scholarly journals Robotics improves alignment accuracy and reduces early revision rates for UKA in the hands of low-volume UKA surgeons

2021 ◽  
Author(s):  
Peter Savov ◽  
Lars-Rene Tuecking ◽  
Henning Windhagen ◽  
Tilman Calliess ◽  
Max Ettinger
Keyword(s):  
Revision Rate ◽  
Joint Line ◽  
Robotic Systems ◽  
Safe Procedure ◽  
Short Term ◽  
Robotic Assisted ◽  
Early Revision ◽  
Low Volume ◽  
Valgus Malalignment

Abstract Purpose It is known that in uni-compartmental knee arthroplasty (UKA) low-volume surgeons have a higher complication and revision rate than high-volume surgeons. Further, robotic-assisted UKA leads to lower early revision rate as well as fewer limb and joint line outliers compared to conventional UKA. The purpose of this study was to retrospectively analyze the outliers’ and revision rate of low-volume UKA surgeons with different robotic systems at short-term follow-up. Methods In this case–control study, 103 robotic-assisted UKAs were included. The procedures were performed between 2016 and 2019 from two low-volume UKA surgeons with an imageless (IL) (63 patients) and image-based (IB) (40 patients) robotic system. Alignment outliers, joint line (JL) reconstruction, complication and revision rates of the two different robotic systems were analyzed. The minimum follow-up was two years. Outliers were defined as a postoperative valgus malalignment greater than 182°. The surgery time for all procedures was evaluated. Results The overall revision rate was 3.9% (4 of 103). Two occurred in the IB group (5.0%) and two in the IL group (3.2%). No valgus malalignment outliers were observed in both groups. The mean JL was not distalized by more than 2 mm in both groups (IL: 1.3 ± 1.6 mm vs. IB: 1.8 ± 0.9 mm, p value 0.08). The IL procedures had a significant lower mean surgery time (55 ± 13 min vs. 68 ± 14, p value 0.001). Conclusion Robotic-assisted UKA is a safe procedure in the hand of low-volume UKA surgeons. Robotic-assisted UKA minimizes overcorrection into valgus mal-alignment. Low revision rates are observed at short-term follow-up for robotic-assisted UKA. The choice of the different robotic systems has no impact on the outcome.

scholarly journals Increased Early Revision Rate with the INFINITY Total Ankle Prosthesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0003
Author(s):  
Elizabeth Cody ◽  
Michel Taylor ◽  
James Nunley ◽  
Selene Parekh ◽  
James DeOrio
Keyword(s):  
United States ◽  
Tibial Component ◽  
Revision Rate ◽  
The United States ◽  
Additional Patient ◽  
Foot And Ankle ◽  
Early Revision ◽  
One Year ◽  
Component Loosening

Category: Ankle Arthritis Introduction/Purpose: Modern total ankle arthroplasties (TAAs) have demonstrated improved survival rates at early- and mid-term follow-up, with revision rates ranging from 4 to 8% at five years. The INFINITY total ankle system (Wright Medical Technology, Arlington, TN) was first used in the United States in 2014. Its advantages include the ability to use patient-specific instrumentation and the option to choose between talar dome resurfacing and flat-cut talar components. While this implant is currently popular in the United States, clinical outcomes have not yet been reported. Our aim was to identify the rate of early revision among patients receiving the INFINITY prosthesis. Methods: Patients from two prospectively-collected databases at the authors’ institution were screened for inclusion in the present study. All patients who underwent a primary TAA with the INFINITY prosthesis and who were at least one year postoperative were included. All surgeries were performed by one of two orthopaedic foot and ankle surgeons with extensive experience in total ankle arthroplasty. The primary outcome was the need for revision surgery, which was defined as removal of one or both metal components. Peri-implant lucency at most recent follow-up was a secondary outcome. Anteroposterior and lateral radiographs at most recent follow-up were graded for lucency independently by two reviewers, both orthopaedic foot and ankle fellows, for individual peri-implant zones (Figure). Each zone was only considered “lucent” if recorded as such by both reviewers. Results: 160 patients underwent TAA with the INFINITY prosthesis between August 2014 and November 2016 with a mean 20 months of follow-up (range, 12-37). Six patients were lost to follow-up. Sixteen patients (10%) underwent revision a mean 1.2 years postoperatively. Revision was performed most commonly for tibial component loosening (seven patients, 4.4%) and deep infection (five patients, 3.1%). Of cases with tibial loosening, progressive lucency and/or subsidence was obvious radiographically in four patients; one patient had equivocal radiographs but loosening was suggested on single-photon emission computed tomography; and two patients revised for persistent pain had loosening confirmed intraoperatively. Of the 108 patients with retained components and at least one year of radiographic follow-up, eight (7.4%) had global lucency around the tibial component at most recent follow-up. Conclusion: Our initial review of patients undergoing TAA with the INFINITY prosthesis demonstrates an elevated early revision rate due to tibial component loosening. The reasons for this finding remain unclear, but could possibly include inadequate bony purchase of the implant’s three prongs, particularly in patients with large preoperative deformities or with imperfect component alignment. We plan to further investigate the possible reasons for this finding in the future by assessing additional patient factors, including age, sex, arthritis type, tobacco use, pre- and postoperative coronal and sagittal alignment, and presence of ipsilateral hindfoot fusion.

The Safety of Ultrasound Guided Tenotomy for Upper and Lower Extremity Tendinopathies: A Retrospective Study

2020 ◽  
Author(s):  
Benjamin Fick ◽  
Daniel Stover ◽  
Ruth Chimenti ◽  
Mederic Hall
Keyword(s):  
Lower Extremity ◽  
Physical Function ◽  
Complication Rate ◽  
Plantar Fascia ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Short Term ◽  
Long Term Follow Up

Abstract Background: Ultrasound guided tenotomy (USGT) is a minimally invasive treatment option for patients with chronic tendinopathy who fail to benefit from conservative exercise interventions. The complication rate and effectiveness of USGT remain poorly defined in the literature. Purpose: This study aimed to evaluate the risks associated with USGT and outcomes across upper extremity and lower extremity tendinopathy/fasciopathy sites. Methods Patients who had USGT at the elbow, patellar, or Achilles tendons or along the plantar fascia were identified by retrospective review of charts. Screening for complications (infection, tendon rupture, and hypersensitivity) and satisfaction with the procedure were assessed at routine short-term follow-up visits and at long-term follow-up via phone/email. Outcomes (pain, quality of life) were assessed using the region specific pain scales and the Short Form-12, respectively, at baseline prior to the procedure, short-term follow up, and long term follow up. Results: A total of 262 patients were identified through chart review. There was a low complication rate of 0.7% including one superficial wound infection and one case of wound hypersensitivity. Prior to USGT, the majority of patients reported moderate/daily pain that decreased by short-term and long-term follow-up to mild/occasional pain (p < 0.05). Additionally, most patients reported abnormally low physical function prior to USGT that was within normal range of physical function by long-term follow-up (p < 0.05). The majority of responders (63% at the plantar fascia to 92% at the Achilles midportion) reported being either ‘very satisfied’ or ‘somewhat satisfied’ with the procedure at short-term follow-up. Conclusions: This study found that USGT is a safe procedure with a low complication rate in a heterogeneous sample. Study findings provide preliminary evidence on the utility of USGT to reduce pain and improve function with a high rate of patient satisfaction.

scholarly journals EXCIMER LASER

2008 ◽  
Vol 15 (01) ◽  
pp. 20-25
Author(s):  
M. ABDUL MOQEET ◽  
IMRAN AZAM BUTT
Keyword(s):  
Study Group ◽  
Safe Procedure ◽  
Spherical Equivalent ◽  
Efficacy And Safety ◽  
Short Term ◽  
Gradual Reduction ◽  
Severe Postoperative Pain ◽  
Lost To Follow Up ◽  
Study Setting

Objectives: To evaluate the efficacy and safety of excimer laserphotorefractive keratectomy for myopia in Pakistani people. Design: Prospective study. Setting: At Al-Shifa Trust EyeHospital Rawalpindi. Period: October, 1995 and Febrauray, 1996. Material & Methods: The study group of thirteenpatients, comprises of 25 eyes, with refractive error ranging from -1.50 to -3.50 D.S (diopters sphere) and less than-1.50 D.C (diopters cylinder).Results: Thirteen eyes (52%) lost to follow up after three months. Only twelve eyes (48%)could be reviewed at six months after photorefractive keratectomy. At one month, eleven eyes (44%) and at threemonths, eight eyes (32%) were hypermetropic within +0.25 to +1.00 diopters of spherical equivalent .At six months onlythree eyes (25%) had hypermetropia within +0.25 to +1.00 diopters spherical equivalent. None of the eyes had anykind of astigmatism more than 1.00 diopter. No over correction of more than +1.00 diopter of spherical equivalent wasobserved in any case. At one month, three months and six months after photo-refractive keratectomy, 88%, 80% and100% eyes had 6/6 visual acuity respectively, without any optical aid. Hundred percent of the eyes showed completehealing of the epithelium on third post operative day. Moderate to severe postoperative pain was experienced by everyone for three days with gradual reduction in intensity. Only one eye (8.33%) had grade 1 haze at six months. Restsof the eyes were clear .No vision threatening complications occurred. Despite the short term follow up, photorefractivekeratectomy appears to be an effective and safe procedure with good predictability for the correction of low myopia.Conclusion: Despite relatively short term follow up of the study; photo refractive keratectomy (PRK) appears to be safeand quite predictable procedure for correction of low myopia.

scholarly journals Significant differences in rates of aseptic loosening between two variations of a popular total knee arthroplasty design

2021 ◽  
Author(s):  
Michael Brown ◽  
Rohan Ramasubbu ◽  
Mark Jenkinson ◽  
James Doonan ◽  
Mark Blyth ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Revision Rate ◽  
Primary Total Knee Arthroplasty ◽  
Cement Mantle ◽  
Kaplan Meier ◽  
Early Revision ◽  
Total Knee

Abstract Purpose The NexGen Legacy Posterior Stabilised (LPS) prosthesis (Zimmer Biomet, Warsaw, IN, USA) has augmentable and non-augmentable tibial baseplate options. We have noted an anecdotal increase in the number of cases requiring early revision for aseptic loosening since adopting the non-augmentable option. The purpose of this study was to ascertain our rates of aseptic tibial loosening for the two implant types within five years of implantation and to investigate the causes for any difference observed. Methods A database search was performed for all patients who underwent primary total knee arthroplasty (TKA) using the NexGen LPS between 2009 and 2015. Kaplan–Meier curves were plotted to assess for differences in revision rates between cohorts. We collected and compared data on gender, age, body mass index, component alignment and cement mantle quality as these were factors thought to affect the likelihood of aseptic loosening. Results Two thousand one hundred seventy-two TKAs were included with five year follow-up. There were 759 augmentable knees of which 14 were revised and 1413 non-augmentable knees of which 48 were revised. The overall revision rate at five years was 1.84% in the augmentable cohort and 3.4% in the non-augmentable cohort. The revision rate for aseptic loosening was 0.26% in the augmentable group and 1.42% in the non-augmentable group (p = 0.0241). Conclusions We have identified increased rates of aseptic loosening in non-augmentable components. This highlights the effect that minor implant changes can have on outcomes. We recommend that clinicians remain alert to implant changes and publish their own results when important trends are observed.

scholarly journals Increased Early Revision Rate With the INFINITY Total Ankle Prosthesis

2018 ◽  
Vol 40 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Elizabeth A. Cody ◽  
Michel A. Taylor ◽  
James A. Nunley ◽  
Selene G. Parekh ◽  
James K. DeOrio
Keyword(s):  
Tibial Component ◽  
Revision Rate ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Secondary Outcome ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Early Revision ◽  
Component Loosening

Background: A number of new 2-component total ankle arthroplasty systems that emphasize minimal bone resection have been introduced for which few clinical outcomes reports are available. Our aim was to identify the rate of early revision among patients receiving the 2-component INFINITY prosthesis. Methods: Patients from 2 prospectively collected databases at the authors’ institution were screened for inclusion in the present study. All patients who underwent a primary total ankle arthroplasty (TAA) with the INFINITY prosthesis and who were at least 1 year postoperative were included. A total of 159 ankles with a mean 20 months of follow up (range, 12-37) met these criteria. All surgeries were performed by 1 of 2 orthopedic foot and ankle surgeons with extensive experience in TAA. The primary outcome was the need for revision surgery, defined as removal of 1 or both metal components. Peri-implant lucency at most recent follow-up was a secondary outcome. Weightbearing radiographs at most recent follow-up were graded for lucency independently by 2 reviewers. Results: Sixteen ankles (10%) underwent revision at a mean 13 months postoperatively. The most common reasons for revision were symptomatic tibial component loosening and deep infection (6 patients each, 3.8%). Of the 108 ankles with retained components and at least 1 year of radiographic follow-up, 8 (7.4%) had global lucency around the tibial component suggestive of loosening at most recent follow-up. Conclusions: Our initial review of patients undergoing TAA with this new 2-component prosthesis demonstrates an elevated early revision rate due to tibial component loosening compared to other implant systems. Level of Evidence: Level IV, case series.

scholarly journals Early Outcomes with the CADENCE Total Ankle Prosthesis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0041
Author(s):  
Calvin J. Rushing ◽  
Gregory C. Berlet ◽  
Christopher F. Hyer
Keyword(s):  
Medical Records ◽  
Low Grade ◽  
Ankle Arthritis ◽  
Single Institution ◽  
Short Term ◽  
Malleolar Fracture ◽  
Ankle Prosthesis ◽  
The Past ◽  
Early Revision

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: A number of two-component, 4th generation total ankle arthroplasty (TAA) prostheses have been introduced to the market within the past few years. The purpose of the present study was to assess early outcomes for the CADENCE total ankle prosthesis. Methods: All patients who underwent primary TAA with CADENCE between August 2016 and June 2018 at a single institution and who were at least 1 year postoperative were included. A total of 32 ankles with a mean follow up of 19 (range, 12-33) months met the criteria. Weightbearing radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6 weeks postoperative, and at the most recent follow-up. Medical records and charts were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al. and Glazebrook at el., respectively. Results: Survivorship for the CADENCE prosthesis was 93.7%. Coronal and sagittal tibiotalar alignment significantly improved after surgery (p< 0.001, p< 0.005), and was maintained at the latest follow-up (p=0.44, p=0.30). Overall, two ankles (6.3%) underwent early revision for aseptic loosening; while 6 (18.8%) underwent a non-revisional reoperation. Nine ankles (28.1%) presented a total of 13 complications (4 high grade, 2 intermediate, and 7 low) according to the Glazebrook classification system. The most common was intraoperative periprosthetic medial malleolar fracture (5 ankles, 15.6%), a low-grade complication. Conclusion: Satisfactory outcomes were observed at short-term follow-up for the CADENCE prosthesis. Additional studies with longer follow-up are warranted.

Robotic-assisted laparoscopic radical cystectomy: Short-term clinical and oncologic follow-up

2008 ◽  
Vol 207 (3) ◽  
pp. S111
Author(s):  
Matthew Pearson ◽  
Jeffrey Nix ◽  
Eric Wallen ◽  
Raj Pruthi
Keyword(s):  
Radical Cystectomy ◽  
Short Term ◽  
Robotic Assisted

scholarly journals Robotic-Assisted versus Conventional Laparoscopic Approach for Rectal Cancer Surgery, First Egyptian Academic Center Experience, RCT

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Yasser Debakey ◽  
Ashraf Zaghloul ◽  
Ahmed Farag ◽  
Ahmed Mahmoud ◽  
Inas Elattar
Keyword(s):  
Rectal Cancer ◽  
Rectal Surgery ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Distal Margin ◽  
Complication Rates ◽  
Safe Procedure ◽  
Short Term ◽  
Robotic Assisted ◽  
Estimated Blood Loss

Background. Undoubtedly, robotic systems have largely penetrated the surgical field. For any new operative approach to become an accepted alternative to conventional methods, it must be proved safe and result in comparable outcomes. The purpose of this study is to compare the short-term operative as well as oncologic outcomes of robotic-assisted and laparoscopic rectal cancer resections. Methods. This is a prospective randomized clinical trial conducted on patients with rectal cancer undergoing either robotic-assisted or laparoscopic surgery from April 2015 till February 2017. Patients’ demographics, operative parameters, and short-term clinical and oncological outcomes were analyzed. Results. Fifty-seven patients underwent permuted block randomization. Of these patients, 28 were assigned to undergo robotic-assisted rectal surgery and 29 to laparoscopic rectal surgery. After exclusion of 12 patients following randomization, 45 patients were included in the analysis. No significant differences exist between both groups in terms of age, gender, BMI, ASA score, clinical stage, and rate of receiving upfront chemoradiation. Estimated blood loss was evidently lower in the robotic than in the laparoscopic group (median: 200 versus 325 ml, p= 0.050). A significantly more distal margin is achieved in the robotic than in the laparoscopic group (median: 2.8 versus 1.8, p< 0.001). Although the circumferential radial margin (CRM) was complete in 18 patients (85.7%) in the robotic group in contrast to 15 patients (62.5%) in the laparoscopic group, it did not differ statistically (p=0.079). The overall postoperative complication rates were similar between the two groups. Conclusion. To our knowledge, this is the first prospective randomized trial of robotic rectal surgery in the Middle East and Northern Africa region. Our early experience indicates that robotic rectal surgery is a feasible and safe procedure. It is not inferior to standard laparoscopy in terms of oncologic radicality and surgical complications. Organization number is IORG0003381. IRB number is IRB00004025.

The INFINITY Total Ankle Prosthesis: Outcomes at Short-Term Follow-up

2020 ◽  
pp. 193864002094619 ◽  
Author(s):  
Calvin J. Rushing ◽  
Kurt Kibbler ◽  
Christopher F. Hyer ◽  
Gregory C. Berlet
Keyword(s):  
Case Series ◽  
The United States ◽  
Fourth Generation ◽  
Low Grade ◽  
Single Institution ◽  
Short Term ◽  
Radiographic Outcomes ◽  
Early Revision ◽  
Grade 3

Background The INFINITY total ankle prothesis remains the most widely used fourth-generation total ankle arthroplasty (TAA) system in the United States. The purpose of the present study was to assess radiographic outcomes for INFINITY at short-term follow-up. Methods All patients who underwent primary TAA with INFINITY between August 2015 and June 2018 at a single institution and who were at least 1 year postoperative were included. A total of 55 ankles with a mean follow up 22 months (range, 12-43 months) met the criteria. Weightbearing radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6 to 8 weeks postoperatively, and at the most recent follow-up. Medical records and charts were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook at el, respectively. Results Overall, INFINITY survivorship was 98.2%. Coronal and sagittal tibiotalar alignment improved after surgery ( P < .001, P = .09, respectively), and was maintained during the latest follow-up ( P = .62, P = .47, respectively). Only 1 ankle (1.8%) required early revision; while 5 (9.1%) indicated non-implant-related revision; 85.5% required no reoperation. In nineteen ankles (34.5%), postoperative periprosthetic lucency was observed; most were not progressive (17 ankles, 89.5%). Twelve complications (3 high grade, 3 intermediate, and 6 low grade) in 11 ankles (20%) were recorded according to the Glazebrook classification system. Conclusion INFINITY survivorship was 98.2% at a mean of 1.8 years of follow-up, and only 1 ankle required prosthetic revision. Additional studies with longer follow-up are warranted for fourth-generation TAA prostheses. Levels of Evidence: Level IV: Case series

Outcome after Robotic-Assisted Thymectomy in Children and Adolescents with Acetylcholine Receptor Antibody-Positive Juvenile Myasthenia Gravis

2017 ◽  
Vol 48 (04) ◽  
pp. 315-322 ◽  
Author(s):  
Heike Kölbel ◽  
Maximilian Müllers ◽  
Olaf Kaiser ◽  
Mahmoud Ismail ◽  
Marc Swierzy ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Children And Adolescents ◽  
Acetylcholine Receptor ◽  
Safe Procedure ◽  
Long Term Outcomes ◽  
Robotic Assisted ◽  
The Mean ◽  
Juvenile Myasthenia Gravis

AbstractThe aim of our study was to describe the long-term outcomes after robotic-assisted thymectomy in a cohort of acetylcholine receptor (AChR)-antibody (Ab)–positive, generalized juvenile myasthenia gravis (JMG). We retrospectively analyzed a cohort of 18 patients (15 females and 3 males) who underwent robotic-assisted thymectomy. At the time of diagnosis, 12/18 patients were prepubertal; the mean age was 9.8 years at the onset of the disease. All patients received therapy with pyridostigmine; additional immunotherapy included: corticosteroid therapy in 18/18, azathioprine in 14/18 patients, mycophenolate mofetil in 4/18, and cyclosporine in 1/18 patients. Eight patients received intravenous immunoglobulin and four plasma exchange. The mean age of patients at thymectomy was 11.7 years (range: 4.2–16 years). The mean duration of postoperative stay was 2.9 days. Thymectomy was followed by gradual clinical improvement (39% patients achieved clinical remission) and dose reduction in steroid therapy in all patients during the follow-up period (mean: 27.4 months). In children and adolescents with AChR-Ab–positive JMG, thymectomy has a beneficial effect on the weaning off immunosuppressive therapy in patients with generalized symptoms and should be considered as a part of multimodal therapy. Robotic-assisted thymectomy is a safe procedure with low morbidity and a comparable clinical outcome compared with the open sternal procedure.

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