Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2023
The utilization of artificial neural networks for the prediction of 90-day unplanned readmissions following total knee arthroplasty.
A reliable predictive tool to predict unplanned readmissions has the potential to lower readmission rates through targeted pre-operative counseling and intervention with respect to modifiable risk factors. This study aimed to develop and internally validate machine learning models for the prediction of 90-day unplanned readmissions following total knee arthroplasty. ⋯ Level III, case-control retrospective analysis.
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Arch Orthop Trauma Surg · Jun 2023
Robotic-assisted TKA reduces surgery duration, length of stay and 90-day complication rate of complex TKA to the level of noncomplex TKA.
Complex primary total knee arthroplasties (TKA) are reported to be associated with excessive episode of care (EOC) costs as compared to noncomplex procedures. The impact of robotic assistance (rTKA) on economic outcome parameters in greater case complexity has not been described yet. The purpose of this study was to investigate economic outcome parameters in the 90-days postoperative EOC in robotic-assisted complex versus noncomplex procedures. ⋯ Robotic-assisted primary TKA reduces the surgical time, inpatient length of stay as well as 90-days complication and readmission rates of complex TKA to the level of noncomplex TKA. Greater case complexity does not seem to have a negative impact on economic outcome parameters when surgery is performed with robotic assistance.
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Arch Orthop Trauma Surg · Jun 2023
Imageless robotic-assisted total knee arthroplasty is accurate in vivo: a retrospective study to measure the postoperative bone resection and alignment.
Conventional instruments for total knee arthroplasty (TKA) have limited accuracy. The occurrence of outliers can negatively influence the clinical outcome and long-term survival of the implant. Orthopaedic robotic systems were developed to increase the accuracy of implant positioning and bone resections. Several systems requiring preoperative imaging have shown a higher degree of precision compared to conventional instrumentation. An imageless system needs less preoperative time and preparation and is more cost effective. Aim of this study was to find out whether this system is as precise, reproduces accurately the surgeon's planning and reduces the occurrence of outliers. ⋯ The described imageless robotic system is accurate in terms of coronal alignment and bone resections. In precision, it is superior to conventional instrumentation and could therefore be used to evaluate new alignment concepts.
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Arch Orthop Trauma Surg · Jun 2023
Subscapularis tendon tears hidden by the medial biceps sling can be missed on arthroscopic examination.
To investigate (1) the prevalence of "hidden lesions" and "non-hidden lesions" of subscapularis tendon tears requiring repair during arthroscopic examination that would be missed by a 30° arthroscope, but could be identified by a 70° arthroscope, from the standard posterior portal and (2) the correlation of preoperative internal rotation weakness and findings of magnetic resonance imaging (MRI) indicating hidden lesions. ⋯ Among the subscapularis tears requiring repair, 19.1% could be identified by a 70° arthroscope, but not by a 30° arthroscope, through the posterior portal. The hidden lesions showed a significantly lower detection rate on preoperative MRI than the non-hidden lesions. Thus, for subscapularis tears suspected on preoperative physical examination, the 70° arthroscope would be helpful to avoid a misdiagnosis.