pfullingen, Germany) with a robotic arm (LBR med R800, KUKA AG, Augsburg, Germany) and a navigation software with a cone-beam-CT Artis zeego (Siemens Healthcare GmbH, Erlangen, Germany). MP were performed using the syngo iGuide Uro-Dyna Artis Zee Ceiling CT (Siemens Healthcare Solutions). Three urologists with varying experience performed 20 punctures each. Success rate, puncture accuracy, puncture planning time (PPT), and needle placement time (NPT) were measured and compared with ANOVA and Chi-Square Test. RESULTS: One hundred eighteen punctures with a success rate of 100% for RP and 78% for MP were included. Puncture accuracy was significantly higher for RP. PPT (RP: 238 ± 90s, MP: 104 ± 21s) and NPT (RP: 128 ± 40s, MP: 81 ± 18s) were significantly longer for RP. The outcome variables did not differ significantly with regard to levels of investigators' experience. CONCLUSION: The accuracy of RP was superior to that of MP. This study paves the way for first in-human application of this robotic puncture system.

Does Computer Navigation or Robotic Assistance Affect the Risk of Periprosthetic Joint Infection in Primary Total Knee Arthroplasty? A Propensity Score-Matched Cohort Analysis.

BACKGROUND: The use of technology during total knee arthroplasty (TKA) has been associated with more accurate component position and less blood loss. Yet to date, the risk of developing prosthetic joint infection (PJI) associated with computer navigation (CN) or robotic assistance (RA) has not been thoroughly evaluated. This study used propensity score-matching (PSM) in a large cohort of primary TKA patients to compare the rate of PJI following conventional TKA (TKA) versus CN-TKA and RA-TKA. METHODS: We retrospectively reviewed 13,015 knees in 11,727 patients who underwent primary TKA at a single institution from 2018 to 2021. The cohort was stratified into TKA, CN-TKA, and RA-TKA groups. 1:1 PSM was applied to 11,834 patients. Propensity score-matching was performed using logistic regression accounting for age, sex, body mass index, Charlson Comorbidity Index (CCI) score, CCI components, and smoking status. Univariate and multivariable analyses were performed to evaluate differences in surgical time and PJI rate. RESULTS: Significantly longer median operating times were noted in the RA-TKA group (14 minutes) compared to TKA (P < .001). The PJI rates among matched cohorts were similar among RA-TKA (0.3%), CN-TKA (0.3%), and conventional TKA (0.5%). Multivariable logistic regressions demonstrated that the use of robotic assistance (odds ratio (OR) = 0.5, P = .423) or computer navigation (OR = 0.61, P = .128) was not associated with increased risk of PJI when compared to conventional TKA. CONCLUSIONS: Use of computer navigation and robotic assistance during primary TKA are associated with longer surgical times, but no difference in PJI frequency within 90 days of surgery.

Human-Robot Collaboration for Healthcare: A Narrative Review.

Robotic applications have often quickly transitioned from industrial to social. Because of this, robots can now engage with people in a natural way and blend in with their surroundings. Due to the lack of medical professionals, growing healthcare costs, and the exponential rise in the population of vulnerable groups like the ill, elderly, and children with developmental disabilities, the use of social robots in the healthcare system is expanding. As a result, social robots are employed in the medical field to entertain and educate hospitalized patients about health issues, as well as to assist the elderly and sick. They are also employed in the dispensing of medications, rehabilitation, and emotional and geriatric care. Thus, social robots raise the standard and effectiveness of medical care. This article explains how patients and healthcare professionals collaborate with robots in the healthcare industry. The objectives of this collaboration are to resolve moral and legal concerns, improve patient outcomes, and improve healthcare delivery. It has a broad range of uses, including telemedicine, rehabilitation, and robotic surgical support. Human-robot interaction is the term used to describe interactions between social robots and people. Many obstacles stand in the way of human-robot interaction in healthcare, including safety concerns, acceptability issues, appropriateness, usefulness, and the worry that robots may replace human carers. In the end, these difficulties result in a poor adoption rate for robotic technology. As a result, the applications and difficulties of human-robot interaction in healthcare are thoroughly evaluated in this research. This study also reviews future safety prospects from human-robot interaction in healthcare, as well as ethical and usability issues including privacy, trust, and safety, and our aims to provide a comprehensive overview of the use of robots in healthcare, including their applications, benefits, challenges, and prospects, to facilitate a deeper understanding of this evolving field.

Effect of Robotic-Assisted Gait at Different Levels of Guidance and Body Weight Support on Lower Limb Joint Kinematics and Coordination.

The Lokomat provides task-oriented therapy for patients with gait disorders. This robotic technology drives the lower limbs in the sagittal plane. However, normative gait also involves motions in the coronal and transverse planes. This study aimed to compare the Lokomat with Treadmill gait through three-dimensional (3D)-joint kinematics and inter-joint coordination. Lower limb kinematics was recorded in 18 healthy participants who walked at 3 km/h on a Treadmill or in a Lokomat with nine combinations of Guidance (30%, 50%, 70%) and bodyweight support (30%, 50%, 70%). Compared to the Treadmill, the Lokomat altered pelvic rotation, decreased pelvis obliquity and hip adduction, and increased ankle rotation. Moreover, the Lokomat resulted in significantly slower velocity at the hip, knee, and ankle flexion compared to the treadmill condition. Moderate to strong correlations were observed between the Treadmill and Lokomat conditions in terms of inter-joint coordination between hip-knee (r = 0.67-0.91), hip-ankle (r = 0.66-0.85), and knee-ankle (r = 0.90-0.95). This study showed that some gait determinants, such as pelvis obliquity, rotation, and hip adduction, are altered when walking with Lokomat in comparison to a Treadmill. Kinematic deviations induced by the Lokomat were most prominent at high levels of bodyweight support. Interestingly, different levels of Guidance did not affect gait kinematics. The present results can help therapists to adequately select settings during Lokomat therapy.

Robotic-assisted versus conventional laparoscopic approach in patients with large rectal endometriotic nodule: the evaluation of safety and complications.

AIM: The aim was to compare postoperative complications in patients undergoing the excision of a rectal endometriotic nodule over 3 cm by a robotic-assisted versus a conventional laparoscopic approach. METHODS: We conducted a retrospective cohort study evaluating prospectively collected data. The main interventions included rectal shaving, disc excision or colorectal resection. All the surgeries were performed in one endometriosis reference institute. To evaluate factors significantly associated with the risk of anastomosis leakage or fistula and bladder atony, we conducted a multivariate logistic regression model. RESULTS: A total of 548 patients with rectal endometriotic nodule over 3 cm in diameter (#ENZIAN C3) were included in the final analysis. The demography and clinical characteristics of women managed by the robotic-assisted (n = 97) approach were similar to those of patients who underwent conventional laparoscopy (n = 451). The multivariate logistic regression demonstrated that the surgical approach (robotic-assisted vs. laparoscopic) was not associated with the rate of anastomosis leakage or fistula (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 0.3-4.0) and bladder dysfunction (aOR 0.5, 95% CI 0.1-1.8). A rectal nodule located lower than 6 cm from the anal verge was significantly associated with anastomosis leakage (aOR 4.1, 95% CI 1.4-10.8) and bladder atony (aOR 4.3, 95% CI 1.5-12.3). Anastomosis leakage was also associated with smoking (aOR 3.2, 95% CI 1.4-7.4), significant vaginal infiltration (aOR 2.7, 95% CI 1.2-6.7) and excision of nodules involving sacral roots (aOR 5.6, 95% CI 1.7-15.5). CONCLUSION: The robotic-assisted approach was not associated with increased risk of main postoperative complications compared to conventional laparoscopy for the treatment of large rectal endometriotic nodules.

Experience matters for robotic assistance: an analysis of case data.

Many robotic procedures require active participation by assistants. Most prior work on assistants' effect on outcomes has been limited in procedural focus and scope, with studies reporting differing results. Knowing how assistant experience affects operating room time could inform operating room case scheduling and provide an impetus for additional assistant training. As such, this retrospective cohort study aimed to determine the association between assistant experience and operating room time for 2291 robotic-assisted operations performed from 2016 to 2022 at our institution. Linear regression showed a significant association between the presence of a junior resident and increased case length differential with an increase of 26.9 min (p = 0.01). There were no significant associations between the presence of a senior resident (p = 0.52), presence of a fellow (p = 0.20), or presence of a physician assistant (p = 0.43) and case length differential. The finding of increased operating room time in the presence of a junior resident during robotic cases supports consideration of the adoption of formal assistant training programs for residents to improve efficiency.

Comparison of Robot-Assisted and Manual Cannula Insertion in Simulated Big-Bubble Deep Anterior Lamellar Keratoplasty.

This study aimed to compare the efficacy of robot-assisted and manual cannula insertion in simulated big-bubble deep anterior lamellar keratoplasty (DALK). Novice surgeons with no prior experience in performing DALK were trained to perform the procedure using manual or robot-assisted techniques. The results showed that both methods could generate an airtight tunnel in the porcine cornea, and result in successful generation of a deep stromal demarcation plane representing sufficient depth reached for big-bubble generation in most cases. However, the combination of intraoperative OCT and robotic assistance received a significant increase in the depth of achieved detachment in non-perforated cases, comprising a mean of 89% as opposed to 85% of the cornea in manual trials. This research suggests that robot-assisted DALK may offer certain advantages over manual techniques, particularly when used in conjunction with intraoperative OCT.

Planning of Medical Flexible Needle Motion in Effective Area of Clinical Puncture.

Lung cancer is the leading cause of cancer deaths worldwide. Although several lung cancer diagnostic methods are available for lung nodule biopsy, there are limitations in terms of accuracy, safety, and invasiveness. Transbronchial needle aspiration (TBNA) is a common method for diagnosing and treating lung cancer that involves a robot-assisted medical flexible needle moving along a curved three-dimensional trajectory, avoiding anatomical barriers to achieve clinically meaningful goals in humans. Inspired by the puncture angle between the needle tip and the vessel in venipuncture, we suggest that different orientations of the medical flexible needle puncture path affect the cost of the puncture trajectory and propose an effective puncture region based on the optimal puncture direction, which is a strategy based on imposing geometric constraints on the search space of the puncture direction, and based on this, we focused on the improved implementation of RCS*. Planning within the TBNA-based lung environment was performed using the rapidly exploring random tree (RRT), resolution-complete search (RCS), and RCS* (a resolution-optimal version of RCS) within an effective puncture region. The experimental results show that the optimal puncture direction corresponding to the lowest cost puncture trajectory is consistent among the three algorithms and RCS* is more efficient for planning. The experiments verified the feasibility and practicality of our proposed minimum puncture angle and puncture effective region and facilitated the study of the puncture direction of flexible needle puncture.

Consideration of pelvic tilt at the time of preoperative planning improves standing acetabular position after robotic-arm assisted total hip arthroplasty.

INTRODUCTION: Approximately half of dislocating total hip arthroplasties (THAs) demonstrate acetabular component position within traditional safe zones. It is unclear if postoperative functional acetabular position can be reliably improved by considering preoperative pelvic tilt. We investigated whether standing cup position targets could be more accurately achieved by considering preoperative standing pelvic tilt in addition to bone landmarks when planning for robot-assisted THA. METHODS: We reviewed 146 THAs performed by a single surgeon using computed tomography-based 3-dimensional planning and robotic technology to guide acetabular reaming and component insertion. Planning for 73 consecutive cases started at 40° of inclination and 22° of anteversion relative to the supine functional plane and was adjusted to better match native hip anatomy. Planning for the next 73 cases was modified to consider standing pelvic position based on standing preoperative radiographs. We compared groups to determine the rate when cups were placed outside our standing targets of 15-30° anteversion and 35-50° inclination. RESULTS: Cup position proved to be reliable in both groups, with 83% of cups in the anatomic planning cohort and 90% of cups in the functional planning cohort achieving standing targets for both anteversion and inclination (p = 0.227). Variances were lower in the functional planning group: 9.4° versus 15.8° of inclination (p = 0.079) and 18.3° versus 26.1° of anteversion (p = 0.352). The range of functional positions was narrower in the functional planning group: 35.7-47.5° versus 31.8-54.9° of inclination and 16.7-35.0° versus 10.1-35.9° of anteversion. DISCUSSION: Our results suggest enhanced planning that considers pelvic tilt, when coupled to a precision tool to achieve the plan, can reliably achieve target standing component positions. Considering preoperative functional pelvic position may improve postoperative functional acetabular component placement in THA, but the clinical benefit of this has yet to be confirmed.

Movement therapy in lung transplantation candidates assisted by a lightweight wearable robot.

The aim of this pilot-study was to investigate the safety, feasibility and tolerability of an assisted mobilization of patients with advanced pulmonary diseases, using a lightweight, exoskeleton-type robot (Myosuit, MyoSwiss AG, Zurich, Switzerland). Ten patients performed activities of daily life (ADL) both with and without the device. The mean age was 53.6 (±5.6) years; 70% were male. The assessment of outcome included the evaluation of vital signs, adverse events, rates of perceived exertion and dyspnea (PRE, PRD), the ability to perform ADL and the individual acceptability. Robotic-assisted mobilization was feasible in all patients. No adverse events occurred. RPE and RPD showed no significant difference with or without the Myosuit (mean difference in RPE -1.7, 95%-confidence interval (CI) -1.16, 4.49; p = 0.211; mean difference in RPD 0.00, 95%-CI -1.88, 1.88; p = 0.475). 80% of patients were interested to participate in a robotic-assisted training on a regular basis. A robotic exoskeleton-assisted mobilization is safe, feasible, well-tolerated and well-accepted. The results are highly encouraging to further pursue this highly innovative approach.

A Review of Exoskeletons Considering Nurses.

Daily tasks of nurses include manual handling to assist patients. Repetitive manual handling leads to high risk of injuries due to the loads on nurses' bodies. Nurses, in hospitals and care homes, can benefit from the advances in exoskeleton technology assisting their manual handling tasks. There are already exoskeletons both in the market and in the research area made to assist physical workers to handle heavy loads. However, those exoskeletons are mostly designed for men, as most physical workers are men, whereas most nurses are women. In the case of nurses, they handle patients, a more delicate task than handling objects, and any such device used by nurses should easily be disinfected. In this study, the needs of nurses are examined, and a review of the state-of-the-art exoskeletons is conducted from the perspective of to what extent the existing technologies address the needs of nurses. Possible solutions and technologies and particularly the needs that have not been addressed by the existing technologies are discussed.