Robotic-Assisted Patellofemoral Replacement-Correlation of Preoperative Planning with Intraoperative Implant Position and Early Clinical Experience: A Minimum 2-Year Follow-up.

Patello-femoral arthroplasty (PFA) is successful in a selected group of patients and yields a good functional outcome. Robotic-assisted knee arthroplasty has been shown to provide better implant positioning and alignment. We aim to report our early outcomes and to compare Mako's (Robotic Arm Interactive Orthopaedic System [RIO]) preoperative implant planning position to our intraoperative PFA implant position. Data for this study was prospectively collected for 23 (two bilateral) patients who underwent robotic-assisted PFA between April 2017 and May 2018. All preoperative implant position planning and postoperative actual implant position were recorded. Presence of trochlear dysplasia and functional outcome scores were also collected. There were 17 (two bilateral) female and 6 male patients with a mean age of 66.5 (range: 41-89) years. The mean follow-up period was 30 (range: 24-37) months. Eighteen knees (72%) had evidence of trochlear dysplasia. The anterior trochlear line was on average, 7.71 (range: 3.3-11.3) degrees, internally rotated to the surgical transepicondylar axis and on average 2.9 (range: 0.2-6.5) degrees internally rotated to the posterior condylar line. The preoperative planning range was 4-degree internal to 4-degree external rotation, 4-degree varus to 6-degree valgus, and 7-degree flexion to 3-degree extension. The average difference between preoperative planning and intraoperative implant position was 0.43 degrees for rotation (r = 0.93), 0.99 degrees for varus/valgus (r = 0.29), 1.26 degrees for flexion/extension (r = 0.83), and 0.34 mm for proudness (r = 0.80). Six patients (24%) had a different size component from their preoperative plan (r = 0.98). The mean preoperative Oxford Knee Score (OKS) was 16 and the mean postoperative OKS was 42. No patient had implant-related revision surgery or any radiological evidence of implant loosening at final follow-up. Our early results of robotic PFA are promising. Preoperative Mako planning correlates closely with intraoperative implant positioning. Longer follow-up is needed to assess long-term patient outcomes and implant survivorship.

A Randomised Controlled Trial of Local Infiltration Analgesia Versus Femoral Nerve Block for Postoperative Analgesia Following Total Knee Arthroplasty.

Background Total knee replacement is often associated with significant postoperative pain. Although the use of a femoral nerve block is well-established, local infiltration analgesia has gained popularity in recent years. We compared single-shot local infiltration analgesia with a single-shot femoral nerve block for patients undergoing primary total knee arthroplasty. Methods A total of 194 patients were randomised to receive either local infiltration analgesia (150 ml bupivacaine 0.067% with adrenaline) or a femoral nerve block (20 ml 0.375% levobupivacaine). Both groups received spinal anaesthesia. The primary outcome measure was the total morphine consumption. Secondary outcome measures included: post-operative pain scores, rehabilitation goals, readiness for discharge, and physical, mental, and functional outcomes, including the Oxford Knee Score (OKS). Results A total of 69 patients in the local infiltration analgesia group and 79 patients in the femoral nerve block group were analysed. Median total morphine consumption was significantly greater in the local infiltration analgesia group as compared to the femoral nerve block group (54.67 mg vs 45 mg, respectively, p=0.0388). The post-operative OKS at six weeks was slightly more improved for the femoral nerve block group than for local infiltration analgesia (12.5 vs 9 point median improvements for the femoral nerve block and local infiltration analgesia groups, respectively, p=0.0261). There were no statistically significant differences in other secondary outcome measures. Conclusion A single-shot femoral nerve block significantly reduces the opioid requirement for primary total knee arthroplasty but is otherwise comparable to single-shot local infiltration analgesia.

Periprosthetic fractures in the distal femur following total knee replacement: A review and guide to management.

The management of distal femoral fractures following a total knee replacement can be complex and requires the equipment, perioperative support and surgical skills of both trauma and revision arthroplasty services. Recent advances in implant technology have changed the management options of these difficult fractures. This article describes the options available and discusses the latest evidence.

The use of radiofrequency energy for arthroscopic chondroplasty in the knee.

We present a review of the current literature surrounding the use of radiofrequency energy for arthroscopic chondroplasty in the knee. This review article summarizes basic science, clinical efficacy, and recent advances in the understanding of radiofrequency energy use for the treatment of chondral lesions. Laboratory evidence of increased mechanical stability and decreased release of inflammatory mediators associated with the use of radiofrequency energy chondroplasty is described with clinical evidence of decreased pain and increased functional scores when compared with mechanical chondroplasty. We re-examine concerns about the immediate side effects of radiofrequency energy use, including damage to local structures, in light of new potentially contradictory results, as well as the progression of techniques and probe design. However, although reported complications are few, because the quality of clinical evidence about safety and efficacy remains low, we suggest cautious and judicious use of this technology until future research has clearly defined the long-term clinical outcomes and risks.

The value of magnetic resonance imaging in investigating a painful total knee arthroplasty.

This case describes a rare cause of pain around a total knee arthroplasty and highlights the importance of a structured approach to the investigation of these patients. Magnetic resonance imaging provided detailed information about the cause of pain despite the presence of a prosthetic joint, and the pathology, primary non-Hodgkin lymphoma, was treated without the need for further surgical intervention.

Hyponatraemia after orthopaedic surgery - a case of pituitary apoplexy.

We describe a case of profound hyponatraemia in a postoperative patient after total hip replacement caused by corticosteroid insufficiency due to a non-functioning pituitary macroadenoma diagnosed by dynamic endocrine tests and radiological imaging. Adopting a multidisciplinary approach, successful diagnosis and management lead to a complete recovery without any long-term sequelae.

Pasteurella abscess in tibial regenerate bone: a case report.

Although superficial pin tract infections during limb lengthening are extremely common, most settle spontaneously or with antibiotics. In contrast, deep infection around pin tracts leading to osteomyelitis and abscess formation is much less frequently observed and may need washout and curettage. We report a case of a 10-year-old boy who presented with latent abscess formation at a tibial lengthening site because of Pasteurella, a rare bacterial cause of infection usually associated with animals. To our knowledge, this is the first reported case of abscess formation within regenerate bone associated with this organism and its late presentation in previously well-healed bone is surprising.