Technology-Assisted Hip and Knee Arthroplasty in Orthopaedic Residency Training: A National Survey.

INTRODUCTION: The adoption of technology-assisted total joint arthroplasty (TA-TJA) is increasing; however, the extent to which TA-TJA is used among orthopaedic trainees is unknown. The purpose of this study was to assess the current use of TA total knee arthroplasty (TKA) and total hip arthroplasty (THA) by orthopaedic residents and to evaluate resident perceptions toward TA-TJA in their surgical training. METHODS: In this cross-sectional study, an anonymous electronic survey was sent to all Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency program coordinators to distribute to their PGY-2 to PGY-5 residents. The survey consisted of 24 questions, including resident demographics, utilization of TA-TJA in their training, and perceptions regarding TA-TJA. RESULTS: A total of 103 orthopaedic residents completed the survey, of whom 68.0% reported using TA-TJA at their institution. Of the residents using TA-TJA, 28.6% used TA for total TKA only, 71.4% used TA for both TKA and THA, and none used TA solely for THA. One-third of residents (33.3%) use TA for more than half of all TKAs conducted, whereas 57.0% use TA for <10% of all THAs conducted. Approximately half of all residents (49.5%) thought that training in TA-TJA should be required during residency, with no significant differences between junior and senior level residents ( P = 0.24). Most (82.0%) thought that trainees should be required to learn conventional TJA before learning TA-TJA. 63.0% thought that technology had a positive effect on their primary TJA training experience; however, 26.0% reported concern that their training conducting conventional TJA may be inadequate. DISCUSSION: This study demonstrates that most orthopaedic residents currently conduct TA-TJA and highlights notable differences in TJA training experiences. These results provide a platform for future work aimed at further optimizing TJA training in residency, particularly as technology continues to rapidly evolve and utilization of TA-TJA is projected to grow exponentially. LEVEL OF EVIDENCE: N/A, survey-based study.

Influence of Limb Position on Venous Blood Flow After Total Knee Arthroplasty: A Prospective Randomized Study.

Previous studies have suggested a clinical advantage when placing the limb in flexion after total knee arthroplasty (TKA). We sought to measure venous flow compared with control values after TKA. Our hypothesis was that the knee flexed positioning would not adversely affect venous flow. Two cohorts were prospectively evaluated. First, volunteers were randomized to positions with the knee flexed to approximately 90° or placed in a fully extended (control) position. Venous flow velocity was measured in the femoral vein every 15 minutes for 2 hours. Subsequently, 32 patients were randomized to 1 of these 2 positions after TKA, and venous flow velocity was measured in both the operative and the contralateral limb. In the healthy volunteer cohort, mean venous flow velocity was significantly higher at all time points in the flexion group compared with the extended control group (P<.05). After TKA, mean flow velocity for an extended knee (control) was 28.5 cm/s. Mean flow velocity for the flexed knee, foot-dependent group was 47.2 cm/s (P=.036) and for the flexed knee, foot-elevated group was 30.4 cm/s (P=.618). Placing the limb in a flexed position after TKA is not detrimental to venous flow velocity and resulted in higher velocities relative to the extended position. Placing the limb at 90° flexion does not cause venous stasis and should not increase the risk of deep venous thrombosis. [Orthopedics. 2023;46(1):8-12.].

Comparison of Outcomes After Robotic-Assisted or Conventional Total Hip Arthroplasty at a Minimum 2-Year Follow-up: A Systematic Review.

BACKGROUND: This systematic review aimed to present an updated analysis of the evidence comparing outcomes between robotic-assisted total hip arthroplasty (robotic THA) and conventional manual total hip arthroplasty (manual THA). METHODS: A PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) systematic review was performed using the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, and Embase. Controlled studies comparing primary robotic THA and manual THA utilizing patient-reported outcome measures (PROMs) at a minimum follow-up of 2 years were included. We also compared radiographic outcomes, dislocation rates, and revision surgical procedures between groups. The ROBINS-I (Risk of Bias in Non-Randomized Studies - of Interventions) and Cochrane Risk of Bias 2.0 tools were used to assess study quality and risk of bias. RESULTS: Of 765 studies identified, 7 articles comparing robotic THA with manual THA met inclusion criteria. A total of 658 patients were assessed, 335 of whom underwent robotic THA. The majority of studies found no significant differences (p > 0.05) in PROMs between the 2 techniques. Two low-quality studies (Level III) found significantly better postoperative PROMs favoring robotic THA at 2 years. When assessing radiographic outcomes, 6 studies showed that robotic THA resulted in more consistent and accurate component placement. No differences in postoperative dislocations, complications, or revision rates were found between groups except in 1 study, which found significantly more dislocations and revisions in the robotic THA cohort. Reported operative times were a mean of 12 to 25 minutes longer when using robotic THA. CONCLUSIONS: The existing literature comparing robotic THA and manual THA is scarce and low-quality, with findings limited by methodological flaws in study design. Although evidence exists to support increased accuracy and reproducibility of THA component placement with robotic THA, this has not been shown to reduce postoperative dislocation and revision rates. Based on the available evidence, functional outcomes are comparable between techniques, and robotic THA appears to be associated with longer operative times. To fully evaluate the utility of robotic THA, additional well-designed, prospective controlled studies with continuous long-term monitoring are required. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Synovial lipomatosis: A rare cause of knee pain in an adolescent female.

Synovial lipomatosis is a benign proliferative disease of the subsynovial adipose which can lead to a variety of presentations. Cases of synovial lipomatosis in children or adolescents are rare. This case report describes an adolescent patient with a rare bilateral presentation of synovial lipomatosis. She had been treated for years prior to her presentation for juvenile idiopathic arthritis. She presented with chronic bilateral knee pain, swelling, and mechanical symptoms. Bilateral MR imaging demonstrated effusions, hypertrophy of the synovium, and polyp-like projections of tissue with the same signal intensity as fat which is pathognomonic for synovial lipomatosis. Arthroscopic synovectomy and extensive debridement of polyp like fat projections of the right knee was performed. Histopathology was consistent with the synovial lipomatosis diagnosis. Postoperatively, the patient was satisfied with her outcome with improved pain relief and function in her right knee.

Thermoreversible gel for delivery of activin receptor-like kinase 5 inhibitor SB-505124 for glaucoma filtration surgery.

The purpose of this study is to investigate a thermoreversible gel using Pluronic F-127 to deliver an activin receptor-like kinase 5 (ALK-5) inhibitor SB-505124 in glaucoma filtration surgery (GFS). The gel was characterized for in vitro drug release and viscosity studies. Cytotoxicity of Pluronic F-127 was examined by MTT assay using cultured rabbit subconjunctival fibroblasts. In addition, Pluronic F-127 gel (18% w/v) containing 5 mg of SB-505124 was applied at the surgical site in an in vivo rabbit GFS model. In the in vitro viscosity study, the gel showed a change in viscosity (from 1000 cps to 45,000 cps) from low temperature (10°C) to body temperature (37°C). The in vitro drug release study demonstrated 100% drug release within 12 h. The gel did not show cytotoxicity to the cultured rabbit subconjunctival cells by MTT assay. In the in vivo rabbit GFS model, the drug was successfully delivered by injection and no severe post-surgical complications were observed. A thermoreversible gel system with SB-505124 was successfully prepared and delivered for the rabbit GFS model, and it may provide a novel delivery system in GFS.

Brain-targeted delivery of Tempol-loaded nanoparticles for neurological disorders.

Brain-targeted Tempol-loaded poly-(lactide-co-glycolide) (PLGA) nanoparticles (NPs) conjugated with a transferrin antibody (OX 26) were developed using the nanoprecipitation method. These NPs may have utility in treating neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease. Central to these diseases is an increased production of reactive oxygen and nitrogen species which may take part in the development of these conditions. As proof of principle, the NPs were loaded with Tempol, a free radical scavenger that has been shown to be protective against oxidative insults. To enhance the delivery of NPs to the central nervous system (CNS), we conjugated the transferrin receptor antibody covalently to PLGA NPs using the NHS-PEG3500-Maleimide crosslinker. The NPs showed a particle size suitable for blood brain barrier (BBB) permeation (particle size 80-110 nm) and demonstrated a sustained drug release behavior. A high cellular uptake of antibody-conjugated NPs was demonstrated in RG2 rat glioma cells. The ability of the Tempol-loaded NPs to prevent cell death by resveratrol in RG2 cells was determined using the MTT assay. The conjugated NPs containing Tempol were more effective in preventing cell viability by resveratrol when compared with unconjugated NPs or free Tempol in solution. Our findings suggest that transferrin-conjugated NPs containing antioxidants may be useful in the treatment of neurodegenerative diseases.