Pyrocarbon radial head arthroplasty offers satisfactory clinical and radiological outcomes with low revision rate: A systematic review.

INTRODUCTION: Pyrocarbon promises to be an optimal material choice for radial head arthroplasty (RHA) due to an elastic modulus comparable to the radial diaphysis and thus providing higher biocompatibility. Primary objective was to determine the complications and revision rates related to the usage of these prostheses. The secondary objective was to assess the clinical and radiological outcomes of Pyrocarbon RHAs. HYPOTHESIS: Pyrocarbon RHAs have good clinical and radiological outcomes with low complications and revisions. METHODS: Ovid MEDLINE and Embase databases were used to search for studies on outcomes and complications of the RHAs using Pyrocarbon radial head prostheses. The systematic review was designed in accordance with the PRISMA guidelines and included studies were appraised using the MINORS tool. Complications and RHA revision rates were assessed. Functional outcomes were reviewed using PROMs (like MEPI, DASH and BMS), post-op range of motion (using goniometer) and grip strength (using the dynamometer). Postoperative radiological outcomes like peri-prosthetic lucency, radial neck osteolysis, radio-capitellar congruence, capitellar erosion, overstuffing/understuffing and osteoarthritis were reported using radiographs. RESULTS: A total of 12 studies cumulatively reporting 353 patients who underwent Pyrocarbon RHAs were included in the review. The mean age of patients across the studies ranged from 47 to 54 years of which 50.5% were males. The majority of radial head replacements were done for acute trauma (87.5%) with the remainder done for arthritis (1.7%) and trauma sequelae (10.8%). Mean follow-up period in the selected studies ranged from 18 to 110 months with minimum follow-up across all studies being 12 months. Modular Pyrocarbon (MoPyC, Tornier™) was the implant of choice in ten studies while two studies used the Ascension Pyrocarbon radial head (Ascension Orthopaedics™). Ten studies demonstrated mean MEPI ranging from 75.5 to 96. Mean extension deficit ranged from 6 to 19 degrees, mean flexion from 120 to 140 degrees, mean pronation from 71 to 87 degrees and mean supination from 63 to 85 degrees. Relative grip strength ranged from 69 to 96% of the contralateral limb. Revisions due to implant-related reasons (intra-prosthetic dissociation, prosthetic fracture, peri-prosthetic loosening, radio-capitellar subluxation and understuffed/overstuffed elbow) was 6.8% (24/353). Radial stress shielding and peri-prosthetic lucency was reported in 10 to 100% of patients across different studies but symptomatic implant loosening leading to revision remained rare (2%, 7/353). Radio-capitellar congruence was reported in 81% to 100% cases while capitellar erosion ranged from 0% to 89%. Pyrocarbon implants specific complications included head-neck intra-prosthetic decoupling (1.1%) and pyrocarbon head fractures (0.9%). In total, 5.7% cases underwent re-surgery due to non-RHA related reasons. DISCUSSION: The pyrocarbon RHA shows good functional outcome, range of motion and low revision rates. This aligns with the working hypothesis of this review. However, pyrocarbon radial head implants have implant-specific complications like pyrocarbon radial head fractures and intra-prosthetic decoupling between stem and head. Despite promising in vitro biomechanical properties, capitellar wear is still a common finding with pyrocarbon RHAs. Despite these factors, pyrocarbon radial head implants are a viable option for radial head arthroplasty. LEVEL OF EVIDENCE: II; Systematic review.

A technical note on percutaneous fixation of trapezium fracture under gravitational traction.

Trapezium fractures rarely present as isolated fractures and warrant anatomical fixation to minimize post-traumatic arthritis. Fixation techniques reported include open approach to trapezium fracture and fixation, percutaneous fixation under image intensifier guidance or percutaneous arthroscopic fixation under gravitational traction. We have reported a novel method of percutaneous fixation of a trapezium Walker type IV coronal split fractures under gravitational traction and per-operative image intensifier guidance. Two percutaneous headless differential pitch screws were used for fixation, which was off-loaded using an inter-metacarpal K-wire. Patient was discharged on the same day with a light-weight cast. The fixation yielded acceptable reduction of the articular surface as confirmed by radiographs. The cast and off-loading K-wire were removed at four weeks post-surgery and hand therapy was commenced. 3-month review showed optimal radiological healing with excellent return to function without pain. In conclusion, using gravitational traction can allow percutaneous fixation of trapezium fractures with excellent results and also make an otherwise complex procedure simpler. LEVEL OF EVIDENCE: IV.

A prospective randomized controlled trial comparing the systemic inflammatory response in conventional jig-based total knee arthroplasty versus robotic-arm assisted total knee arthroplasty.

AIMS: The primary aim of this study was to compare the postoperative systemic inflammatory response in conventional jig-based total knee arthroplasty (conventional TKA) versus robotic-arm assisted total knee arthroplasty (robotic TKA). Secondary aims were to compare the macroscopic soft tissue injury, femoral and tibial bone trauma, localized thermal response, and the accuracy of component positioning between the two treatment groups. METHODS: This prospective randomized controlled trial included 30 patients with osteoarthritis of the knee undergoing conventional TKA versus robotic TKA. Predefined serum markers of inflammation and localized knee temperature were collected preoperatively and postoperatively at six hours, day 1, day 2, day 7, and day 28 following TKA. Blinded observers used the Macroscopic Soft Tissue Injury (MASTI) classification system to grade intraoperative periarticular soft tissue injury and bone trauma. Plain radiographs were used to assess the accuracy of achieving the planned postioning of the components in both groups. RESULTS: Patients undergoing conventional TKA and robotic TKA had comparable changes in the postoperative systemic inflammatory and localized thermal response at six hours, day 1, day 2, and day 28 after surgery. Robotic TKA had significantly reduced levels of interleukin-6 (p < 0.001), tumour necrosis factor-α (p = 0.021), ESR (p = 0.001), CRP (p = 0.004), lactate dehydrogenase (p = 0.007), and creatine kinase (p = 0.004) at day 7 after surgery compared with conventional TKA. Robotic TKA was associated with significantly improved preservation of the periarticular soft tissue envelope (p < 0.001), and reduced femoral (p = 0.012) and tibial (p = 0.023) bone trauma compared with conventional TKA. Robotic TKA significantly improved the accuracy of achieving the planned limb alignment (p < 0.001), femoral component positioning (p < 0.001), and tibial component positioning (p < 0.001) compared with conventional TKA. CONCLUSION: Robotic TKA was associated with a transient reduction in the early (day 7) postoperative inflammatory response but there was no difference in the immediate (< 48 hours) or late (day 28) postoperative systemic inflammatory response compared with conventional TKA. Robotic TKA was associated with decreased iatrogenic periarticular soft tissue injury, reduced femoral and tibial bone trauma, and improved accuracy of component positioning compared with conventional TKA. Cite this article: Bone Joint J 2021;103-B(1):113-122.

The learning curve of robotic-arm assisted acetabular cup positioning during total hip arthroplasty.

BACKGROUND: Robotic-arm assisted surgery aims to reduce manual errors and improve the accuracy of implant positioning and orientation during total hip arthroplasty (THA). The objective of this study was to assess the surgical team's learning curve for robotic-arm assisted acetabular cup positioning during THA. METHODS: This prospective cohort study included 100 patients with symptomatic hip osteoarthritis undergoing primary total THA performed by a single surgeon. This included 50 patients receiving conventional manual THA and 50 patients undergoing robotic-arm assisted acetabular cup positioning during THA. Independent observers recorded surrogate markers of the learning curve including operative times, confidence levels amongst the surgical team using the state-trait anxiety inventory (STAI) questionnaire, accuracy in restoring native hip biomechanics, acetabular cup positioning, leg-length discrepancy, and complications within 90 days of surgery. RESULTS: Cumulative summation (CUSUM) analysis revealed robotic-arm assisted acetabular cup positioning during THA was associated with a learning curve of 12 cases for achieving operative times (p < 0.001) and surgical team confidence levels (p < 0.001) comparable to conventional manual THA. There was no learning curve of robotic-arm assisted THA for accuracy of achieving the planned horizontal (p = 0.83) and vertical (p = 0.71) centres of rotation, combined offset (p = 0.67), cup inclination (p = 0.68), cup anteversion (p = 0.72), and correction of leg-length discrepancy (p = 0.61). There was no difference in postoperative complications between the two treatment groups. CONCLUSIONS: Integration of robotic-arm assisted acetabular cup positioning during THA was associated with a learning curve of 12 cases for operative times and surgical team confidence levels but there was no learning curve effect for accuracy in restoring native hip biomechanics or achieving planned acetabular cup positioning and orientation.

Computerised tomography-based planning with conventional total hip arthroplasty versus robotic-arm assisted total hip arthroplasty: study protocol for a prospective randomised controlled trial.

BACKGROUND: Robotic-arm assisted surgery aims to reduce manual errors and improve the accuracy of implant positioning during total hip arthroplasty. The objective of this study is to compare the accuracy of implant positioning, restoration of hip biomechanics, patient satisfaction, functional outcomes, implant survivorship, cost-effectiveness, and complications in conventional manual total hip arthroplasty (CO THA) versus robotic-arm assisted total hip arthroplasty (RO THA). Preoperative pelvic computerised tomography (CT) scans will be used to create patient-specific, virtual, three-dimensional reconstructions for surgical planning in both treatment groups. METHODS AND ANALYSIS: This prospective randomised controlled trial will include 60 patients with symptomatic hip osteoarthritis undergoing primary THA. Following informed consent, patients will be randomised to CO THA (control group) or RO THA (investigation group) at a ratio of 1:1 using an online random number generator. Observers will review patients at regular intervals for 2 years after surgery to record predefined study outcomes relating to the accuracy of implant positioning, hip biomechanics, postoperative rehabilitation, clinical progress, functional outcomes, cost-effectiveness, and complications. Primary and secondary objectives will be used to quantify and draw inferences on differences in the efficacy of treatment between the two groups. Intention-to-treat and per-protocol population analysis will be undertaken. Intention to treat relates to the allocated treatment (CO THA or RO THA), and per-protocol refers to the actual treatment received by the patient. The following statistical methods will be employed to analyse the data: descriptive statistics, independent t test, paired t test, analysis of variance, Fisher exact test, chi-square test, and graphical displays. Ethical approval was obtained from the London-Bromley Research Ethics Committee, UK. The study is sponsored by University College London, UK. DISCUSSION: This study compares a comprehensive and robust range of clinical, functional, and radiological outcomes in CT-planned CO THA versus CT-planned RO THA. The findings of this study will enable an improved understanding of the differences in CO THA versus RO THA with respect to patient satisfaction, functional outcomes, implant survivorship, cost-effectiveness, and complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT04095845 . Registered on 19 September 2019.

Robotic-arm assisted medial unicondylar knee arthroplasty versus jig-based unicompartmental knee arthroplasty with navigation control: study protocol for a prospective randomised controlled trial.

BACKGROUND: There remains a paucity of clinical studies assessing how any differences in accuracy of implant positioning between robotic-arm assisted unicompartmental knee arthroplasty (RO UKA) and conventional jig-based unicompartmental knee arthroplasty (CO UKA) translate to patient satisfaction, functional outcomes, and implant survivorship. The objectives of this study are to compare accuracy of implant positioning, limb alignment, patient satisfaction, functional outcomes, implant survivorship, cost-effectiveness, and complications in CO UKA versus RO UKA. Computer navigation will be used to assess intraoperative knee kinematics in all patients undergoing CO UKA. METHODS AND ANALYSIS: This prospective randomised controlled trial will include 140 patients with symptomatic medial compartment knee arthritis undergoing primary UKA. Following informed consent, patients will be randomised to CO UKA (control group) or RO UKA (investigation group) at a ratio of 1:1 using an online random number generator. The primary objective of this study is to compare accuracy of implant positioning in CO UKA versus RO UKA. The secondary objectives are to compare the following outcomes between the two treatment groups: limb alignment, surgical efficiency, postoperative functional rehabilitation, functional outcomes, quality of life, range of motion, resource use, cost effectivness, and complications. Observers will review patients at regular intervals for 2 years after surgery to record predefined study outcomes pertaining to these objectives. Ethical approval was obtained from the London-Bloomsbury Research Ethics Committee, UK. The study is sponsored by University College London, UK. DISCUSSION: This study compares a comprehensive and robust range of clinical, functional, and radiological outcomes in CO UKA versus RO UKA. The findings of this study will provide an improved understanding of the differences in CO UKA versus RO UKA with respect to accuracy of implant positioning, patient satisfaction, functional outcomes, implant survivorship, cost-effectiveness, and complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT04095637 . Registered on 19 September 2019.

Surgical Repair of Distal Musculotendinous T Junction Injuries of the Biceps Femoris.

BACKGROUND: Nonoperative management of injuries to the distal musculotendinous T junction of the biceps femoris is associated with variable periods of rehabilitation and high risk of recurrence. To our knowledge, the efficacy of operative treatment in patients with these acute injuries has not been previously reported. HYPOTHESIS: Surgical repair of injuries to the distal musculotendinous T junction of the biceps femoris would enable return to preinjury level of sport with low risk of recurrence. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This prospective single-surgeon study included 34 professional athletes (mean age, 26.4 ± 3.1 years; 31 male [91.2%]; 3 female [8.8%]; body mass index, 25 ± 2.0 kg/m2) undergoing primary surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris. All study patients underwent a standardized postoperative rehabilitation program. Predefined study outcomes relating to time for return to sporting activity, patient satisfaction, range of motion, hamstring muscle strength, passive range of motion, functional progress, and complications were recorded at regular intervals after surgery. Mean follow-up time was 28.4 months (range, 24.0-36.3 months) from date of surgery. RESULTS: All study patients returned to their preinjury level of sporting activity. Mean time from surgical repair to full sporting activity was 11.7 ± 3.6 weeks. No patients had recurrence of the primary injury. At 1-year follow-up, 18 patients (52.9%) were very satisfied and 16 patients (47.1%) were satisfied with the outcomes of their surgery. At 3 months after surgery, patients had improved mean passive straight leg raise (69.7° ± 11.7° vs 24.1° ± 7.4°; P < .001); increased mean isometric hamstring muscle strength at 0° (93.1% ± 5.4% vs 63.1% ± 7.7%; P < .001), 45° (76.8% ± 9.7% vs 24.8% ± 8.3%; P < .001), and 90° (96.4% ± 3.9% vs 85.6% ± 5.9%; P < .001); higher mean lower extremity functional scores (64.5 ± 4.5 vs 27.2 ± 5.4; P < .001); and improved mean Marx Activity Rating Scale scores (10.7 ± 2.7 vs 2.2 ± 2.1; P < .001) compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery. CONCLUSION: Surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up.

Acute Surgical Repair of Complete, Nonavulsion Proximal Semimembranosus Injuries in Professional Athletes.

BACKGROUND: Nonoperative management of proximal semimembranosus injuries is associated with prolonged periods of convalescence and high risk of recurrence. To our knowledge, the outcomes of acute surgical repair for complete, nonavulsion proximal semimembranosus injuries have not been previously reported. HYPOTHESIS: Acute surgical repair of complete, nonavulsion proximal semimembranosus injuries enables early return to sporting activity with low risk of recurrence. STUDY DESIGN: Case series: Level of evidence, 4. METHODS: This prospective single-surgeon study included 20 professional athletes undergoing acute primary surgical repair of complete, nonavulsion proximal semimembranosus injuries confirmed on preoperative magnetic resonance imaging. All study patients underwent a standardized postoperative rehabilitation program. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 27.6 months (range, 24.0-34.6 months) from date of surgery. RESULTS: Of the 20 patients, 19 (95%) returned to their preinjury level of sporting activity. Mean ± SD time from surgical repair to full sporting activity was 11.9 ± 5.7 weeks. No patients had recurrence of the primary injury. At 3 months after surgery, patients had improved mean passive straight leg raise (71.5° ± 5.9° vs 31.1° ± 7.2°; P < .001); increased mean isometric hamstring muscle strength at 0° (83.8% ± 5.9% vs 48.4% ± 8.3%; P < .001), 15° (77.6% ± 6.0% vs 52.3% ± 14.7%; P < .001), and 45° (88.6% ± 5.4% vs 66.7% ± 13.1%; P < .001); higher mean lower extremity functional scores (64.8 ± 4.6 vs 34.4 ± 5.1; P < .001); and improved Marx activity rating scores (10.7 ± 1.6 vs 5.5 ± 2.0; P < .001) as compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery. CONCLUSION: Acute surgical repair of complete, nonavulsion proximal semimembranosus injuries is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up.

Musculotendinous Junction Injuries of the Proximal Biceps Femoris: A Prospective Study of 64 Patients Treated Surgically.

BACKGROUND: Injuries to the hamstring complex most commonly involve the proximal musculotendinous junction of the long head of the biceps femoris (MTJ-BFlh). Nonoperative management of these injuries is associated with prolonged rehabilitation and high risk of recurrence. To our knowledge, the surgical management of acute MTJ-BFlh injuries has not been previously reported. HYPOTHESIS: Surgical repair of acute MTJ-BFlh injuries enables return to sporting activity with low risk of recurrence. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 64 patients (42 male and 22 female) undergoing surgical repair of acute MTJ-BFlh injuries were included. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time after surgery was 29.2 months (range, 24.0-37.1 months). RESULTS: All study patients returned to their preinjury levels of sporting activity. Mean ± SD time from surgical intervention to return to sporting activity was 13.4 ± 5.1 weeks. Three patients had reinjury at the operative site: 1 (1.6%) with MTJ-BFlh injury and 2 (3.2%) with myofascial tears. At 3 months after surgery, patients had improved mean passive straight-leg raise (72.0° ± 11.4° vs 24.1° ± 6.8°; P < .001); increased mean isometric hamstring muscle strength at 0° (84.5 % ± 10.4% vs 25.9% ± 8.9%; P < .001), 15° (89.5% ± 7.3% vs 41.2% ± 9.7%; P < .001), and 45° (93.9% ± 5.1% vs 63.4% ± 7.6%; P < .001); higher mean Lower Extremity Functional Scale scores (71.5 ± 5.0 vs 29.8 ± 6.3; P < .001); and improved mean Marx activity rating scores (9.8 ± 2.2 vs 3.8 ± 1.9; P < .001), as compared with preoperative scores. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery. CONCLUSION: Surgical repair of acute MTJ-BFlh injuries enables return to preinjury level of sporting function with low risk of recurrence at short-term follow-up.

The direct superior approach versus posterior approach for total hip arthroplasty: study protocol for a prospective double-blinded randomised control trial.

BACKGROUND: The direct superior approach (DSA) is a minimally invasive modification of the posterior approach (PA) that preserves the iliotibial band and short external rotators except for the piriformis or conjoint tendon during total hip arthroplasty (THA). The objective of this study is to compare patient satisfaction, functional outcomes, accuracy of implant positioning, component stability, gait, cost-effectiveness, and complications in the DSA versus PA for THA. METHODS AND ANALYSIS: This prospective double-blinded randomised control trial will include 80 patients with symptomatic hip osteoarthritis undergoing primary THA. Following informed consent, patients will be randomised to THA using the PA (control group) or DSA (investigation group) at a ratio of 1:1 using an online random number generator. Blinded observers will review patients at regular intervals for 2 years after surgery to record predefined study outcomes relating to postoperative rehabilitation, clinical progress, functional outcomes, accuracy of implant positioning, gait analysis on force plate treadmill, implant migration with radiosteriometric analysis, cost-effectiveness, and complications. A superiority study design will be used to evaluate whether the DSA provides improved outcomes compared to the PA for THA. Evaluation of study outcomes in DSA and PA will be used to quantify and draw inferences on differences in the efficacy of treatment between the two groups. Intention-to-treat and per-protocol population analysis will be undertaken. The following statistical methods will be employed to analyse the data: descriptive statistics, independent t test, paired t test, analysis of variance, Fisher exact test, chi-square test, and graphical displays. Ethical approval was obtained from the London-Fulham Research Ethics Committee, UK. The study is sponsored by University College London, UK. DISCUSSION: This study compares a comprehensive and robust range of clinical, functional, and radiological outcomes in THA performed using the PA versus DSA. The findings of this study will provide an improved understanding of the differences in the PA versus DSA for THA with respect to patient satisfaction, functional outcomes, implant survivorship, gait, cost-effectiveness, and complications. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04191993. Registered on 10 December 2019.

The effect of anterior cruciate ligament resection on knee biomechanics.

AIMS: The objectives of this study were to assess the effect of anterior cruciate ligament (ACL) resection on flexion-extension gaps, mediolateral soft tissue laxity, maximum knee extension, and limb alignment during primary total knee arthroplasty (TKA). METHODS: This prospective study included 140 patients with symptomatic knee osteoarthritis undergoing primary robotic-arm assisted TKA. All operative procedures were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess study outcomes pre- and post-ACL resection with knee extension and 90° knee flexion. This study included 76 males (54.3%) and 64 females (45.7%) with a mean age of 64.1 years (SD 6.8) at time of surgery. Mean preoperative hip-knee-ankle deformity was 6.1° varus (SD 4.6° varus). RESULTS: ACL resection increased the mean extension gap significantly more than the flexion gap in the medial (mean 1.2 mm (SD 1.0) versus mean 0.2 mm (SD 0.7) respectively; p < 0.001) and lateral (mean 1.1 mm (SD 0.9) versus mean 0.2 mm (SD 0.6) respectively; p < 0.001) compartments. The mean gap differences following ACL resection did not create any significant mediolateral soft tissue laxity in extension (gap difference: mean 0.1 mm (SD 2.4); p = 0.89) or flexion (gap difference: mean 0.2 mm (SD 3.1); p = 0.40). ACL resection did not significantly affect maximum knee extension (change in maximum knee extension = mean 0.2° (SD 0.7°); p = 0.23) or fixed flexion deformity (mean 4.2° (SD 3.2°) pre-ACL release versus mean 3.9° (SD 3.7°) post-ACL release; p = 0.61). ACL resection did not significantly affect overall limb alignment (change in alignment = mean 0.2° valgus (SD 1.0° valgus; p = 0.11). CONCLUSION: ACL resection creates flexion-extension mismatch by increasing the extension gap more than the flexion gap. However, gap differences following ACL resection do not create any mediolateral soft tissue laxity in extension or flexion. ACL resection does not affect maximum knee extension or overall limb alignment. Cite this article: Bone Joint J 2020;102-B(4):442-448.

Surgical Management of Chronic Incomplete Proximal Hamstring Avulsion Injuries.

BACKGROUND: Chronic incomplete proximal hamstring avulsion injuries are debilitating injuries associated with prolonged periods of convalescence and poor return to preinjury level of function. This study explores the efficacy of operative intervention for these injuries on patient satisfaction, muscle strength, range of motion, functional performance, return to preinjury level of sporting activity, and injury recurrence. HYPOTHESIS: Surgical intervention of chronic incomplete proximal hamstring avulsion injuries enables return to preinjury level of sporting function with low risk of clinical recurrence. STUDY DESIGN: Case series: Level of evidence, 4. METHODS: This prospective single-surgeon study included 41 patients with incomplete proximal hamstring avulsion injuries refractory to 6 months of nonoperative treatment. All study patients underwent primary operative repair of the avulsed proximal hamstring tendon and received standardized postoperative rehabilitation. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 28.2 months (range, 25.0-35.0 months) from date of surgery. RESULTS: All patients returned to their preinjury level of sporting activity. Mean ± SD time from surgery to return to full sporting activity was 22.2 ± 6.7 weeks. There were no episodes of clinical recurrence. At 3 months after surgery, 39 patients (95.1%) were satisfied/very satisfied with the outcomes of their surgery, and as compared with preoperative values, improvements were recorded in isometric hamstring muscle strength at 0° (84.9% ± 10.9% vs 40.4% ± 8.8%; P < .001), 15° (89.6% ± 7.6% vs 44.2% ± 11.1%; P < .001), and 45° (94.1% ± 5.1% vs 66.4% ± 9.0%; P < .001); mean passive straight leg raise angle (71.2°± 13.5° vs 45.4°± 11.9°; P < .001); mean lower extremity functional score (70.9 ± 5.1 vs 48.4 ± 5.2; P < .001); and mean Marx activity rating score (5.6 ± 2.8 vs 2.7 ± 1.0; P < .001). High patient satisfaction and functional outcome scores were maintained at 1- and 2-year follow-up. CONCLUSION: Operative repair of chronic incomplete proximal hamstring avulsion injuries enabled return to preoperative level of sporting function with no episodes of clinical recurrence at short-term follow-up. Surgical intervention was associated with high patient satisfaction and improved isometric hamstring muscle strength, range of motion, and functional outcome scores as compared with preoperative values. High patient satisfaction and improved functional outcomes were sustained at 2-year follow-up.

Robotic technology in total knee arthroplasty: a systematic review.

Robotic total knee arthroplasty (TKA) improves the accuracy of implant positioning and reduces outliers in achieving the planned limb alignment compared to conventional jig-based TKA.Robotic TKA does not have a learning curve effect for achieving the planned implant positioning. The learning curve for achieving operative times comparable to conventional jig-based TKA is 7-20 robotic TKA cases.Cadaveric studies have shown robotic TKA is associated with reduced iatrogenic injury to the periarticular soft tissue envelope compared to conventional jig-based TKA.Robotic TKA is associated with decreased postoperative pain, enhanced early functional rehabilitation, and decreased time to hospital discharge compared to conventional jig-based TKA. However, there are no differences in medium- to long-term functional outcomes between conventional jig-based TKA and robotic TKA.Limitations of robotic TKA include high installation costs, additional radiation exposure, learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs.Further higher quality studies are required to compare differences in conventional TKA versus robotic TKA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness. Cite this article: EFORT Open Rev 2019;4:611-617. DOI: 10.1302/2058-5241.4.190022.

The current role of robotics in total hip arthroplasty.

Robotic total hip arthroplasty (THA) improves accuracy in achieving the planned acetabular cup positioning compared to conventional manual THA.Robotic THA improves precision and reduces outliers in restoring the planned centre of hip rotation compared to conventional manual THA.Improved accuracy in restoring hip biomechanics and acetabular cup positioning in robotic THA have not translated to any differences in early functional outcomes, correction of leg-length discrepancy, or postoperative complications compared to conventional manual THA.Limitations of robotic THA include substantive installation costs, additional radiation exposure, steep learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs.Further higher quality studies are required to compare differences in conventional versus robotic THA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness. Cite this article: EFORT Open Rev 2019;4:618-625. DOI: 10.1302/2058-5241.4.180088.

Acute Surgical Excision of a Traumatic Fat Fracture in a Professional Soccer Player.

INTRODUCTION: Surgical excision of fat fractures is often reserved for patients with large chronic deformities to improve cosmetic appearance. To our knowledge, the acute surgical management of a traumatic fat fracture has not been previously reported. CASE REPORT: This case report describes the management of a professional soccer player that developed a traumatic fat fracture over the lateral thigh. The patient presented with persistent pain, reduced range of movement, and inability to participate in sporting activity. Symptoms were refractory to non-operative treatment. Following acute surgical excision of the fat fracture, the patient was able to make an early return to sporting activity with no complications at short-term follow-up. CONCLUSION: Acute surgical excision of a traumatic fat fracture may be used as an avenue for improving pain, enhancing functional rehabilitation, and facilitating early return to pre-injury level of function.