Surgical technology international最新文献

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.

Introduction: The results of cementless robotic-assisted total knee arthroplasty (RA-TKA) have not been evaluated in obese patient populations. The purpose of this study was to evaluate the rates of aseptic loosening, patient-reported outcomes, and surgical complications of cementless RA-TKA cases in obese and nonobese patient cohorts.

Materials and methods: A retrospective review between 2018 to 2021 of a single-surgeon series was conducted, producing 1,546 patients. Patients were categorized as either obese (body mass index [BMI] <35) or nonobese (BMI <35), generating 472 and 1,092 patients, respectively. The average BMI was 40.5 (range, 35.0 to 64.1) in the obese group and 28.6 (range, 16.5 to 34.9) in the nonobese group. The primary outcome was the rate of aseptic loosening. Secondary outcomes included patient-reported outcomes, comprising Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement (KOOS JR) scores, and the reduced Western Ontario and McMaster Universities Arthritis Index (r-WOMAC) scores. Charts were reviewed to establish rates of postoperative surgical complications. Significance tests were conducted using either t-tests or Chi-squared independence tests, and a p-value of <0.05 was considered significant.

Results: There were no cases of aseptic loosening in the obese or nonobese cohorts, making survivorship 100% for both. While preoperative KOOS JR and r-WOMAC scores were significantly worse in the obese group, they were not statistically significant at either six-week or 12-month timepoints. The obese cohort had statistically greater improvements in r-WOMAC total scores at six weeks and 12 months; they also had statistically significant superior improvement in KOOS JR at 12 months. There were no statistically significant differences in postoperative surgical-related complications.

Conclusion: We demonstrated that rates of aseptic loosening and patient-reported outcomes in obese patients undergoing RA-TKA are excellent, and patient-reported outcomes demonstrated superior improvement in the obese cohort compared to those in the non-obese cohort.

There were 63 outpatient medial unicompartmental knee arthroplasties (UKAs) performed by Mako robotic assistance by six surgeons. There were 40 men and 23 women who had a mean age of 65.1 years (range, 38 to 80). Their mean body mass index (BMI) was 29.6 (range 21.8 to 39.2), and 28 patients had a BMI over 35. Overall, patient perceptions of the procedure were excellent (mean 9.2 rating of 10), which was not different by sex or body mass index. There were no 30-day complications or readmissions. At one year, there was one case revised for maltracking, resulting in a revision rate of 1.6% (1 out of 63 patients) with no cases of aseptic loosening. There were two other patients that had minor procedures (nerve ablation and removal of a loose body). The results of this prospective study confirm that outpatient robotic-arm assisted medial UKA is safe and feasible with a positive patient perspective of the procedure.

Chronic wounds are notoriously challenging to heal as they are often halted in their normal healing process. The concept of TIME (Tissue, Inflammation/Infection, Moisture imbalance, Epithelial edge advancement) has been widely utilized in clinical practice to prepare wound beds and promote healing, particularly in longstanding wounds. Traditional methods of wound bed preparation are often inadequate in healing chronic wounds or they may not be tolerated by patients. A variety of interventions have been developed in recent decades to address these components and improve chronic wound outcomes. Evolutions in tissue preparation include emerging enzymatic debridement agents and ultrasound-assisted debridement. Wound infection can be managed through a variety of new methods including advanced wound dressings, surfactants, and fluorescence imaging. Portable negative pressure wound therapy devices provide a new, convenient method for exudate management. Finally, epithelial advancement can be enhanced with technologies such as cellular, acellular, and matrix-like products (CAMPs), topical medications, and electrical stimulation.