SICOT-J最新文献

Purpose: This study aimed to evaluate the impact of Robotic-Assisted Total Hip Arthroplasty (RATHA) versus Conventional Total Hip Arthroplasty (CTHA) on perioperative blood loss and blood transfusion requirements in patients with hip arthritis.

Methods: This was a prospective cohort study, conducted at a high-volume tertiary care center from January 2021 to January 2023. Two hundred patients undergoing primary THA, were equally divided between RATHA (using the MAKO SmartRobotics system) and CTHA cohorts. Primary outcomes measured were perioperative hemoglobin changes, estimated blood loss (EBL), and transfusion rates. Secondary outcomes included operative times, hospital stays, and transfusion-related adverse events.

Results: The mean pre-operative hemoglobin levels were comparable between the cohorts. However, the RATHA group demonstrated significantly lower post-operative day 1 hemoglobin drops, reduced EBL (1212.7 mL vs. 1565.24 mL in CTHA; p < 0.0001), and fewer transfusions (7 vs. 29 in CTHA; p < 0.0001). Operative times were shorter in the RATHA group (68.01 min vs. 77.1 min in CTHA; p < 0.0001). All robotic cohort patients were discharged within 3 days, while 14% (N = 7) of the CTHA group required extended hospital stay.

Conclusion: This study demonstrates that RATHA significantly reduces perioperative blood loss, hemoglobin drop, and blood transfusion rates compared to CTHA. The observed decrease in operative time and hospital stay in the RATHA group further suggests that robotic assistance may enhance procedural efficiency and support faster patient recovery.

Background: Peri-megaprosthetic joint infections (PJI) in tumor surgery are complex and challenging complications that significantly impact the outcomes of the patients. The occurrence of PJI poses a substantial threat to the success of these operations. This review aims to identify and summarize the risk factors associated with PJI in tumor surgery with megaprosthetic reconstruction as well as to determine the overall risk of PJI in limb salvage surgery.

Methods: A thorough examination of published literature, scrutinizing the incidence of PJI in tumor prostheses after limb salvage surgery was done. Research studies that documented the incidence of PJI in tumor patients who underwent limb salvage surgery, and explored the risk factors associated with the occurrence of PJI were deemed eligible.

Results: A total of 15 studies were included in the analysis and underwent comprehensive examination. After the exploration of key parameters, several significant risk factors for PJI concerning the type of implant coating, surgical site characteristics, patient demographics, and procedural factors were recorded.

Discussion: The findings underscore the need for a nuanced approach in managing tumor patients undergoing limb salvage surgery and megaprosthetic reconstruction, with emphasis on individualized risk assessments and individualized preventive strategies.

Introduction: Mesenchymal chondrosarcoma (MCS) is a malignant, biphasic, high-grade, primitive mesenchymal tumor that has a well-differentiated, organized hyaline component. MCS has a poor prognosis, and treatment recommended for localized MCS is based on wide resection while controversy remains regarding the efficacy of adjuvant chemotherapy and radiotherapy. In this study, we aimed to investigate the prognostic factors of MCS, especially the efficacy of adjuvant chemotherapy and radiotherapy for localized MCS.

Methods: Eighty patients with MCS pathologically diagnosed between 2006 and 2022 from the Japanese National Bone and Soft Tissue Tumor Registry database were analyzed retrospectively.

Results: Patients with distant metastases at presentation (n = 23) had significantly shorter survival than those without (n = 57) (5-year disease-specific survival 19.9% [95% confidence interval (CI): 5.6-50.7] vs. 79.8% [95% CI: 62.4-90.4]; p < 0.0001). In the group without distant metastasis at presentation (n = 57), R1 or R2 surgical margin was a risk factor for unfavorable local recurrence (hazard ratio (HR): 17.44 [95% CI: 2.17-139.98]; p = 0.007). There was no correlation between adjuvant radiotherapy and local recurrence rate (HR 5.18 [95% CI: 0.99-27.12]; p = 0.051). R1 or R2 surgical margin was a risk factor for unfavorable disease-specific survival (HR 17.42 [95% CI: 2.18-138.90]; p = 0.007). There was no correlation between adjuvant chemotherapy and disease-specific survival (HR 0.99 [95% CI: 0.28-3.47]; p = 0.990).

Discussion: Patients with MCS and distant metastases at presentation have a poor prognosis, and wide resection is important for the treatment of localized MCS. The efficacy of adjuvant radiotherapy and chemotherapy could not be determined because of the small number of patients.

Introduction: Robot-assisted instrumentation during total hip arthroplasty (THA) has the potential to improve acetabular cup positioning. This study aimed to evaluate the precision of robotic-arm-assisted THA (rTHA) and assess whether the system can provide accurate cup positioning comparable to conventional THA (cTHA).

Methods: A single-center prospective cohort study consisting of 151 patients who underwent THA (108 rTHA and 43 cTHA). The robotically assisted system was used to match the postoperative computed tomography (CT) image of the pelvis with the planned and intraoperative anatomical landmarks. The cTHA cohort underwent hip replacement using the standard manual procedure, with acetabular component locations assessed during and after surgery.

Results: The rTHA cohort was significantly younger, but no other significant differences were found between the two cohorts in preoperative baseline data. In rTHA cohort, the planned inclination (40.0 ± 0.3°) closely matched the intraoperative (40.2 ± 2.7°; p = 0.54) and postoperative (40.7 ± 4.0°; p = 0.07) measurements. However, anteversion showed a significant increase from planned (19.4 ± 1.5°) to postoperative CT scan (28.7 ± 7.0°; p < 0.001). There was evidence of proportional bias in the measurements (p < 0.001). In the cTHA cohort, the mean inclination (43.1 ± 5.1°) did not show any significant change between the preoperative plans and postoperative assessments (p = 0.12); however, there was a remarkable change in the mean anteversion (17.6 ± 6.4°) between postoperative measurements and the preoperative plans (p < 0.001). The average anteversion in the preoperative plans did not differ remarkably between the rTHA and cTHA cohorts. However, the average inclination was substantially different between the two cohorts (p < 0.001). Both groups had no significant differences in the proportion of cups outside the referenced safe zones.

Conclusion: The results suggest that while robotic-assisted guidance ensures consistent cup inclination, there may be more variability in achieving the planned anteversion, which warrants further investigation into the factors influencing postoperative changes in acetabular orientation.

Background: Total knee arthroplasty (TKA) for patients with a large preoperative deformity (more than 10° varus or valgus) remains a challenge leading to a high rate of outliers, unsatisfactory functional results, or early prosthetic loosening. Robotic arm-assisted TKA (RATKA) has shown improvements in implant positioning accuracy. This study aimed to assess RATKA implant positioning accuracy and functional results at one year postoperative for patients with a large preoperative deformity.

Methods: From November 2019 to July 2022, 500 RATKA were performed. About 74 patients with more than 10° of varus or valgus global deformity were included. Each patient received a semi-constrained implant. The difference between the valgus or varus value planned intra-operatively and the varus or valgus measured on one-year postoperative X-rays has been assessed. Functional outcomes (VAS, range of motion, KOOS) have also been evaluated.

Results: For varus, the mean difference was 0.54 ± 1.21°, all patients (100%) had a difference of less than 3° at one-year post-operative. For valgus, the mean difference was 0.63 ± 1.29°, most patients (92%) had a difference of less than 3° at one year postoperative. Overall, 98.6% (n = 73) of cases had a difference of less than 3° at one-year postoperative. The mean VAS was 1.6 ± 1.4 [1;4]. Mean flexion was 132 ± 7.6° [100;145]. A total of 69 patients (93%) had a good or excellent KOOS score (KOOS total > 70) at one year post-operative.

Conclusion: For large preoperative deformities, RATKA provides a high degree of accuracy in implant positioning, permitting it to fit the desired alignment without compromising knee stability, and giving the possibility of using semi-constrained implants. At one year postoperative, functional results are encouraging and most patients have recovered an optimal range of motions.

Introduction: The COVID-19 pandemic has significantly affected access to timely care for patients with hip osteoarthritis requiring total hip replacement (THR). This study aimed to assess the changes in surgical activity, outpatient treatment, length of stay (LOS), discharge destinations, readmission rates, clinical outcomes, and patient satisfaction before and after the pandemic at our institution.

Materials and methods: This retrospective study encompassed patients undergoing primary THR through the direct anterior approach at a single university hospital. Data on demographic characteristics, surgical technique, perioperative management, LOS, discharge destinations, complications, and clinical outcomes were collected. Furthermore, a comparative analysis between the pre-pandemic (2019) and post-pandemic (2022) periods was conducted.

Results: There was a 14% increase in surgical activity post-pandemic, with 214 patients undergoing surgery in 2019 versus 284 in 2022. The percentage of patients managed as outpatients significantly increased from 0.5% in 2019 to 29.6% in 2022 (p < 0.001). LOS decreased from 2.7 ± 1 [0-8] days to 1.4 ± 1.1 [0-12] days (p < 0.001), and the rate of discharge to rehabilitation centres declined from 21.5% to 8.8% (p < 0.001). No significant increase in the readmission rates was observed (1.4% in both periods). At two months postoperatively, the mean HHS and satisfaction rates were comparable between the two groups (p = 1 and p = 0.73, respectively).

Discussion: Despite the challenges posed by the COVID-19 pandemic, surgical activity at our institution demonstrated an increase compared to the pre-pandemic levels by expanding outpatient care, reducing LOS, and increasing rates of home discharges. Importantly, these changes did not adversely affect rehospitalization rates or early clinical outcomes.

Level of evidence: IV.

Introduction: There is controversy about the management of unicompartmental knee osteoarthritis (OA) in young, active patients with anterior cruciate ligament (ACL) insufficiency. This study compares the subjective, radiological, and functional results of total knee replacement (TKR) vs. combined medial unicompartmental knee replacement (UKR) with ACL reconstruction.

Method: Twelve patients suffering from medial OA and ACL deficiency with varus knee deformity and/or tibial slope <10° and absence of patellofemoral-related problems were eligible for combined UKR and ACL reconstruction (Group A). Twenty-six patients matched for age, male/female ratio and body mass index who received TKR in the same time frame were included as a control group (Group B). Oxford Knee Score (OKS), WOMAC index of osteoarthritis, Knee Osteoarthritis Outcome Score (KOOS), and routine X-rays were used for assessment.

Results: Ten years after surgery, the mean overall KOOS score, OKS, WOMAC index increased from preoperatively, showing a statistically significant difference (p < 0.001). In terms of KOOS, OKS, or WOMAC scores at the most recent follow-up, there was no discernible difference between the groups (p = n.s.). Three years following surgery, one female patient in group A received revision TKR due to the lateral compartment's osteoarthritis developing and the patient's pain persisting. Concerning radiographic assessment, at the most recent follow-up (average 7.9 years in group A and 8.8 years in group B), there were no radiographic indications of implant loosening or proof of pathologic radiolucent lines.

Conclusions: UKR combined with ACL restoration offers clinical and radiographic outcomes comparable to TKR 10 years following surgery with no elevated risk of complications.

Introduction: To prevent infection after limb-sparing surgery for primary malignant bone tumors, it is important to cover the megaprosthesis with muscle tissue that has sufficient blood flow. Coverage with a lateral gastrocnemius flap has been reported in cases of distal femoral replacement in which the vastus lateralis and vastus intermedius muscles have been resected; however, the risk of peroneal nerve palsy is reportedly high because the muscle flap passes near the peroneal head. This study was performed to examine the postoperative outcomes of patients with primary malignant bone tumors of the distal femur who underwent wide resection (including the vastus lateralis and vastus intermedius muscles) followed by reconstruction with a megaprosthesis and coverage of the lateral side of the prosthesis with a sartorius muscle flap.

Methods: We retrospectively analyzed three patients who underwent reconstruction with a megaprosthesis after wide resection of a primary malignant bone tumor of the distal femur involving the vastus lateralis and vastus intermedius muscles and reconstruction of the soft tissue defect on the lateral side of the prosthesis with a sartorius muscle flap.

Results: The average defect size was 6 × 13 cm, the average time required for a sartorius muscle flap was 100 min, and the average implant coverage was 93%. The average postoperative follow-up period was 35 months, during which no postoperative complications such as infection, skin necrosis, or nerve palsy occurred.

Discussion: The distally based sartorius muscle flap is easy to elevate in the supine position, has minimal functional loss after harvesting, and has minimal risk of nerve palsy. It can be advocated as the first option for coverage of soft tissue defects lateral to distal femoral replacement.

Introduction: This systematic review aims to critically assess the literature comparative studies investigating collared and collarless Corail stem in primary total hip arthroplasty (THA) to find differences in revision rates, radiographic and clinical outcomes, and postoperative complications between these two types of the same stem.

Methods: Eligible studies were found by searching PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews from conception till May 2023. The PRISMA guidelines were followed. The investigation encompassed randomized controlled trials, case series, comparative, cohort, and observational studies that assessed at least one comparative outcome or complication between collared and collarless Corail stems.

Results: Twelve comparative studies with 90,626 patients undergoing primary THA were included. There were 40,441 collared and 58,543 collarless stems. The follow-up ranged from 12 to 360 months. Our study demonstrated no significant difference in stem revision relative risk (RR = 0.68; 95% confidence interval (CI), 0.23, 2.02; p = 0.49), number of radiolucent lines (RR = 0.3; 95% CI, 0.06, 2.28; p = 0.29) and overall complication risk (RR = 0.62; 95% CI, 0.22, 1.76; p = 0.37) between collared and collarless stems. The collared stems demonstrated significantly lesser subsidence (mean difference: 1.01 mm; 95% CI, -1.77, -0.25; p = 0.009) and risk of periprosthetic fractures (RR = 0.52; 95% CI, 0.29, 0.92; p = 0.03).

Conclusion: The comparative studies between collared and collarless stem groups showed similar survival and overall complication rates and functional outcomes. The similar revision rates between groups make the impact of higher subsidence for collarless stems uncertain. The lower risk of periprosthetic fractures in the collared stems group must be clarified further but could be related to increased rotational stability.

Introduction: This study aimed to systematically review the literature and identify the surgical management strategy for fixed flexion contracture in primary total knee arthroplasty (TKA) surgery, pre-, intra-, and post-operatively. Secondary endpoints were etiologies and factors favoring flexion contracture.

Materials and methods: Searches were carried out in November 2023 in several databases (Pubmed, Scopus, Cochrane, and Google Scholar) using the following keywords: "flexion contracture AND TKA", "fixed flexion deformity AND TKA", "posterior capsular release AND TKA", "posterior capsulotomy in TKA", "distal femoral resection AND TKA". Study quality was assessed using the STROBE checklist and the Downs and Black score. Data concerning factors or strategies leading to the development or prevention of flexion contracture after TKA were extracted from the text, figures, and tables of the included references. The effect of each predictive factor on flexion contracture after TKA was recorded.

Results: Thirty-one studies were identified to meet the inclusion and exclusion criteria. These studies described a variety of preoperative and intraoperative factors that contribute to the development or correction of postoperative flexion contracture. The only clearly identified predictor of postoperative flexion contracture was preoperative flexion contracture. Intraoperative steps described to correct flexion contracture were: soft-tissue balancing (in posterior and medial compartments), distal femoral resection, flexion of the femoral component, and posterior condylar resection. However, no study has investigated these factors in a global model.

Discussion: This review identified various pre-, intra-, and post-operative factors predictive of post-operative flexion contracture. In practice, these factors are likely to interact, and it is therefore crucial to further investigate them in a comprehensive model to develop an algorithm for the management of flexion contracture.

Level of evidence: IV.