scholarly journals The Impact of Workflow on Cutting Time for Partial Knee Arthroplasty

10.29007/xj7f ◽  
2019 ◽  
Author(s):  
Emily Hampp ◽  
Laura Scholl ◽  
Md Haque ◽  
Chunyan Wu ◽  
Geoffrey Westrich ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Clinical Setting ◽  
Pairwise Comparison ◽  
Bone Resection ◽  
Robotic Assisted ◽  
Trigger Time ◽  
Partial Knee Arthroplasty ◽  
Time Required ◽  
The Impact ◽  
Cutting System

To date, there are no studies aimed at characterizing the active cutting time for a robotic-assisted PKA procedure and the impact of workflow. This study quantified the active cutting time for three medial PKA workflows using the same robotic-assisted system.Three surgeons each prepared six cadaveric knees for PKA with robotic-assisted technology using one of three workflows: A) burr-only, using a legacy cutting system and burr design; B) burr-only, using a new cutting system and burr design; or C) planar, using a new cutting system, burr design and saw. For a burr-only workflow, the femur and tibia were prepared with a burr. For a planar workflow, the femur and tibia were prepared with a burr and saw. The total mean trigger time to complete all femoral or tibial bony resections was measured and statistically compared between workflows using ANOVA and Tukey Pairwise Comparison.There was statistically significant less time required to prepare the femur and tibia in B and C, compared to A (p≤0.05). Less time was required in C than B, but this was not statistically significant (p>0.05). Workflow A took an average of 429±104 seconds (range, 314 to 529 seconds), B took an average of 302±40 seconds (range, 244 to 363 seconds), and C took an average of 236±50 seconds (range, 196 to 332 seconds).The new burr design, when used with both burr-only and planar workflows, has the potential to be more efficient (30 and 45% faster, respectively) compared to the legacy burr using the burr-only workflow, for a medial PKA. Bone resection time should be investigated in a clinical setting.

scholarly journals HURWA Robotic-Assisted TKA System is Suitable for a Variety of Prosthesis Types

2021 ◽  
Author(s):  
Xingye Li ◽  
Zheng Li ◽  
Xiaofeng Zhang ◽  
Lele Ding ◽  
Jun Yan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Relief ◽  
Knee Arthroplasty ◽  
Joint Replacement ◽  
Life Quality ◽  
Bone Resection ◽  
Surgical Interventions ◽  
Robotic Assisted ◽  
Total Knee ◽  
Preoperative Plan

Abstract Background Total knee arthroplasty (TKA) is an effective and also mature surgical interventions that improves life quality and provides pain relief. Accurate bone cuts are important to prevent TKA malalignment and it requires cautious preoperative plan and precise bone resection. Recently, robotic-assisted TKA techniques have been used to improve the accuracy of bone resection and implantation. However, the system described above suits for only one prosthesis type. Methods Five types (MicroPort_CS, Smith& Nephew_GII, Johnson&Johnson_PFC_PS, kingnow _VLQX_PS and Akmedical_A3GT_PS) implants were included in our study and three Sawbones models were used for each implant. Procedures were performed by experienced joint replacement surgeons using HURWA robotic-assisted TKA system. Results our study indicated that the bone resection error of HURWA robotic-assisted system was below 0.5 mm (with SDs below 0.3 mm), and all of the bone resection angles were below 0.5° (with SDs below 0.3°). The bone resection angles and levels deviation of different brand prosthesis types were below 0.5 mm (with SDs below 0.3 mm) and below 0.5° (with SDs below 0.3°) respectively. Conclusion It suggested that our system may be suitable for different prosthesis types.

scholarly journals Are Early Results of Robotic Assisted Medial Unicompartmental Knee Arthroplasty Successful?

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0013
Author(s):  
Uğur Haklar ◽  
Ertuğrul Ulusoy ◽  
Tayfun Şimşek ◽  
Nuray Terzi
Keyword(s):  
Knee Arthroplasty ◽  
Scoring System ◽  
Sagittal Plane ◽  
Radiographic Evaluation ◽  
Robotic Assisted ◽  
Partial Knee Arthroplasty ◽  
Early Results ◽  
Significant Difference ◽  
Medial Unicompartmental Knee Arthroplasty ◽  
Anatomic Axis

Objectives: Robotic surgery studies have been increasing in literature in the past years due to its operative advantages on reducing error and improving functional success in partial knee arthroplasty. Methods: Data were prospectively collected in 21 patients (31 knees) who underwent MAKOplasty, robotic assisted unicondylar medial knee arthroplasty, between June 2013 – January 2014 in our clinic with an average follow-up time of 5.5 months. Clinical outcomes were evaluated with American Knee Society Scoring System. Additionally, intra-operative digitally planned implant positions on the robot’s software were compared with post-operative radiographic component alignment. In the radiographic evaluation; anatomic axis of the tibia was observed in the coronal plane. Tibial posterior slope and flexion angle of the femoral component were observed in the sagittal plane. Results: Pre-operatively 1 patient was scored fair (60 points) and 20 patients were scored poor (mean, 46.6 points) on American Knee Society Scoring System. Post-operatively all 21 patients had excellent knee scores (mean, 99.67 points). Function-wise 7 patients were scored fair (mean, 60 points) and 14 patients were scored poor (mean, 30.7 points) again on American Knee Society Functional Scoring System. Post-operatively all 21 patients exhibited excellent function scores (mean, 99.04 points). In the radiological evaluation, intra-operative robotic analyses were compared with post-operative radiographic alignment. No significant difference was observed statistically (paired t-test, p < 0.05). This comparison is valuable as Lonner, Hernigou, Collier report that mal-alignment by as little as 2° may predispose to implant failures. Conclusion: Robotic assistance greatly improves clinical and functional outcomes and may help prevent implant failures due to surgical error and mal-alignment in partial knee arthroplasty.

scholarly journals ‘You see the empty bed which means it’s either a transplant or a death’: a qualitative study exploring the impact of death in the haemodialysis community

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046537
Author(s):  
Sheera Sutherland ◽  
Kirsty E Durley ◽  
Kirsty Gillies ◽  
Margaret Glogowska ◽  
Daniel S Lasserson ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Clinical Setting ◽  
Support Services ◽  
Research Team ◽  
Central Importance ◽  
Semistructured Interviews ◽  
Age Range ◽  
The Impact ◽  
Community Patients

ObjectiveTo explore the impact of the death of a patient in the haemodialysis unit on fellow patients.MethodsWe interviewed patients on dialysis in a tertiary dialysis centre using semistructured interviews. We purposively sampled patients who had experienced the death of a fellow patient. After interviews were transcribed, they were thematically analysed by independent members of the research team using inductive analysis. Input from the team during analysis ensured the rigour and quality of the findings.Results10 participants completed the interviews (6 females and 4 males with an age range of 42–88 years). The four core themes that emerged from the interviews included: (1) patients’ relationship to haemodialysis, (2) how patients define the haemodialysis community, (3) patients’ views on death and bereavement and (4) patients’ expectations around death in the dialysis community. Patients noticed avoidance behaviour by staff in relation to discussing death in the unit and would prefer a culture of open acknowledgement.ConclusionStaff acknowledgement of death is of central importance to patients on haemodialysis who feel that the staff are part of their community. This should guide the development of appropriate bereavement support services and a framework that promotes the provision of guidance for staff and patients in this unique clinical setting. However, the authors acknowledge the homogenous sample recruited in a single setting may limit the transferability of the study. Further work is needed to understand diverse patient and nurse experiences and perceptions when sharing the knowledge of a patient’s death and how they react to loss.

scholarly journals Room Size Influences Flow in Robotic-Assisted Surgery

2021 ◽  
Vol 18 (15) ◽  
pp. 7984
Author(s):  
Falisha Kanji ◽  
Tara Cohen ◽  
Myrtede Alfred ◽  
Ashley Caron ◽  
Samuel Lawton ◽  
...  
Keyword(s):  
New Technology ◽  
Surgical Robots ◽  
Physical Size ◽  
Robotic Assisted ◽  
Surgical Technology ◽  
Room Size ◽  
Robotic Assisted Surgery ◽  
Academic Hospitals ◽  
Environmental Causes ◽  
The Impact

The introduction of surgical technology into existing operating rooms (ORs) can place novel demands on staff and infrastructure. Despite the substantial physical size of the devices in robotic-assisted surgery (RAS), the workspace implications are rarely considered. This study aimed to explore the impact of OR size on the environmental causes of surgical flow disruptions (FDs) occurring during RAS. Fifty-six RAS procedures were observed at two academic hospitals between July 2019 and January 2021 across general, urologic, and gynecologic surgical specialties. A multiple regression analysis demonstrated significant effects of room size in the pre-docking phase (t = 2.170, df = 54, β = 0.017, p = 0.035) where the rate of FDs increased as room size increased, and docking phase (t = −2.488, df = 54, β = −0.017, p = 0.016) where the rate of FDs increased as room size decreased. Significant effects of site (pre-docking phase: p = 0.000 and docking phase: p = 0.000) were also demonstrated. Findings from this study demonstrate hitherto unrecognized spatial challenges involved with introducing surgical robots into the operating domain. While new technology may provide benefits towards patient safety, it is important to consider the needs of the technology prior to integration.

scholarly journals Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
K Giesinger ◽  
JM Giesinger ◽  
DF Hamilton ◽  
J Rechsteiner ◽  
A Ladurner
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Pain Relief ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Normal Weight ◽  
World Health ◽  
Obese Patients ◽  
Total Knee ◽  
The Impact

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

A cautionary case: osteoporotic femur fracture after robotic-assisted total knee arthroplasty

2021 ◽  
Author(s):  
H. E. Skibicki ◽  
D. Y. Ponzio ◽  
J. A. Brustein ◽  
Z. D. Post ◽  
A. C. Ong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femur Fracture ◽  
Robotic Assisted ◽  
Total Knee

scholarly journals Exoplanet mass estimation for a sample of targets for the Ariel mission

2021 ◽  
Author(s):  
J. R. Barnes ◽  
C. A. Haswell
Keyword(s):  
Radial Velocity ◽  
Input Parameter ◽  
Noise Sources ◽  
Time Commitment ◽  
Low Mass ◽  
Time Required ◽  
Fixed Input ◽  
The Impact ◽  
Quadrature Sampling

AbstractAriel’s ambitious goal to survey a quarter of known exoplanets will transform our knowledge of planetary atmospheres. Masses measured directly with the radial velocity technique are essential for well determined planetary bulk properties. Radial velocity masses will provide important checks of masses derived from atmospheric fits or alternatively can be treated as a fixed input parameter to reduce possible degeneracies in atmospheric retrievals. We quantify the impact of stellar activity on planet mass recovery for the Ariel mission sample using Sun-like spot models scaled for active stars combined with other noise sources. Planets with necessarily well-determined ephemerides will be selected for characterisation with Ariel. With this prior requirement, we simulate the derived planet mass precision as a function of the number of observations for a prospective sample of Ariel targets. We find that quadrature sampling can significantly reduce the time commitment required for follow-up RVs, and is most effective when the planetary RV signature is larger than the RV noise. For a typical radial velocity instrument operating on a 4 m class telescope and achieving 1 m s−1 precision, between ~17% and ~ 37% of the time commitment is spent on the 7% of planets with mass Mp < 10 M⊕. In many low activity cases, the time required is limited by asteroseismic and photon noise. For low mass or faint systems, we can recover masses with the same precision up to ~3 times more quickly with an instrumental precision of ~10 cm s−1.

Impact of Weight-Band Dosing of Tinzaparin for Venous Thromboembolism Prophylaxis on Persistent Wound Drainage in Adult Patients Undergoing Hip and Knee Arthroplasty

2021 ◽  
pp. 106002802110242
Author(s):  
Cassandra Cooper ◽  
Ouida Antle ◽  
Jennifer Lowerison ◽  
Deonne Dersch-Mills ◽  
Ashley Kenny
Keyword(s):  
Body Weight ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Thromboembolism Prophylaxis ◽  
Wound Drainage ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Background: Persistent wound drainage and venous thromboembolism (VTE) are potential complications of total joint arthroplasty, and these risks can be challenging to balance in clinical practice. Anecdotal observation has suggested that following joint arthroplasty, persistent wound drainage occurs more frequently with higher body weight and higher doses of tinzaparin when compared with lower body weight and lower doses of tinzaparin. Objective: The overall purpose of this study was to describe the impact of a tinzaparin weight-band dosing table for VTE prophylaxis on wound healing, thrombosis, and bleeding outcomes in patients undergoing total joint arthroplasty. Methods: This retrospective chart review included patients who underwent total hip or knee arthroplasty and received tinzaparin for thromboprophylaxis per their weight-banding category. The primary outcome was the incidence of persistent wound drainage. Secondary outcomes include the occurrence of VTE and clinically important bleeding during hospital admission. Results: A total of 231 patients were included in the analysis. There was no significant difference in persistent wound drainage between the 3 weight categories, and there were no differences in rates of VTE or clinically important bleeding. Concurrent use of low-dose acetylsalicylic acid was associated with a 3-fold increased risk of persistent wound drainage (risk ratio = 3.35; 95% CI = 2.14-5.24; P = 0.00003). Conclusion and Relevance: In joint arthroplasty patients, we observed no significant difference in rates of persistent wound drainage between various weight categories receiving different weight-banded doses of tinzaparin. Our results do not suggest that the current weight-band dosing table for tinzaparin needs to be adjusted to optimize patient outcomes.

The Impact of Gastric Bypass Surgery Compared to Total Knee Arthroplasty on Knee Symptoms

2018 ◽  
Vol 04 (02) ◽  
Author(s):  
Hafiz Kassam ◽  
Allan Okrainec ◽  
Timothy Jackson ◽  
Michael G Zyweil ◽  
Anthony V Perruccio ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Gastric Bypass ◽  
Knee Arthroplasty ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Total Knee ◽  
The Impact
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