Efficacy of the newly designed "SkyWalker" robot compared to the MAKO robotic system in primary total knee arthroplasty: a one-year follow-up study.

PURPOSE: Robot-assisted surgical systems for performing total knee arthroplasty (TKA) have gained significant attention. This study was designed to compare the surgical outcomes in primary TKA surgery between the recently developed "SkyWalker" robot system and the more commonly used MAKO robot. METHODS: A total of 75 patients undergoing primary TKA surgery by the same surgical team were included in this study, with 30 patients in the "SkyWalker" group and 45 patients in the "MAKO" group. We documented the osteotomy plan for both robotic systems. The lower limb alignment angles were evaluated by postoperative radiographic assessment. The operation time, estimated blood loss, postoperative hospital stays, and changes in laboratory indexes were collected during hospitalization. In addition, a comparative evaluation of knee functional assessments and complications was conducted during six month and one year follow-ups. RESULTS: There were no significant differences between the two groups in terms of the accuracy of restoring lower limb alignment, estimated blood loss, or operation time. The knee function assessments at six months and one year postoperatively were similar in both groups. Except for day three after surgery, the level of interleukin-6 (IL-6) and the change in IL-6 (∆IL-6) from preoperative baseline were higher in the "SkyWalker" group than in the MAKO group (median: 20.53 vs. 14.17, P=0.050 and median: 17.30 vs. 10.09, P=0.042, respectively). Additionally, one patient from the MAKO group underwent revision surgery at nine months postoperatively due to ongoing periprosthetic discomfort. CONCLUSIONS: The newly developed "SkyWalker" robot showed comparable efficacy to the MAKO robot in terms of lower limb alignment accuracy and postoperative six month and one year follow-up of clinically assessed resumption of knee function.

Sagittal Alignment in Total Knee Arthroplasty: Are There Any Discrepancies Between Robotic-Assisted and Manual Axis Orientation?

BACKGROUND: Sagittal alignment determines the extension and flexion of knee prostheses in total knee arthroplasty (TKA). The definition of the sagittal axes may be different between the Mako TKA system (Stryker) and the conventional manual intramedullary approach. Whether there is any discrepancy between the 2 approaches has not been well studied. METHODS: We retrospectively analyzed 60 full-length computed tomographic (CT) scans of the lower extremities of 54 patients. The femur and tibia were modeled by using Mimics (Materialise). The Mako mechanical axes were determined according to the Mako TKA Surgical Guide. The manual intramedullary axes were determined according to the central axis of the tibial proximal and femoral distal medullary cavities. The femoral, tibial, and combined angular discrepancies were measured in the sagittal plane. RESULTS: On the femoral side, the Mako mechanical axis was more likely to be located in an extended position relative to the manual intramedullary axis (56 of 60 knees). The median angular discrepancy was 2.46° (interquartile range [IQR], 1.56° to 3.43° [range, -1.06° to 5.24°]). On the tibial side, the Mako mechanical axis was likely to be located in a flexed position relative to the manual intramedullary axis (57 of 60 knees). The median angular discrepancy was 2.40° (IQR, 1.87° to 2.84° [range, -0.79° to 4.20°]). The angular discrepancy of the femoral-tibial sagittal angle was 4.63° (IQR, 3.71° to 5.64° [range, 1.20° to 9.02°]). CONCLUSIONS: Compared with manual TKA, the Mako system is more likely to result in a decreased posterior tibial slope and extension of the femoral prosthesis. It may also influence the evaluation of lower-extremity extension and flexion. When using the Mako system, special attention should be given to these discrepancies. LEVEL OF EVIDENCE: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Can mobile-bearing unicompartmental knee arthroplasty achieve natural gap-balancing? An observational study with a novel pressure sensor.

BACKGROUND: Mobile-bearing unicompartmental knee arthroplasty (MB-UKA) is an effective treatment for anteromedial knee osteoarthritis. Meticulous intraoperative soft tissue balancing remains challenging yet consequential for a successful operation. Currently, surgeons rely mostly on their experience during soft tissue balancing, yielding unreproducible results. The purpose of this study was to quantified measure the soft tissue tension of medial compartment and determine if an optimal "target" tension values with the natural state exists. METHODS: This was an observational study of 24 consecutive patients. All 30 UKAs were performed by a single surgeon. The piezoresistive sensor was custom designed to fit in the medial compartment gap. Contact pressures were measured at 5 angular positions of the knee intraoperatively: 0°, 20°, 45°, 90°, and 110° of flexion. The change in pressure from extension (20° position) and flexion (110° position) was also calculated (E-FPD). Data on age, sex, body mass index, operative side, and bearing size were collected. Outcome measures were measured at baseline and at the 6-month postoperative follow-up; Oxford Knee Score, visual analog scale score, and range of motion were compared to evaluate clinical outcomes. RESULTS: There was a significant improvement in patients in all measured outcomes at 6 months from baseline (P < 0.05). The E-FPD of 14.9 N (8.9, 24.6) was indicative of appropriate soft tissue balancing throughout the functional range of knee motion. Of 30 knees, 22 were 3-mm bearing and 8 were 4- or 5-mm bearing. The pressure data of the 3-mm bearing group was larger than that of the non-3-mm bearing group for each knee flexion degree, but the difference was not statistically significant (P > 0.05). CONCLUSIONS: Objective data from sensor output may assist surgeons in decreasing loading variability during MB-UKA. The data suggested that MB-UKA could not accurately restore soft tissue tension to the natural state, which was related to the inability of MB-UKA surgical instruments to fine adjust the bone cut and soft tissue release. STUDY REGISTRATION: Chinese Clinical Trial Registry ( http://www.chictr.org.cn ): ChiCTR1900024146.

Effect of Silver Nanoparticles With Thermoplastic Polyurethane on Postoperative Rehabilitation of Diabetic Patients With Open Fracture of Lower Extremities.

Objective: This retrospective study aims to explore the effect of silver nanoparticles with thermoplastic polyurethane (TPU/NS) on the rehabilitation of diabetic patients with open fracture of lower extremities. Methods: Diabetic patients (n = 98) with open fracture of lower extremities treated in our hospital were analyzed retrospectively from June 2015 to December 2021. TPU/NS nanocomposites were prepared for postoperative treatment of diabetic patients with open fracture of lower extremities. First, the cultured Staphylococcus aureus and Escherichia coli were used to test the antibacterial effect of TPU/NS dressing in vitro. After using TPU/NS dressing (observation group) and traditional dressing (control group), the inflammatory reaction, clinical treatment, functional rehabilitation, and adverse reactions in patients were compared. Results: TPU/NS dressing effectively inhibited the growth of bacteria with a minimum inhibitory concentration of 2 µg/mL. The usage of TPU/NS dressing reduced the inflammatory reaction by reducing positive rate of bacteria after the dressing on the seventh day postoperatively. Besides, the times of dressing, stopping time of wound exudation, wound healing time, length of hospital stay, and VAS score in the observation group were lower than those in the control group; the incidence of adverse reactions after treatment was lower in the observation group as compared with the control group (17.07% vs. 35.09%). Meanwhile, the functional rehabilitation and life quality of patients in the observation group were better TPU/NS dressing treatment. Conclusion: TPU/NS dressing has the function of promoting the postoperative recovery of patients by inhibiting the bacterial infection of the wound, thus improving the limb function and life quality. As a result, there was a tremendous potential to apply the constructed TPU/NS membrane to diabetic patients with open fractures, especially those with soft tissue injury.

Quantitative analysis of local microcirculation changes in early osteonecrosis of femoral head: DCE-MRI findings.

Aim: This study aims to quantitatively analyze the changes in local microcirculation in early osteonecrosis of the femoral head (ONFH) by dynamic contrast-enhanced (DCE) MRI and to explore the pathophysiological mechanisms of early ONFH. Patients and Methods: We selected 49 patients (98 hips) aged 21-59 years who were clinically diagnosed with early ONFH. A total of 77 femoral heads were diagnosed with different degrees of necrosis according to the Association Research Circulation Osseous (ARCO) staging system, and 21 femoral heads were judged to be completely healthy. All patients underwent DCE-MRI scanning. Pseudocolor images and time-signal intensity curves were generated by Tissue 4D processing software. The volume transfer constant (K trans), extracellular extravascular space, also known as vascular leakage (V e), and transfer rate constant (K ep) of healthy and different areas of necrotic femoral heads were measured on perfusion parameter maps. The differences and characteristics of these parameters in healthy and different areas of necrotic femoral heads were analyzed. Results: The signal accumulation in healthy femoral heads is lower than that of necrotic femoral heads in pseudocolor images. The time-signal intensity curve of healthy femoral heads is along the horizontal direction, while they all have upward trends for different areas of necrotic femoral heads. The mean value of K trans of healthy femoral heads was lower than the integration of necrotic, boundary, and other areas (F = 3.133, P = .036). The K ep value of healthy femoral heads was higher than the integration of lesion areas (F = 6.273, P = .001). The mean V e value of healthy femoral heads was smaller than that of the lesion areas (F = 3.872, P = .016). The comparisons of parameters between different areas and comparisons among healthy areas and lesion areas showed different results. Conclusion: ONFH is a complex ischemic lesion caused by changes in local microcirculation. It mainly manifests as increased permeability of the vascular wall, blood stasis in the posterior circulation, high intraosseous pressure in the femoral head, and decreased arterial blood flow. The application of DCE-MRI scanning to quantitatively analyze the visual manifestations of microcirculation after early ONFH is an ideal method to study the microcirculation changes of necrotic femoral heads.

Internal fixation and unicompartmental knee arthroplasty for an elderly patient with patellar fracture and anteromedial osteoarthritis: A case report.

BACKGROUND: Open reduction and internal fixation (ORIF) is the traditional surgical treatment for patellar fractures, and unicompartmental knee arthroplasty (UKA), especially Oxford UKA, has been increasingly used in patients with medial knee osteoarthritis (OA). However, the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear. We present the case of a patient with a patellar fracture and anteromedial OA. CASE SUMMARY: We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA. She also experienced a recent left patellar fracture. ORIF and Oxford UKA were performed in a single stage. The patient showed excellent postoperative clinical results. CONCLUSION: ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.

MicroRNA-1226-3p has a tumor-promoting role in osteosarcoma.

Osteosarcoma is a malignant bone tumor that commonly occurs in young individuals. It accounts for 10% of solid tumors in those who are 15-19 years old. MicroRNA (miRNA/miR) dysregulation serves a crucial role in the molecular mechanism of osteosarcoma. The present study reported a novel miRNA (miR-1226-3p) and investigated its function in osteosarcoma. miR-1226-3p mimics and miR-1226-3p antisense oligonucleotides were transfected into human osteosarcoma SaOS-2 cells to alter miR-1226-3 expression, while the hFOB 1.19 cell line was used as the control. The apoptosis rate was analyzed using a dead cell apoptosis kit. TNF receptor-associated factor 3 (TRAF3) protein expression was assayed by western blotting. The results of bioinformatics and clinical specimen analyses revealed that higher expression levels of miR-1226-3p were associated with lower survival rates. Additionally, the results of experiments on cultured cells revealed that miR-1226-3p promoted the proliferation of SaOS-2 cells, while miR-1226-3p inhibition decreased cell proliferation and increased apoptosis. Furthermore, it was revealed that miR-1226-3p targeted TRAF3 in SaOS-2 cells. In conclusion, the present study suggested that miR-1226-3p promoted the proliferation of osteosarcoma cells.