Robotic-arm assisted versus conventional unicompartmental knee arthroplasty : exploratory secondary analysis of a Randomised Controlled Trial

Objectives: This study reports on a secondary exploratory analysis of the early clinical outcomes of an randomised clinical trial comparing Robotic-arm Assisted Uni-compartmental Knee Arthroplasty (UKA) for medial compartment osteoarthritis of the knee compared to Manual UKA performed using traditional surgical jigs. This follows reporting of primary outcomes of implant accuracy and gait analysis that showed significant advantages in the Robotic-arm assisted group.Methods139 patients were recruited from a single centre. Patients were randomised to receive either a manual UKA implanted with the aid of traditional surgical jigs, or a UKA implanted with the aid of a tactile guided Robotic-arm Assisted system. Outcome measures included: American Knee Society Score (AKSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Hospital Anxiety Depression (HAD) Scale, University of California at Los Angeles (UCLA) Activity Scale, SF-12, Pain Catastrophising Scale (PCS), Somatic Disease (Primary care evaluation of mental disorders [PRIME-MD] score), Pain Visual Analogue Scale (VAS), Analgesic use, Patient Satisfaction, complications relating to surgery, 90 day Pain diaries and the requirement for revision surgery.ResultsFrom day 1 post-operation through to week 8 post-operation the median pain scores for Robotic-arm Assisted group were 55.4% lower than those observed in the Manual surgery group (p = 0.040). A greater proportion of patients receiving Robotic-arm Assisted surgery improved their UCLA activity score.At 3 months post-operation, the Robotic-arm Assisted group had better AKSS scores (Robotic median 164 (Quarter 1 131, Quarter 3 178), Manual 143 (Quarter 1 132, Quarter 3 166)), although no difference was noted with the OKS.At 1 year post-operation, the observed differences with the AKSS had narrowed from 21 points to 7 points (p = 0.106) (Robotic median=171 (Quarter 1 153, Quarter 3 179), Manual median=164 (Quarter 1 144, Quarter 3 182 No difference was observed with the OKS, and almost half of each group reached the ceiling limit of the score (OKS > 43).The key factors associated with achieving excellent outcome on the AKSS were a pre-operative activity level > 5 on the UCLA activity score and use of Robotic-arm surgery. Factors associated with a poor outcome were manual surgery and pre-operative depression.Conclusions: Robotic-arm assisted surgery results in improved early pain scores and early function scores in some patient reported outcomes measures, but no difference was observed, at 1 year post operatively. Although improved results favoured the Robotic arm assisted group in active patients (i.e. UCLA > = 5), these do not withstand more stringent multiplicity adjustments

Recent Progress in CuInS2 Thin-Film Solar Cell Research at NASA Glenn

The National Aeronautics and Space Administration (NASA) is interested in developing low-cost highly efficient solar cells on light-weight flexible substrates, which will ultimately lower the mass-specific power (W/kg) of the cell allowing extra payload for missions in space as well as cost reduction. In addition, thin film cells are anticipated to have greater resistance to radiation damage in space, prolonging their lifetime. The flexibility of the substrate has the added benefit of enabling roll-to-roll processing. The first major thin film solar cell was the "CdS solar cell" - a heterojunction between p-type CuxS and n-type CdS. The research on CdS cells started in the late 1950s and the efficiency in the laboratory was up to about 10 % in the 1980s. Today, three different thin film materials are leading the field. They include amorphous Si, CdTe, and Cu(In,Ga)Se2 (CIGS). The best thin film solar cell efficiency of 19.2 % was recently set by CIGS on glass. Typical module efficiencies, however, remain below 15 %

Robotic arm-assisted bi-unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty : a prospective randomized controlled trial

Aims The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery. Methods An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery. The hip-knee-ankle angle (HKAA) was also measured to identify any differences between the two groups. Results The pre- to postoperative changes in joint anatomy were significantly less in patients undergoing bi-UKA in all three planes in both the femur and tibia, except for femoral sagittal component orientation in which there was no difference. Overall, for the six parameters of alignment (three femoral and three tibial), 47% of bi-UKAs and 24% TKAs had a change of < 2° (p = 0.045). The change in HKAA towards neutral in varus and valgus knees was significantly less in patients undergoing bi-UKA compared with those undergoing TKA (p < 0.001). Alignment was neutral in those undergoing TKA (mean 179.5° (SD 3.2°)) while those undergoing bi-UKA had mild residual varus or valgus alignment (mean 177.8° (SD 3.4°)) (p < 0.001). Conclusion Robotic-assisted, cruciate-sparing bi-UKA maintains the natural anatomy of the knee in the coronal, sagittal, and axial planes better, and may therefore preserve normal joint kinematics, compared with a mechanically aligned TKA. This includes preservation of coronal joint line obliquity. HKAA alignment was corrected towards neutral significantly less in patients undergoing bi-UKA, which may represent restoration of the pre-disease constitutional alignment (p < 0.001)

Robotic arm-assisted bi-unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty : a prospective, randomised controlled trial

Unicompartmental knee arthroplasty (UKA) is associated with faster postoperative recovery than total knee arthroplasty (TKA), sparing cruciate ligaments and normal joint surfaces. Although registry data indicate that revision rates are higher following UKA than TKA, robotic arm-assistance can improve accuracy of implant positioning and restoration of normal kinematics, when compared to manual implantation. Bi-unicompartmental knee arthroplasty (Bi-UCKA) with manual implantation has been demonstrated to maintain native joint obliquity better than TKA, but not as well as UKAs. There has been no RCT to date examining whether the benefits of UKA hold true for robotic-assisted Bi-UCKA compared to TKA

Robotic-arm-assisted vs conventional unicompartmental knee arthroplasty. The 2-year clinical outcomes of a randomized controlled trial

Background: Unicompartmental knee arthroplasty (UKA) for treatment of medial compartment osteoarthritis has potential benefits over total knee arthroplasty but UKA has a higher revision rate. Robotic-assisted UKA is increasingly common and offers more accurate implant positioning and limb alignment, lower early postoperative pain but evidence of functional outcome is lacking. The aim was to assess the clinical outcomes of a single-centre, prospective, randomised controlled trial, comparing robotic-arm-assisted UKA with conventional surgery. Methods: A total of 139 participants were recruited and underwent robotic-arm-assisted (fixed bearing) or conventional (mobile bearing) UKA. Fifty-eight patients in the robotic-arm-assisted group and 54 in the manual group at 2 years. The main outcome measures were the Oxford Knee Score, American Knee Society Score and revision rate. Results: At 2 years, there were no significant differences for any of the outcome measures. Sub-group analysis (n = 35) of participants with a preoperative University of California Los Angeles Activity Scale >5 (more active) was performed. In this sub-group, the median Oxford Knee Score at 2 years was 46 (IQR 42.0-48.0) for robotic-arm-assisted and 41 (IQR 38.5-44.0) for the manual group (P = .036). The median American Knee Society Score was 193.5 (IQR 184.0-198.0) for the robotic-arm-assisted group and 174.0 (IQR 166.0-188.5) for the manual group (P = .017). Survivorship was 100% in robotic-arm-assisted group and 96.3% in the manual group. Conclusion: Overall, participants achieved an outcome equivalent to the most widely implanted UKA in the United Kingdom. Sub-group analysis suggests that more active patients may benefit from robotic-arm-assisted surgery. Long term follow-up is required to evaluate differences in survivorship

Soil mobility of surface applied polyaromatic hydrocarbons in response to simulated rainfall

Polyaromatic hydrocarbons (PAHs) are emitted from a variety of sources and can accumulate on and within surface soil layers. To investigate the level of potential risk posed by surface contaminated soils, vertical soil column experiments were conducted to assess the mobility, when leached with simulated rainwater, of six selected PAHs (naphthalene, phenanthrene, fluoranthene, pyrene, benzo(e)pyrene and benzo(ghi)perylene) with contrasting hydrophobic characteristics and molecular weights/sizes. The only PAH found in the leachate within the experimental period of 26 days was naphthalene. The lack of migration of the other applied PAHs were consistent with their low mobilities within the soil columns which generally parallelled their log Koc values. Thus only 2.3% of fluoranthene, 1.8% of pyrene, 0.2% of benzo(e)pyrene and 0.4% of benzo(ghi)perylene were translocated below the surface layer. The PAH distributions in the soil columns followed decreasing power relationships with 90% reductions in the starting levels being shown to occur within a maximum average depth of 0.94 cm compared to an average starting depth of 0.5 cm. A simple predictive model identifies the extensive time periods, in excess of 10 years, required to mobilise 50% of the benzo(e)pyrene and benzo(ghi)perylene from the surface soil layer. Although this reduces to between 2 and 7 years for fluoranthene and pyrene, it is concluded that the possibility of surface applied PAHs reaching and contaminating a groundwater aquifer is unlikely

A ‘Baby GDA’: Norwich’s Airspace during the Second World War

Throughout the Second World War, the Luftwaffe attacked Norwich on various occasions. The impact this had on the city was recorded visually on the ‘Norwich Bomb Map’. This cartographic depiction, however, only records a single ‘horizontal’ component of the aerial ‘battlescape’. In reality, the aerial battlefield comprised a combination of Norwich’s air defences and the flightpaths of the Luftwaffe bombers, which existed in three-dimensional space. As other scholars have developed methodologies for reconstructing anti-aircraft ‘fire domes’, this article will combine these concepts with a new approach that reconstructs historic flightpaths to give a three-dimensional overview of Norwich’s ‘Gun Defended Area’. By examining all components of Norwich’s airspace, this article will demonstrate the importance of considering the vertical component of a battlescape