Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2021
ReviewAssistive technologies in knee arthroplasty: fashion or evolution? Rate of publications and national registries prove the Scott Parabola wrong.
Most opponents of assistive technologies in orthopedic surgery consider them as a marketing ruse or fashion. Our hypothesis was that many innovations in modern knee arthroplasty are not following the Scott Parabola. This parabola represents the visual curve of a procedure or therapy showing great promise at the beginning, becoming the standard treatment after reports of encouraging results, only to fall into disuse due to adverse outcome reports. This study aimed to assess the interest in these assistive technologies by (1) their number of publications/year and (2) their actual surgical use reported in the National Joint Registries. ⋯ Most of the innovations in modern knee arthroplasty are not following the Scott Parabola. After a fast rise, these techniques do not disappear but continue to evolve. Their evolution is synergistic, and techniques appeared to be linked to each other's. Despite persisting concerns about the cost-efficiency of assisting technologies in knee arthroplasties, the interest and use do not decrease and seems to be directly linked to an exponential increase in interest for a better understanding of alignment targets and improved functional recovery.
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Robotics applied to orthopedics has become an interesting topic both from the surgical point of view and the engineering one. The main goal of those systems is the enhancement of joint arthroplasty surgery, providing the robotic support to precisely and accurately prepare the bone, restore the limb alignment and the physiological kinematics of the joint. Various robotic systems are currently available on the market, each addressing specific kind of surgeries and characterized by a series of specific features that may involve different requirements and/or modus operandi. ⋯ Each surgeon, when considering if and which robotic system to adopt, has to properly evaluate the different benefits and drawbacks involved to find the surgical robot that fits his needs the best.
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Arch Orthop Trauma Surg · Dec 2021
Robotic-assisted unicompartmental knee arthroplasty is associated with earlier discharge from physiotherapy and reduced length-of-stay compared to conventional navigated techniques.
Computer-assisted surgery (CAS) has been used to improve intraoperative accuracy to restore patient's anatomy and joint kinematics. It is not yet known whether robotic systems provide significant benefits over established navigation techniques. ⋯ III (Therapeutic) Retrospective Cohort Study.
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Arch Orthop Trauma Surg · Dec 2021
A prospective study on outcome of patient-specific cones in revision knee arthroplasty.
Cones are known to be good substitutes for metaphyseal and diaphyseal bone loss during revision total knee arthroplasty (RTKA). Often the off-the-shelf cones do not fit to the individual patient's anatomy. New 3D-printing additive technologies allow to develop patient-specific cones. The aim of this prospective study was to describe their outcome. ⋯ The original additive technology for designing and producing patient-specific metaphyseal and diaphyseal cones with different porosity zones for extensive femoral and tibial bone defects in RTKA is precise and clinically effective solution, at least in the short term. It could be a valid alternative to "off-the-shelf" cones or sleeves as well as structural allografts and even mega-prosthesis, but a longer follow-up period is required to assess its medium- and long-term reliability.
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Arch Orthop Trauma Surg · Dec 2021
Intraoperative virtual reality distraction in TKA under spinal anesthesia: a preliminary study.
The effect of patient anxiety during the perioperative period has been shown to be of great importance in its influence on post-operative recovery. Over the last 10 years, virtual reality (VR) has been developed in anesthesia for patient's distraction by immersion. The aim of this study was to evaluate post-operative patient anxiety the day after TKA surgery under spinal anesthesia (SA) with or without VR distraction. ⋯ Using VR for immersive distraction seemed to lead to no difference in patient anxiety in TKA under SA. Intra-operative adverse events were decreased, and post-operative comfort was increased. Patient satisfaction was not modified. This preliminary study is encouraging and gives us arguments to involve larger number of patients while exploring the various possibilities offered by VR.