Robotic-arm assisted lateral unicompartmental knee arthroplasty: 5-Year outcomes & survivorship

INTRODUCTION: Robotic-arm assisted unicompartmental knee arthroplasty (RA-UKA) has demonstrated accurate component positioning and excellent outcomes for medial components. However, there is a paucity of literature on lateral compartment RA-UKA. The purpose of our study was to assess the midterm clinical outcomes and survivorship of lateral RA-UKA. METHODS: This study was a retrospective review of a single-center prospectively maintained cohort of 33 patients (36 knees) indicated for lateral UKA. Perioperative, and postoperative two- and five-year Knee injury Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC), and Forgotten Joint Score (FJS) patient reported outcome measures were collected. Five-year follow-up was recorded in 29 patients (32 knees). RESULTS: Mean follow up was 5.1 ± 0.1 years. Mean age and BMI was 70.9 ± 7.2 years and 29.0 ± 4.2 kg/m2, respectively. At discharge, mean distance walked was 273.4 ± 70.4 feet, and mean pain score was 2.0 ± 2.5. At 2-year follow up, mean KOOS, WOMAC, and FJS were 75.1 ± 13.5, 15.0 ± 7.2, and 81.0 ± 23.3, respectively. At 5-year follow up, mean KOOS, WOMAC, and FJS were 75.3 ± 14.6, 14.9 ± 5.0, and 75.8 ± 27.4, respectively. Mean change in KOOS and WOMAC were 35.6 ± 27.1 and 11.7 ± 13.4 (p\u3c .001 and p\u3c .001). 94% of patients were very satisfied/satisfied, 3% neutral, and 3% dissatisfied. 91% met activity expectations, and 59% were more active than before. Survivorship was 100% at 5 years. DISCUSSION: In this study, lateral RA-UKA demonstrated significantly improved clinical outcomes, high patient satisfaction, met expectations, and excellent functional recovery at midterm follow up. Comparative studies are needed to determine differences between robotic-assisted and conventional lateral UKA, as well as TKA

5-Year Survivorship and Outcomes of Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty

Purpose: While unicompartmental knee arthroplasty (UKA) has demonstrated benefits over total knee arthroplasty (TKA) in selected populations, component placement continues to be challenging with conventional surgical instruments, resulting in higher early failure rates. Robotic-arm-assisted UKA (RA-UKA) has shown to be successful in component positioning through preop planning and intraop adjustability. The purpose of this study is to assess the 5-year clinical outcomes of medial RA-UKA. Methods: This study was a retrospective review of a single-center prospectively maintained cohort of 133 patients (146 knees) indicated for medial UKA from 2009 to 2013. Perioperative data and 2- and 5-year Knee injury Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC), and Forgotten Joint Score (FJS) outcome measures were collected. Five-year follow-up was recorded in 119 patients (131 knees). Results: Mean follow-up was 5.1 ± 0.2 years. Mean age and BMI were 68.0 ± 8.1 years and 29.3 ± 4.7 kg/m(2), respectively. At 2-year follow-up, mean KOOS, WOMAC, and FJS were 71.5 ± 15.3, 14.3 ± 7.9, and 79.1 ± 25.8, respectively. At 5-year follow-up, mean KOOS, WOMAC, and FJS were 71.6 ± 15.2, 14.2 ± 7.9, and 80.9 ± 25.1, respectively. Mean change in KOOS and WOMAC was 34.6 ± 21.4 and 11.0 ± 13.6, respectively (p \u3c 0.001 and p \u3c 0.001). For patient satisfaction at last follow-up, 89% of patients were very satisfied/satisfied and 5% were dissatisfied. For patient activity expectations at last follow-up, 85% met activity expectations, 52% were more active than before, 25% have the same level of activity, 23% were less active than before, and 89% were walking without support. All patients returned to driving after surgery at a mean 15.2 ± 9.4 days. Survivorship was 95% (95% CI 0.91-0.98) at 5 years. One knee (1%) had a patellofemoral revision, two knees (1.3%) were revised to different partial knee replacements, and five knees (3.4%) were converted to TKA. Conclusion: Overall, medial RA-UKA demonstrated improved patient-recorded outcomes, high patient satisfaction, met expectations, and excellent functional recovery. Midterm survivorship was excellent. Longitudinal follow-up is needed to evaluate long-term outcomes of robotic-arm-assisted UKA procedures

Management of Bone Marrow Lesions of the Hip With Subchondral Calcium Phosphate Injection: Surgical Technique and Tips

Bone marrow lesions (BMLs) are localized areas of edema within subchondral bone, which are often due to early chondromalacia changes, subchondral insufficiency stress or microfractures, and/or avascular necrosis. The presence of BMLs worsen outcomes after arthroscopy and arthroplasty, thus making their management important in the preservation of hip function. In recent years, the advent of Subchondroplasty (SCP; Zimmer Knee Creations Incorporated, Exton, PA)—a minimally invasive surgical technique that involves injecting an isothermic calcium phosphate solution to stabilize BMLs—has shown promising results in managing pain from osteoarthritis (OA). The SCP material (AccuFill Bone Substitute Material, Zimmer Knee Creations Incorporated) has a similar physical and chemical structure to native bone mineral. In this Technical Note, we discuss a surgical approach for managing acetabular and femoral head BMLs with SCP. We also review the prior clinical trials reporting on SCP for knee OA. SCP may be a promising technique as part of the treatment algorithm for managing hip OA, and clinical trial enrollment has begun for hip SCP. On the basis of these results, further investigations into this procedure may be warranted

sj-docx-2-hss-10.1177_15563316231183093 – Supplemental material for Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review

Supplemental material, sj-docx-2-hss-10.1177_15563316231183093 for Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review by Mohammed A. Munim, Linsen T. Samuel, James T. Rosneck and Atul F. Kamath in HSS Journal®</p

sj-docx-4-hss-10.1177_15563316231183093 – Supplemental material for Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review

Supplemental material, sj-docx-4-hss-10.1177_15563316231183093 for Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review by Mohammed A. Munim, Linsen T. Samuel, James T. Rosneck and Atul F. Kamath in HSS Journal®</p

sj-docx-3-hss-10.1177_15563316231183093 – Supplemental material for Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review

Supplemental material, sj-docx-3-hss-10.1177_15563316231183093 for Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review by Mohammed A. Munim, Linsen T. Samuel, James T. Rosneck and Atul F. Kamath in HSS Journal®</p

sj-docx-1-hss-10.1177_15563316231183093 – Supplemental material for Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review

Supplemental material, sj-docx-1-hss-10.1177_15563316231183093 for Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review by Mohammed A. Munim, Linsen T. Samuel, James T. Rosneck and Atul F. Kamath in HSS Journal®</p

Robotic-arm assisted bicompartmental knee arthroplasty: Durable results up to 7-year follow-up

BACKGROUND: The purpose of our study was to investigate the mid-term clinical and functional outcomes of robotic-arm assisted Bicompartmental knee arthroplasty (BiKA). METHODS: This study reviewed a single-centre prospectively maintained cohort of 50 patients (53 knees) who underwent BiKA (patellofemoral and medial compartment) at 5- and 7-year postoperative follow-up. RESULTS: Mean follow-up was 7.1 ± 0.1 years (range, 7.0-7.3). Kaplan-Meier survivorship rates at 5 and 7 years were 96% and 93%, respectively. At 7-year follow-up, patient satisfaction was 76% satisfied, 13% neutral, and 11% not satisfied. Mean KSS-FS was 80.5 ± 15.8 (range, 30-100) with 82% of patients reporting walking more than 10 blocks, 89% reporting walking without support, and 100% able to go up and down stairs with 61% requiring use of a rail. Three patients (four knees) underwent revision surgery. CONCLUSIONS: Our study reported excellent survivorship and functional outcomes, and good-excellent satisfaction at mid-term follow-up for robotic-arm assisted BiKA

An Increase in Same-day Discharge After Total Joint Arthroplasty During the COVID-19 Pandemic Does Not Influence Patient Outcomes: A Retrospective Cohort Analysis

Background: The coronavirus disease 2019 (COVID-19) pandemic caused major transitions in total joint arthroplasty (TJA), notably with the increased utilization of same-day discharge (SDD) pathways. This study assessed the effect of accelerated discharge pathways following the resumption of elective cases during the COVID-19 pandemic on SDD rates, adverse events, and characteristics associated with successful SDD following total hip and total knee arthroplasty. Methods: This retrospective study split patients into cohorts: TJA prior to COVID-19 (pre-COVID, July 2019-December 2019) and TJA following the resumption of elective surgeries (post-COVID, July 2020-December 2020). Patient characteristics such as age, sex, body mass index, American Society of Anesthesiologists score, and pertinent comorbidities were analyzed, and length of stay, 30-day emergency department (ED) visit rates, readmissions, and reoperations were compared. Results: A total of 1333 patients met inclusion criteria that were divided into pre-COVID (692) and post-COVID (641) cohorts. The pre-COVID group had a median age of 69 years (interquartile range 63-76), and the post-COVID group had a median age of 68 years (interquartile range 61-75) (P = .024). SDD increased from 0.1% to 28.9% (P < .001), and length of stay decreased from 1.3 days to 0.89 days (P < .001). There was no change in 30-day ED visits, readmissions, or reoperations (P = .817, P = .470, and P = .643, respectively). There was no difference in ED visits, readmissions, or reoperations in SDD patients. The odds of SDD were associated with age (P < .001, odds ratio [OR] = 0.94), body mass index (P = .006, OR = 0.95), male sex (P < .001, OR = 1.83), and history of tobacco use (P < .001, OR = 1.87). Conclusions: At our institution, the COVID-19 pandemic accelerated the utilization of SDD pathways without increasing ED visits, readmissions, or reoperations

The role of prehabilitation with a telerehabilitation system prior to total knee arthroplasty.

Background: The purpose of the current study was to evaluate the usage of prehabilitation on a telehealth platform prior to total knee arthroplasty (TKA) and its impact on short-term outcomes. Specifically, the study examined whether patients participating in a prehabilitation program impacted length of stay (LOS) and discharge disposition. Methods: A total of 476 consecutive patients who underwent TKA at three institutions were included. The average age of the 476 patients was 65.1 years (range, 35 and 93 years). There was a total of 114 patients who utilized the novel prehabilitation program that provided exercises, nutritional advice, education regarding home safety and reducing medical risks, and pain management skills prior to surgery. A group of 362 patients who did not utilize the program formed the control cohort. The outcomes evaluated were LOS and discharge disposition to home, home with health aide (HHA), or skilled nursing facility (SNF). Results: The average LOS in the prehabilitation group was significantly shorter than in the control group (2.0 vs. 2.7 days, P\u3c0.001). Additionally, prehabilitation patients had more favorable discharge disposition status in comparison to the control group. In the prehabilitation patients, 77.2% went home without assistance, compared to 42.8% in the control group (P\u3c0.001). Also, significantly fewer patients in the prehabilitation group were discharged to a SNF when compared to the control group (1.8% vs. 21.8%, P\u3c0.0001). Conclusions: Prehabilitation preceding TKA in the current study showed early benefits in LOS and discharge disposition. This study will help expand the current literature and educate orthopaedic surgeons on a novel technology. To truly appreciate the role of telerehabilitation in the setting of TKA, further investigation is needed to investigate long-term outcomes, cost analysis, and patient and clinician satisfaction