Assem A. Sultan

Coronal Correction for Severe Deformity Using Robotic-Assisted Total Knee Arthroplasty

Abstract Although robotic‐assisted total knee arthroplasty (TKA) has the potential to accurately reproduce neutral alignment, it is still unclear if this correction is attainable in patients who have severe varus or valgus deformities. Therefore, the purpose of this study was to assess a single surgeons experience with correcting coronal deformities using the robotic‐assisted TKA device. Specifically, we looked at correction of varying degrees of varus and valgus deformity in patients who underwent robotic arm‐assisted TKA. A total of 330 robotic‐assisted TKA cases performed by a single surgeon were analyzed. Preoperative CT scans were registered to the robotic‐assisted software to create a three‐dimensional rendering from which coronal alignment was measured. Postoperative coronal alignment measurements were taken in the operating room using the robotic‐assisted device after trial component placement. The robotic‐assisted device uses optical tracking from navigation probes placed on the distal femur and proximal tibia. The robotic‐assisted software can register these probes as bony landmarks to measure coronal alignment in the distal plane of the femoral component and proximal plane of the tibial component. A total of 261 cases were of varus knees, 46 cases were of valgus knees, and 23 cases had 0° preoperative alignment. Severe deformity was defined as 7° or greater deformity. Preoperative neutral alignment was defined as 0°, while postoperative neutral alignment was defined as 0° ± 3°. There were 129 patients with and initial severe varus and 7 patients with an initial severe valgus deformity of 7° or greater. Patients were divided into varus or valgus cohorts, and analysis was performed on the overall cohort, as well as nonsevere (<7°) and severe (7° or greater) deformity cohorts. All 132 knees with initial varus deformity of less than 7° were corrected to neutral (mean 1°, range ‐1‐3°). A total of 82 knees (64%) with 7° or greater varus deformity were corrected to neutral (mean 2°, range 0‐3°). However, roughly 30% of patients with severe deformity who were not corrected to neutral were still corrected within a couple of degrees of neutral. There were seven knees with 7° or greater valgus deformity, and all were corrected to neutral (mean 2°, range 0‐3°). This study demonstrated that all knees were corrected in the appropriate direction within a few degrees of neutral, and no knees were overcorrected. The implication of this ability to achieve alignment goals on clinical outcomes will need to be evaluated in future studies. The results from this study demonstrate the potential for the robotic‐assisted device during TKA in helping surgeons achieve a preoperatively planned desired neutral alignment.

Patient Satisfaction Outcomes after Robotic Arm-Assisted Total Knee Arthroplasty: A Short-Term Evaluation

&NA; Robotic arm‐assisted total knee arthroplasty (RATKA) presents a potential, new added value for orthopedic surgeons. In todays health care system, a major determinant of value can be assessed by patient satisfaction scores. Therefore, the purpose of the study was to analyze patient satisfaction outcomes between RATKA and manual total knee arthroplasty (TKA). Specifically, we used the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to compare (1) pain scores, (2) physical function scores, and (3) total patient satisfaction outcomes in manual and RATKA patients at 6 months postoperatively. In this study, 28 cemented RATKAs performed by a single orthopedic surgeon at a high‐volume institution were analyzed. The first 7 days were considered as an adjustment period along the learning curve. Twenty consecutive cemented RATKAs were matched and compared with 20 consecutive cemented manual TKAs performed immediately. Patients were administered a WOMAC satisfaction survey at 6 months postoperatively. Satisfaction scores between the two cohorts were compared and the data were analyzed using Students t‐tests. A p‐value < 0.05 was used to determine statistical significance. The mean pain score, standard deviation (SD), and range for the manual and robotic cohorts were 5 ± 3 (range: 0–10) and 3 ± 3 (range: 0–8, p < 0.05), respectively. The mean physical function score, SD, and range for the manual and robotic cohorts were 9 ± 5 (range: 0–17) and 4 ± 5 (range, 0–14, p = 0.055), respectively. The mean total patient satisfaction score, SD, and range for the manual and robotic cohorts were 14 points (range: 0–27 points, SD: ± 8) and 7 ± 8 points (range: 0–22 points, p < 0.05), respectively. The results from this study further highlight the potential of this new surgical tool to improve short‐term pain, physical function, and total satisfaction scores. Therefore, it appears that patients who undergo RATKA can expect better short‐term outcomes when compared with patients who undergo manual TKA.

A Comparison of Relative Value Units in Primary Versus Revision Total Knee Arthroplasty

BACKGROUNDnIn total knee arthroplasty (TKA), revision cases are often technically more challenging, and require more operative time and aftercare than primary cases. These time and effort differences should therefore be appropriately compensated for when using the relative value unit (RVU) system. Therefore, the purpose of this study is to compare the mean (1) RVUs; (2) operative times; and (3) RVU/min; and (4) perform an individualized idealized surgeon annual cost difference analysis for primary vs revision TKA.nnnMETHODSnCurrent Procedural Terminology code 27447 identified 165,439 primary TKA patients, while Current Procedural Terminology code 27487 identified 8081 revision TKA patients from the National Surgical Quality Improvement Program database. The mean RVUs, operative times, and RVU/min were calculated. Dollar amount per minute, per case, per day, and year were also calculated. Students t-test, with a cut-off P-value of <.05, was used in order to identify any statistical differences in mean RVUs, operative times, and RVU/min.nnnRESULTSnThe mean RVUs for primary TKA was 22, while for revision TKA was 27 (P < .001). The mean operative time for primary TKA was 94 minutes, while for revision TKA was 149xa0minutes (P < .001). The mean RVU/min for primary TKA was 0.26, while for revision TKA was 0.22 (P < .001). The dollar amounts calculated for primary vs revision TKA were per minute (

Have the annual trends of total hip arthroplasty in rheumatoid arthritis patients decreased

9.33 vs

Gap-Balancing versus Measured Resection Technique in Total Knee Arthroplasty: A Comparison Study

7.90), per case (

The Association Between Readmission and Patient Experience in a Total Hip Arthroplasty Population

877.12 vs

The Impact of Spino-pelvic Alignment on Total Hip Arthroplasty Outcomes; A Critical Analysis of Current Evidence

1176.43), per day (

Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection

4385.60 vs

Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty

3529), and projected a

Classification systems of hip osteonecrosis: an updated review

137,008.70 annual cost difference.nnnCONCLUSIONnOrthopedic surgeons are reimbursed at a higher rate per minute for primary cases compared to revision TKA (0.26 vs 0.22, P < .001). The annual difference can amount to nearly