Surgical technology international最新文献

Introduction: While arthroscopic TFCC debridement (TFCC-D) has proven successful for the treatment of pathological tears, a subset of patients may present with persistent or recurrent ulnar-sided wrist pain and require revision debridement, repair, and/or ulnar shortening osteotomy (USO). We present a retrospective comparative study that evaluates the clinical outcomes of 83 patients who underwent TFCC-D (N=17) or TFCC-D+USO (N=66).

Materials and methods: Preoperative ulnar variance was measured on standard posteroanterior (PA) view and gripping PA view radiographs. Clinical outcomes at final follow up included visual analog scale (VAS) pain scores, grip and pinch strength recovery, active wrist range of motion, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient Rated Wrist Evaluation (PRWE) questionnaires.

Results: We report on 83 cases, mean age 45 years (range, 18-74 years), who underwent surgery between September 2016 and March 2020. Mean follow-up time was 93 weeks (range, 49-237 weeks). Mean VAS scores decreased from 7.4 to 5.3 in the TFCC-D group and from 6.7 to 2.9 in the TFCC-D+USO group. Patients in the TFCC-D group reported significantly higher QuickDASH (44.6 vs. 17.0) and PRWE scores (76.8 vs. 30.7) compared to the TFCC-D+USO group. Nine TFCC-D cases were indicated for revision compared with one TFCC-D+USO case. Eight of the nine TFCC-D cases indicated for revision exhibited positive ulnar variance on gripping PA view.

Conclusions: Patients treated with TFCC-D+USO reported superior outcomes to those treated with TFCC-D alone on the basis of pain scores, QuickDASH and PRWE scores, and need for revision surgery.

Introduction: Access to a patient's surgeon has become increasingly difficult given increased volumes of total joint arthroplasty (TJA). A surgeon-specific conversational chatbot has the theoretical advantage of engaging and guiding patients through the perioperative journey irrespective of surgeon availability. The purpose of this study was to retrospectively assess if enrollment in a perioperative chatbot was associated with improved outcomes following TJA compared to a historical cohort not enrolled.

Materials and methods: We identified 1,338 TJA patients who enrolled in a Short Message Service (SMS) chatbot from 2020-2022 with greater than three months of follow up. Similarly, we identified a historical cohort of 1703 patients not enrolled in the SMS chatbot. The associations of chatbot enrollment on emergency department visits and readmissions within 30 and 90 days postoperatively were analyzed.

Results: Chatbot enrollment was associated with a significantly decreased odds ratios of emergency department visits at 30 and 90 days postoperatively (0.40 and 0.45 respectively, p<0.0001) compared to a historical cohort not enrolled. There was also a significantly decreased odds ratio of readmission by 90 days postoperatively (0.60, p=0.0168) for those enrolled in the SMS chatbot.

Conclusions: Chatbot enrollment was associated with decreased odds ratios of emergency department visits and readmissions following TJA compared to a historical cohort without access to a perioperative chatbot. Perioperative chatbots may provide an opportunity to further improve patient outcomes following TJA.

The demand for safe and effective surface disinfection solutions in the perioperative has led to the development of technologies beyond traditional chemical disinfectants, which are often associated with limitations including improper application, harmful residues, and environmental risks. Ultraviolet C (UVC) light has emerged as a powerful, chemical-free, and reusable alternative capable of neutralizing a wide range of pathogens without leaving residual contaminants. Despite its potential, conventional UVC technologies face limitations, including inconsistent coverage, user-dependent efficacy, and safety concerns related to exposure times. This paper provides a comprehensive comparison of various UVC disinfection technologies, highlighting their unique features, applications, and limitations in the perioperative period. Among these, the UVCeed Mobile UVC Disinfection Device (UVCeed, LLC, Effingham, Illinois) stands out as a novel innovation that transcends the capabilities of traditional UVC tools. By integrating cutting-edge augmented reality (AR), artificial intelligence (AI), and gamification, UVCeed enhances user safety, optimizes disinfection accuracy, and ensures an intuitive, engaging experience. Its real-time visual feedback and intelligent exposure control address the critical gaps in earlier UVC technologies. UVCeed's transformative approach sets a new benchmark in surface disinfection, offering unparalleled effectiveness, user-friendliness, and environmental sustainability across healthcare, consumer, and industrial applications.

Introduction: Cemented kinematic alignment (KA) total knee arthroplasty (TKA) is popular due to its superior patient-reported outcome scores (PROs). A new cementless version of a KA-optimized implant is available. The femoral component features a 20° trochlear groove and medial spherical articulation. The tibial insert features a medial socket, creating native anterior-posterior stability and a lateral flat articular surface promoting native medial pivot rotation. The present study aimed to determine whether clinical outcomes for patients receiving the cementless KA-optimized implant are equivalent to those receiving the cemented version after six weeks. This comparison is essential because lower PROs could indicate delayed osteointegration of the components, like dysfunction associated with delayed fracture union.

Materials and methods: The study included 95 cementless KA TKAs matched 1:1 with 95 cemented KA TKAs based on surgery date, age, preoperative knee deformity, sex, and surgeon. Patients completed the Oxford Knee Score (OKS) and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) both preoperatively and at six weeks, as well as the Forgotten Joint Score (FJS) at six weeks. A Wilcoxon two-sided equivalence test was used to test the null hypothesis that results were comparable for the cementless and cemented KA TKAs.

Results: The analysis included 114 females and 76 males, with a mean age of 68 years and a body mass index (BMI) of 31kg/m². Preoperatively and at six weeks, the age, sex distribution, BMI, knee extension and flexion, OKS, and KOOS JR scores for cementless and cemented KA TKAs were equivalent. At six weeks, the FJS scores were also equivalent.

Conclusion: The KA-optimized implant closely resembling native knee morphology did not show evidence of delayed osteointegration. After six weeks, knee motion and PROs were equivalent to those of the cemented implants. However, longer-term monitoring of this new cementless implant is necessary.

Introduction: There is a wide range of nonoperative options to manage symptomatic knee osteoarthritis (OA). This paper aimed to 1) define the treatment sequence for patients undergoing up to four subsequent rounds (i.e., cryoneurolysis) of superficial (Cryo-Superficial) and/or deep genicular nerves (Cryo-Deep/Both), intra-articular corticosteroid injections (IA-CS), triamcinolone extended-release (IA-TA-ER), hyaluronic acid (IA-HA), or non-steroidal anti-inflammatory drugs (IA-NSAIDs); 2) compare usage of extended-release versus standard corticosteroid injections; and 3) quantify distribution of repeated treatments.

Materials and methods: We identified 502 patients with symptomatic knee OA and received nonoperative intervention within the Innovations in Genicular Outcomes (IGOR) registry from 2021 to 2024. Treatment journey during follow up was presented aggregating baseline patient demographics, along with sequence of nonoperative treatments per patient, duration, and frequency of repeated use. Repeated use of Round 1 treatment for subsequent treatment rounds was estimated with descriptive statistics.

Results: Fifty-three percent of patients received only the original Round 1 treatment option, either single/repeated dose and did not receive any alternative treatment. Seventy-three percent of patients treated with intra-articular extended-release triamcinolone (IA-TAER) repeated the treatment at least once, whereas 60% of those treated with other treatments did so. No adverse events were reported in patients during repeated treatments.

Conclusion: Patients who received IA-TAER were more likely to repeat the same injection, with 73% repeating at least once and no adverse events were attributed to repeated injections. Approximately half of the patients have switched from the initial treatment offered during follow up, with the use of IA-TAER associated with higher rates of repeated treatment. Significance and Innovation 1. Our study used a newly developed real-world registry IGOR to characterize treatment progression for patients with symptomatic knee OA undergoing up to five rounds of nonoperative treatment. 2. Non-surgical interventions included cryoneurolysis, intra-articular injections of NSAIDs, hyaluronic acid injections, corticosteroid, or extended release steroid (triamcinolone) injections. 3. We found 73% of patients treated with intra-articular extended-release steroid injections repeated treatment at least once, relative to 60% by other treatments. 4. We found approximately half of patients switched from initial treatment offered during follow up, with the use of IA-TAER associated with higher rates of repeated treatment.

Surgical site infections (SSIs) remain a significant complication in modern healthcare, particularly in orthopaedic surgery, where implants carry potential risk of contamination with biofilm formation. Traditional disinfection methods, such as chemical agents or ultraviolet-C (UVC) devices, carry limitations and may not ensure consistent and comprehensive anti-microbial effects. To this end, a novel technology UVCeed, an advanced disinfection system integrating artificial intelligence (AI), augmented reality (AR), and gamification, offers a promising solution to improve infection control within the operating room (OR). This narrative review explores the application of UVCeed technology in surgical environments, with a special focus on orthopaedic surgery. The paper discusses the unique advantages of UVCeed to enhancing surface sterilization, mitigating airborne contaminants, and overall augmenting existing infection control protocols. By leveraging real-time feedback mechanisms and intelligent dose optimization, UVCeed serves as an advancement in the approach to perioperative surgical disinfection.

Introduction: A portable medical rehabilitation device with adaptive telemedicine technology provides an adjunct therapy following total knee arthroplasty (TKA). The physician-monitored internet-based interface allows for physician-directed or free use of the portable medical rehabilitation device by the patient. The purpose of this study was to characterize patients' satisfaction with its use, as well as its impact on perioperative range of motion (ROM).

Materials and methods: After institutional review board (IRB) approval, patients who used the portable rehab device postoperatively completed a 12-question survey that assessed use and satisfaction metrics at their six-week postoperative visit. Range of motion (ROM) at their six-week postoperative visit was analyzed against their survey responses. A total of 101 patients (42 men, 58 women, one preferred not to answer; 101 knees) were available for analysis, with a mean patient age of 68 years (range 48-84 years).

Results: Overall satisfaction was 93%, with 14.9% noted "helpful," 45.5% "strongly helpful," and 32.7% "very strongly helpful." Insurance covered the cost in 72%, while 23% paid for their device out of pocket with minimal impact, and 5% felt the out-of-pocket cost to be not worthy of the benefit. Nearly all (96%) of the patients stated they would recommend the device. Patients reported using their portable medical rehabilitation device for approximately two to three weeks (39.6%), two to three times per day (65.3%), and 11 to 15 minutes per session (69.3%). Older patients had lower usage than younger patients (p<0.001), and men trended toward higher usage than women (p=0.055). Mean six-week postoperative knee ROM was a 0-111° arc of motion. Change in ROM was not found to correlate with duration of use (p=0.385).

Conclusion: The portable medical device is an option for rehabilitation after TKA with high patient satisfaction and low-cost burden, while achieving an appropriate arc of motion by six weeks following TKA. Further comparative investigations will be needed to determine the optimal duration of use following TKA.

Introduction: The purpose of this article is to describe a standardized approach for creating a physician-modified endovascular graft (PMEG) based on the Zenith Flex® (Cook Medical Inc., Bloomington, Indiana) platform.

Technique: A sterile template is constructed based on computed tomography angiography (CTA) measurements. Once the Zenith Flex® bifurcated endograft is desheathed, the template is placed over the device and adjusted so that the planned fenestrations do not overlap with the struts. The fenestration locations are marked on the fabric of the endograft and created using high-temperature cautery. The distal part of a snare is obtained, braided around a modified angiometer with a diameter matching the fenestration, and secured around the corresponding fenestration with locking sutures. Diameter-reducing ties are added by first securing a suture loop at the 12 o'clock position of each Z-stent, then the trigger wire is repositioned to the outside of the endograft at the 6 o'clock position and threaded through each of the loops to constrain the Z-stents. The endograft is reloaded through the peel-away sheath and is ready for the procedure.

Conclusion: A PMEG with diameter-reducing ties and reinforced fenestrations can be constructed in a standardized fashion using the Zenith Flex® platform, providing an endovascular treatment option for complex abdominal aortic aneurysms when custom-made endografts are unavailable.

Clinical impact: Fenestrated endovascular aortic repair is an important treatment option for complex abdominal aortic aneurysms. However, custom-made fenestrated devices may not be available in all regions or medical centres, and their use is limited in urgent situations. Familiarity with constructing a physician-modified endovascular graft can provide patients with an endovascular treatment option in such situations. This step-by-step guide to constructing a physician-modified endovascular device based on the Zenith Flex® platform can help surgeons create a bespoke fenestrated device with diameter-reducing ties and reinforced fenestrations in a standardized fashion within a matter of hours.

Introduction: A surgeon performing kinematically aligned total knee arthroplasty (KA TKA) through a mid-vastus approach can use an insert goniometer to select the optimal insert thickness. The insert goniometer provides the value of soft-tissue-driven tibial internal rotation during passive knee flexion. This study tested whether the insert goniometer can identify one insert thickness that maximizes tibial rotation while restoring full knee extension during KA TKA performed through a medial parapatellar approach.

Materials and methods: One surgeon trialed goniometer inserts from a 10 to 14mm thickness with a medial ball-in-socket and flat lateral articular conformity in 33 patients treated with unrestricted caliper-verified KA, PCL retention, and a medial parapatellar approach. The medial insert had markings that measured tibial orientation relative to a sagittal line on the femoral trial component at full extension and 90° flexion (+ external/ - internal). The difference of tibial external orientation in extension and tibial internal orientation at 90° flexion computed tibial internal rotation.

Results: Of the 33 TKAs, a 10mm (N =13) or 14mm thick (N =2) insert maximized tibial internal rotation. In these TKAs, a 1mm thinner or thicker liner was not trialed, respectively. The remaining liner thicknesses maximizing tibial rotation were 11mm in 12 TKAs, 12mm in four TKAs, and 13mm in two TKAs. Mean ± SD maximal tibial rotation was 17 ± 4.1°, which was 4° more than with a 1mm thinner (13 ± 5°) and 1mm thicker (13 ± 5.3°) insert (p<0.001).

Conclusions: Surgeons performing KA TKA through a medial parapatellar approach can utilize the insert goniometer to select the insert thickness that maximizes tibial rotation. Maximizing tibial rotation with a medial ball-in-socket and lateral flat insert conformity restores physiologic knee kinematics and dynamically stabilizes the patella.

Introduction: Chronic wounds, burns, and traumatic injuries present significant clinical challenges due to infection risks, delayed healing, and complications such as scarring. Advanced wound care has evolved with the development of skin substitutes, categorized into biologic and synthetic matrices. Synthetic skin substitutes have gained popularity due to their reduced risk of disease transmission, cost-effectiveness, and ability to enhance wound healing through structural support and bacterial biocidal properties.

Materials and methods: This review uses the Centers for Medicare and Medicaid to identify unique synthetic skin substitutes. Each company was contacted to obtain details about their respective products, including their composition, mechanisms of action, clinical applications, and advantages. Studies, case reports, and clinical trials from the PubMed database, Google Scholar, and ClinicalTrials.gov were also assessed to compare the effectiveness of these products in managing acute, chronic, and complex wounds.

Results: The review found that synthetic skin substitutes offer several key advantages in managing chronic and complex wounds. These substitutes enhance wound healing by promoting cell migration, granulation tissue formation, and angiogenesis. They are also associated with improved cosmetic outcomes, reduced infection risks, and quicker wound closure. Many of the products reviewed demonstrated significant improvements in healing rates, with some showing faster recovery than traditional treatments. Additionally, the synthetic materials reduced the need for frequent dressing changes and minimized discomfort for patients. Overall, the results indicate that synthetic skin substitutes effectively improve wound care outcomes across various wound types.

Conclusion: While synthetic skin substitutes offer promising outcomes in wound management, limitations such as high initial costs and the need for further research persist. Nonetheless, their ability to reduce infection risks, accelerate healing, and improve patient comfort makes them a valuable alternative to traditional biologic substitutes. Future studies should focus on long-term cost-effectiveness and broader clinical applications to validate their widespread use.