ABSTRACT
Background Total knee arthroplasty (TKA) is the definitive surgical treatment for end-stage osteoarthritis and has been proven to relieve pain and improve function. With the rise in demand and the number of TKA procedures every year, more studies have been conducted on robotic TKA. Objective The objective of this study is to compare the postoperative pain between robotic and conventional TKA and the postoperative functional level between robotic and conventional TKA. Method This is a quantitative, observational, prospective study conducted from February 2022 to August 2022 amongst patients in the orthopaedic department of King Fahad Medical City, Riyadh, Saudi Arabia, who have undergone primary TKA for end-stage osteoarthritis using robotic TKA and conventional TKA. After applying the exclusion and inclusion criteria, a total of 26 patients (12 robotic and 14 conventional) were included in the study. The patients were assessed at three time points: two weeks, six weeks, and three months post-op. They were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and the visual analogue scores (VAS) used to assess pain. Result A total of 26 patients were included in this research. The patients were divided into two groups: 12 robotic TKA patients and 14 conventional TKA patients. In this study, while comparing patients who underwent robotic TKA with those who underwent conventional TKA, no statistical significance was found regarding pain and function at all stages postoperatively. Conclusion There was no short-term difference between robotic and conventional TKA regarding pain and function. There is a need for further extensive research on robotic TKA in terms of cost-effectiveness, complications, implant survivorship, and long-term outcomes.
ABSTRACT
Introduction An optimal hip implant is biocompatible, durable, and resistant to chemical and mechanical wear. This analysis aimed to compare failure (revision) and complication rates between ceramic-on-ceramic (CoC) and ceramic-on-highly-crosslinked-polyethylene (CoHXLPE) implants. Methods This review comprised of scientific literature published between 1995 and 2019. We included randomized controlled trials in adults (>18 years) that presented results of CoC and CoHXLPE total hip arthroplasty (THA) with more than two years of mean follow-up and drafted in English. The primary outcomes for this analysis were complications, revision rates, and loosening rates. Results Eight studies (1,689 hips) were included in this systematic review. There was no significant differences between COC and CoHXLPE for the risk of post-surgical complications (relative risk [RR]: 1.98, 95% confidence interval [CI]: 0.83-4.69, P = 0.12). Revision rates (RR: 1.25, 95% CI: 0.71-2.20, P = 0.43] and loosening rates between the two implants were not significantly different (RR: 1.17, 95% CI: 0.30-4.52, P = 0.82). Conclusion We report no significant differences between CoHXLPE and CoC in adults undergoing primary THA. Although introduced relatively recently, CoHXLPE is a cost-effective bearing that can be used for younger patients with no risk of increased complications in comparison to CoC. Further studies with longer follow-up periods are recommended to confirm the findings of this meta-analysis.
ABSTRACT
INTRODUCTION: Combined femoral arterial and nerve injury does not often occur in cases of proximal femur fracture (hip fracture) and is often overlooked in the emergency medical setting. Physicians should be aware of this rare but possible combination of injuries, which can lead to devastating and disabling patient outcomes. PRESENTATION OF CASE: A 42-year-old Ethiopian male was struck by a steel pipe, rushed to the emergency room, and diagnosed with a left subtrochanteric fracture of the femur. Although promptly taken to surgery for fixation and exploration of the femoral artery, it became necessary to amputate his leg 1 week later. DISCUSSION: Blunt injuries to the femoral nerve and femoral arterial tree are associated with high morbidity and mortality rates. These injuries should not be overlooked when diagnosing patients with blunt trauma to the femur. CONCLUSION: When treating patients presenting with blunt trauma to the femur, several factors may obfuscate the clinician's need to perform a thorough examination of the femoral artery and femoral nerves. Among other things, the patient may not immediately present with signs of hemodynamic instability, similar to our reported case. The clinician may also be invested in treating the patient according to the Advanced Trauma Life Support protocol. When treating blunt hip trauma patients, clinicians should recognize that even blunt trauma to the femur may critically damage the femoral artery and nerve.
