The ROSA robotic-arm system reliably restores joint line height, patella height and posterior condylar offset in total knee arthroplasty.

INTRODUCTION: There is growing interest in the use of robotic TKA to improve accuracy of component positioning in Total Knee Arthroplasty (TKA). The aim of this study was to investigate the accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Patella Height and Posterior Condylar Offset (PCO). METHODS: This was a retrospective review of a prospectively-maintained database of the initial 100 consecutive TKAs performed by a high volume surgeon using the ROSA® knee system. Both the image-based and imageless workflow were used and two prosthesis types were implanted. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to Joint Line Height, Patella Height and Posterior Condylar Offset. RESULTS: 100 consecutive patients undergoing TKA using the ROSA system were included; mean age 70 years (range 49-95 years). Mean change in joint line height was 0.2 mm, patella height (Insall-Salvati ratio) 0.01 and posterior condylar offset 0.02 mm; there was no statistically significant difference between the pre and post-operative values. No difference was demonstrated between image-based or imageless workflows, or between implant design (Persona versus Vanguard) regarding joint line height, patella height and PCO. CONCLUSION: This study validates the use of the ROSA® knee system in accurately restoring Joint Line Height, Patella Height and Posterior Condylar Offset in TKA surgery. No significant differences were found between imageless and image-based groups, or between implant designs (Persona versus Vanguard).

Mako versus ROSA: comparing surgical accuracy in robotic total knee arthroplasty.

There is increasing adoption of robotic surgical technology in Total Knee Arthroplasty. The ROSA® knee system can be used in either image-based mode (using pre-operative calibrated radiographs) or imageless modes (using intra-operative bony registration). The Mako knee system is an image-based system (using a pre-operative CT scan). This study aimed to compare surgical accuracy between the ROSA and Mako systems with specific reference to joint line height, patella height, posterior condylar offset and tibial slope. This was a retrospective review of a prospectively collected data of the initial 50 consecutive ROSA TKAs and the initial 50 consecutive Mako TKAs performed by two high-volume surgeons. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to joint line height (JLH), patella height (PH), tibial slope (TS) and posterior condylar offset (PCO). Mean difference between pre- and post-operative radiographs using the ROSA knee system of joint line height was 0.47 mm (SD 0.95) posterior condylar offset 0.16 mm (SD 0.76), tibial slope 0.9 degrees (SD 1.6) and patella height 0.01 (SD 0.05). Mean difference using the MAKO knee system of joint line height was 0.26 (SD 1.08), posterior condylar offset -0.26 mm (SD 0.78), tibial slope 1.8 degrees and patella height 0.03. No significant difference was demonstrated between the accuracy of component positioning of the ROSA or MAKO knee systems. Our study is the first study to compare the accuracy of the ROSA and MAKO knee systems in total knee arthroplasty. Both systems are highly accurate in restoring native posterior condylar offset, joint line height, tibial slope and patella height in TKA with no significant difference demonstrated between the two groups.

The management of non-diagnostic soft tissue tumour biopsies using a multi-disciplinary team approach: A 10-year retrospective review at a specialist sarcoma unit.

Non-Diagnostic (ND) biopsies are occasionally encountered during the investigation of soft tissue sarcoma. We performed a retrospective review of all ND soft tissue biopsies discussed at our regional Multi-Disciplinary Team (MDT) meeting between 2004 & 2014 with the aim of establishing the incidence of ND biopsies, identifying predictive factors for repeat biopsies and evaluating the effectiveness of MDT decisions. We identified 80 ND out of 3233 biopsies. Diagnostic Yield (DY) was 97.5%, 76.0% and 77.8% for the first, second and third successive biopsy respectively. With an MDT approach utilising radiological and clinical information, the diagnostic success rate achieved was 98.5%, 82.0% and 77.8% for the first, second and third biopsies respectively. Malignant tumours (sarcoma & carcinoma) were 19 times more likely to undergo an increasing number of biopsies compared to benign lesions (p < 0.01), while repeat biopsies were less useful for suspected benign lesion. Although a repeat biopsy was only performed in 63% of cases, there were no patients originally diagnosed with a benign lesion that re-presented with the same lesion subsequently being malignant throughout the study period. Our study shows that a specialist MDT approach leads to high diagnostic rates and is a safe and effective method of preventing unnecessary, repeat biopsies where the initial biopsy is ND.

The impact of a spinal best practice tariff on compliance with the British Spine Registry.

AIMS: The British Spine Registry (BSR) was introduced in May 2012 to be used as a web-based database for spinal surgeries carried out across the UK. Use of this database has been encouraged but not compulsory, which has led to a variable level of engagement in the UK. In 2019 NHS England and NHS Improvement introduced a new Best Practice Tariff (BPT) to encourage input of spinal surgical data on the BSR. The aim of our study was to assess the impact of the spinal BPT on compliance with the recording of surgical data on the BSR. METHODS: A retrospective review of data was performed at a tertiary spinal centre between 2018 to 2020. Data were collated from electronic patient records, theatre operating lists, and trust-specific BSR data. Information from the BSR included operative procedures (mandatory), patient consent, email addresses, and demographic details. We also identified Healthcare Resource Groups (HRGs) which qualified for BPT. RESULTS: A total of 3,587 patients were included in our study. Of these, 1,684 patients were eligible for BPT. Between 2018 and 2019 269/974 (28%) records were complete on the BSR for those that would be eligible for BPT. Following introduction of BPT in 2019, 671/710 (95%) records were complete having filled in the mandatory data (p < 0.001). Patient consent to data collection also improved from 62% to 93%. Email details were present in 43% of patients compared with 68% following BPT introduction. CONCLUSION: Our study found that following the introduction of a BPT, there was a statistically significant improvement in BSR record completion compliance in our unit. The BPT offers a financial incentive which can help generate further income for trusts. National data input into the BSR is important to assess patient outcome following spinal surgery. The BSR can also aid future research in spinal surgery. Cite this article: Bone Jt Open 2021;2-3:198-201.

Is Surgical Training Prepared for the "Second Wave" of COVID-19? A Collaborative Perspective.

Restructuring of surgical services during the 'first wave' of the coronavirus-disease 2019 pandemic led to significant disruption in surgical learning opportunities provided to junior surgeons. Recent challenges faced by trainees have never been faced before. These include disruption to surgical opportunities available, completing assessments and attending educational events. With a 'second wave' now upon the United Kingdom it is vitally important we reflect upon the 'first wave' to ensure junior surgeons are able to achieve appropriate surgical case numbers, complete assessments and progress to the next stage of training. Alternate assessment methods in the United Kingdom need to be considered should the pandemic continue and clear information should be provided to surgical trainees regarding career progression. These are difficult times for surgical training and we need to endeavor that trainees are provided with opportunities similar to their predecessors albeit in difficult circumstances. This is to ensure the future standard of surgical patient care remains of the highest standard.

Should Denosumab or Radical Surgery Be Recommended for a Spinal Giant Cell Tumour in a Fertile Female?

Giant cell tumour (GCT) of the spine is a benign aggressive tumour with high recurrence rates. Patients can be asymptomatic due to the slow growth rate and present with localized pain or neurological dysfunction. Current management strategies include intralesional curettage, total en-bloc resection (TER) and denosumab therapy. Treatment strategies can be particularly challenging in women of childbearing age who wish to conceive, as the risks of tumour recurrence need to be balanced against the fetal complications associated with adjuvant denosumab therapy. This case report discusses the management options and controversies for women of childbearing age with GCT of the thoracic spine. Clinicians need to be aware of the complications associated with TER and denosumab treatment when managing GCTs of the spine in young females.

The incidence of venous thromboembolism in total joint replacement during COVID-19 pandemic: has lockdown had an influence?

AIMS: As the first wave of the COVID-19 pandemic began to dip, restarting elective orthopaedics became a challenge. Protocols including surgery at 'green' sites, self-isolation for 14 days, and COVID-19 testing were developed to minimize the risk of transmission. In this study, we look at risk effects of 14-day self-isolation on the incidence of venous thromboembolism (VTE) in our green site hospital among patients undergoing total joint replacement (TJR). METHODS: This retrospective cohort study included 50 patients who underwent TJR. Basic demographic data was collected including, age, sex, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), type of surgery, and complications at two and four weeks. Univariate and multivariate analysis were used to identify risk factors associated with an increased risk of VTE. RESULTS: A total of 50 patients were included in our study, with 24 males and 26 females. The mean age was 67.86 (SD 11.803). Overall, 8% of patients suffered a VTE complication; symptomatic non-fatal pulmoary embolism was confirmed in 6% of patients (n = 3) as an inpatient, and symptomatic deep vein thrombosis was diagnosed in 2% of patients (n = 1) within two weeks of their operation. All patients were found to be female (p < 0.001), had a BMI > 30 (p = 0.317), and were immobile prior to their operation using walking aids (p = 0.016). CONCLUSION: The incidence we report is much higher than the reported incidence in the literature, which we believe is related to the 14-day self-isolation period and immobility prior to their operation. We recommend that all patients undergoing TJR that require a period of self-isolation, are pre-assessed prior to self-isolation for their risk of VTE, potentially using mechanical and chemical prophylaxis to reduce the likelihood of developing VTE.Cite this article: Bone Jt Open 2020;1-12:751-756.

Enhanced recovery protocol and hidden blood loss in patients undergoing total knee arthroplasty.

BACKGROUND: Perioperative blood loss and postoperative pain following total knee arthroplasty prevent early mobilisation of patients. The Enhanced Recovery Protocol (ERP) followed for patients in our institute aims at reducing post operative pain, blood loss and length of stay. MATERIALS AND METHODS: 50 consecutive patients that underwent ERP following total knee arthroplasty with another group of 70 patients that underwent the same surgery without ERP were compared in terms of hidden blood loss and length of hospital stay. Hidden blood loss was calculated according to previously described method. RESULTS: Reduction in blood loss was found in both males (305 ml) and females (150 ml) following ERP. Length of stay reduced by 1.5 days in both genders. Regression analysis showed a significant correlation between body weight and blood loss in females. CONCLUSION: Enhanced recovery protocol could be a useful tool to reduce patient morbidity and reduce length of inpatient stay.