Robot‐assisted total hip arthroplasty: Clinical outcomes and complication rate The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint Subacute pain and function after fast‐track hip and knee arthroplasty Groningen orthopaedic exit strategy: Validation of a support program after total hip or knee arthroplasty. Small Increase of Actual Physical Activity 6 Months After Total Hip or Knee Arthroplasty Effects of Tourniquet Use on Quadriceps Function and Pain in Total Knee Arthroplasty Functional capacity and actual daily activity do not contribute to patient satisfaction after total knee arthroplasty Total knee arthroplasty with an oxidised zirconium femoral component: ten-year survivorship analysis. Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach Emerging Ideas: Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study. Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study Continuous spinal anaesthesia or continuous epidural anaesthesia for post-operative pain control after hip replacement? Comparison of robot-assisted and conventional total knee arthroplasty: A controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of alignment Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. The John Insall Award: No Functional Benefit After Unicompartmental Knee Arthroplasty Performed With Patient-specific Instrumentation: A Randomized Trial Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. Laparoscopic Compared With Robotic Sacrocolpopexy for Vaginal Prolapse: A Randomized Controlled Trial
BACKGROUND The purpose of this study was to report minimum 2-year outcomes and complications for robotic-arm-assisted total hip arthroplasty ( THA )  . METHODS Data were prospect ively collected and retrospectively review ed between June 2011 and April 2014 . Inclusion criteria were primary robotic-arm-assisted THAs treating idiopathic osteoarthritis with ≥ 2-year follow-up .  Demographics , operating time , complications , 2-year outcome scores and satisfaction , and subsequent surgeries were recorded . RESULTS There were 181 cases eligible for inclusion , of which 162 ( 89.5 % ) had minimum 2-year follow-up . At the latest follow-up , the mean visual analogue scale was 0.7 , satisfaction was 9.3 , Harris hip score was 91.1 and forgotten joint score was 83.1 . Six ( 3.7 % ) intraoperative complications and six ( 3.7 % ) postoperative complications were reported . No leg length discrepancies ( LLDs ) or dislocations were reported . CONCLUSIONS Robotic-arm-assisted THA demonstrates favourable short-term outcomes and does not result in a higher complication rate compared to non-robotic THA as reported by the literature OBJECTIVE To evaluate the relationship between patient expectations of  total joint arthroplasty ( TJA ) and health related quality of life plus satisfaction 6 months after surgery . Methods . This prospect i ve cohort study included patients undergoing primary total hip ( THA ) and knee arthroplasty ( TKA ) .  Patients were evaluated with  self-report question naires prior to surgery and 6 months post-surgery . Medical Outcomes Study Short Form 36 ( SF-36 ) , the Western Ontario McMaster Universities Osteoarthritis Index ( WOMAC ) , and a satisfaction scale were used to evaluate outcomes at final followup . Multivariate regression models were used to evaluate the impact of expectations on outcomes . RESULTS There were 102 patients with THA and 89 with TKA . Mean age was 66 years . All patients achieved significant improvements in their WOMAC and SF-36 scores following surgery . Patient expectations regarding surgery were not associated with their age , gender , index joint of surgery , marital status , or race . Expectations were not correlated with pre-operative functional health status . Expectation of complete pain relief after surgery was an independent predictor of better physical function and improvement in level of pain at 6 months post-surgery . Expectation of low risk of complications from TJA was an independent predictor of greater satisfaction . CONCLUSIONS Patient expectations were important independent predictors of improved functional outcomes and satisfaction following TJA . Greater underst and ing of the relationship between expectations and outcomes may improve the process of care and outcomes of TJA Purpose Despite reduction in radiological outliers in previous r and omized trials comparing robotic-assisted versus conventional total knee arthroplasty ( TKA ) , no differences in short-term functional outcomes were observed . The aim of this study was to determine whether there was improvement in functional outcomes and quality -of-life ( QoL ) measures between robotic-assisted and conventional TKA . Methods All 60 knees ( 31 robotic-assisted ; 29 conventional ) from a previous r and omized trial were available for analysis . Differences in range of motion , Knee Society ( KSS ) knee and function scores , Oxford Knee scores ( OKS ) , SF-36 subscale and summative ( physical PCS/mental component scores MCS ) were analysed . In addition , patient satisfaction , fulfilment of expectations and the proportion attaining a minimum clinical ly important difference ( MCID ) in KSS , OKS and SF-36 were studied . Results Both robotic-assisted and conventional TKA displayed significant improvements in majority of the functional outcome scores at 2 years . Despite having a higher rate of complications , the robotic-assisted group displayed a trend towards higher scores in SF-36 QoL measures , with significant differences in SF-36 vitality ( p = 0.03 ) , role emotional ( p = 0.02 ) and a larger proportion of patients achieving SF-36 vitality MCID ( 48.4 vs 13.8 % , p = 0.009 ) . No significant differences in KSS , OKS or satisfaction/expectation rates were noted . ConclusionS ubtle improvements in patient QoL measures were observed in robotic-assisted TKA when compared to conventional TKA . This finding suggests that QoL measures may be more sensitive and clinical ly important than surgeon-driven objective scores in detecting subtle functional improvements in  robotic-assisted TKA  patients .Level of evidence II OBJECTIVE To quantify the magnitude of change seen with pain , function , and quality of life outcomes 6 months after  total hip and knee arthroplasties ( THA , TKA )  within a community based cohort of a regional health district . METHODS An inception cohort of 504 patients who received primary THA ( 228 ) or TKA ( 276 ) was prospect ively followed . All patients resided in the community and were assessed within one month prior to surgery and 6 months postoperatively . Health related quality of life measures were evaluated with the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index and the Medical Outcome Survey Short Form SF-36 . Perioperative factors were extracted from medical charts . Health services utilization data were collected from regional health data bases . RESULTS Over 75 % of patients reported improvement in joint-specific pain and function , regardless of the type of joint replaced . Other health dimensions such as social function , bodily pain , physical function , vitality , and general health showed significant improvement after surgery . Those psychosocial dimensions with modest changes had baseline values comparable to age and sex adjusted normal values ; whereas , bodily pain and physical function , which had large changes , had values lower than the normal values . Ninety-one percent of patients receiving THA were satisfied with their surgery , whereas 77 % were satisfied with their TKA . The average length of stay was 7 days and the in-hospital complication rate was 0.34 per patient . CONCLUSION Large improvements were reported for pain and function after joint arthroplasties , while small to moderate changes were seen in other areas related to quality of life .  Patients with hip arthroplasties showed greater improvement in pain and function and were more satisfied with their outcomes than patients with knee arthroplasties . Although pain and function show large improvements , bodily pain and physical function were less than the values reported in the general population Background Hip replacement ( arthroplasty ) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint . For older patients , several design s of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money . However , in younger more active patients , there is approximately a 50 % failure rate at 25 years for traditional implants . Hip resurfacing is a relatively new arthroplasty technique . In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified , including the risk of femoral neck fracture and collapse of the head of the femur . The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty . Secondary aims include assessment of complication rates for both procedures as well cost effectiveness . Methods / design All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study . A r and omisation sequence will be produced and administered independently . After consenting , all patients will be clinical ly review ed and hip function , quality of life and physical activity level will be assessed through question naires . The allocated surgery will then be performed with the preferred technique of the surgeon . Six weeks post-operation hip function will be assessed and complications recorded . Three , six and 12 months post-operation hip function , quality of life and physical activity level will be assessed . Additional information about patients ' out-of-pocket expenses will also be collected . Trial registration Current Controlled Trials IS RCT N33354155UKCLRN portfolio ID In a well‐defined fast‐track setup for total hip and knee arthroplasty , with a multimodal analgesic regimen consisting of intra‐operative local anaesthetic infiltration and oral celecoxib , gabapentin and paracetamol for 6 days postoperatively , we conducted a prospect i ve , consecutive , observational study . The purpose was to describe the prevalence and intensity of subacute postoperative pain and opioid related side effects , use of analgesics and functional ability 1–10 and 30 days postoperatively . Fast‐track total hip and knee arthroplasty with early discharge ( < 3 days ) result ed in acceptable levels of pain and postoperative nausea and vomiting with concomitant low use of opioids in > 95 % of patients after discharge before day 10 after total hip arthroplasty . However , after total knee arthroplasty 52 % patients reported moderate pain ( VAS 30–59 mm ) , and 16 % severe pain ( VAS ≥ 60 mm ) when walking 1 month after surgery with a concomitant increase in the use of strong opioids . These results emphasise the need for improvement in analgesia after discharge following total knee arthroplasty , to facilitate rehabilitation OBJECTIVE Validation of the program theory of the Groningen orthopaedic exit strategy ( GOES ) , a theory-driven program aim ing to improve the rehabilitation of total hip and knee arthroplasty patients after shortened hospital stay . First part of the program theory is the action theory , hypothesising that the GOES treatment positively influences the mediating variables ( self-efficacy , social support , pain-coping ) . The second part , the conceptual theory , hypothesis a positive relationship between these variables and the outcome variables ( ADL functioning , physical activity behaviour , quality of life ) . METHODS Patients were r and omly assigned to the GOES or control groups .  Question naires were used to assess mediating and outcome variables in 103 patients ( 50 GOES , 53 controls ) pre-operatively , and 6 and 26 weeks post-operatively . RESULTS No difference was seen between the two groups in terms of changes between pre-operative and post-operative mediating variables ( action theory ) . Moderate-to-large correlations explaining reasonable amount of variance ( 22 % , 25 % , 56 % ) were found between the mediating and outcome variables ( conceptual theory ) . CONCLUSION The conceptual theory is supported ; however , as the treatment did not influence the mediating variables ( action theory ) , it has no added value in its current form . PRACTICE IMPLICATION S The treatment needs to be adjusted ; it is discussed that individualised treatment could be more effective Abstract Limitation in daily physical activity is one of the reasons for total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) . However , studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning . We determined the effect of THA or TKA on patients ’ actual physical activity and body function ( pain , stiffness ) , capacity to perform tasks , and self-reported physical functioning . We also assessed whether there are differences in the effect of the surgery between patients undergoing THA or TKA  and whether the improvements vary between these different outcome measures . We recruited patients with long-st and ing end-stage osteoarthritis of the hip or knee awaiting THA or TKA .  Measurements were performed before surgery and 3 and 6 months after surgery . Actual physical activity improved by 0.7 % . Patients ’ body function , capacity , and self-reported physical functioning also improved . The effects of the surgery on these aspects of physical functioning were similar for THA and TKA . The effect on actual physical activity ( 8 % ) was smaller than on body function ( 80%–167 % ) , capacity ( 19%–36 % ) , and self-reported physical functioning ( 87%–112 % ) . Therefore , in contrast to the large effect on pain and stiffness , patients ’ capacity , and their self-reported physical functioning , the improvement in actual physical activity of our patients was less than expected 6 months after surgery . Level of Evidence : Level I , prospect i ve study . See the Guidelines for Authors for a complete description of levels of evidence Purpose A pneumatic tourniquet is commonly used in total knee arthroplasty ( TKA ) to improve surgical field visualisation but may result in quadriceps muscle ischaemia . We performed this study to analyse the effect of the tourniquet on recovery following TKA . Material s and Methods A prospect i ve r and omised single-blinded trial was undertaken to examine the effect of the tourniquet on post-operative pain , swelling , blood loss , quadriceps function and outcome following TKA . Twenty patients with osteoarthritis of the knee were r and omised to tourniquet or no tourniquet groups . Quadriceps function was assessed using surface electromyography ( EMG ) during active knee extension . Results The no tourniquet group had significantly less pain in the early post-operative period compared to the tourniquet group . There was no difference in Oxford knee score , range of motion , or thigh and knee swelling up to 12 months post-operatively . Quadriceps function , measured by surface EMG , was compromised for the first six months post-surgery by tourniquet use . The radiological cement mantle at the bone prosthesis interface at 12-month follow-up was not affected by the absence of a tourniquet . Conclusions We believe that it is safe and beneficial for our patients to routinely perform TKA without a tourniquet Background After total knee arthroplasty ( TKA ) only 75 - 89 % of patients are satisfied . Because patient satisfaction is a prime goal of all orthopaedic procedures , optimization of patient satisfaction is of major importance . Factors related to patient satisfaction after TKA have been explored , but no studies have included two potentially relevant factors , i.e. the functional capacity of daily activities and actual daily activity . This present prospect i ve study examines whether functional capacity and actual daily activity ( in addition to an extensive set of potential factors ) contribute to patient satisfaction six months after TKA . Methods A total of 44 patients were extensively examined preoperatively and six months post surgery . Functional capacity was measured with three capacity tests , focusing on walking , stair climbing , and chair rising . Actual daily activity  was measured in the patient 's home situation by means of a 48-hour measurement with an Activity Monitor . To establish which factors were related to patient satisfaction six months post surgery , logistic regression analyses were used to calculate odds ratios . Results Preoperative and postoperative functional capacity and actual daily activity had no relation with patient satisfaction . Preoperatively , only self-reported mental functioning was positively related to patient satisfaction . Postoperatively , based on multivariate analysis , only fulfilled expectations regarding pain and experienced pain six months post surgery were related to patient satisfaction . Conclusions Functional capacity and actual daily activity do not contribute to patient satisfaction after TKA . Patients with a better preoperative self-reported mental functioning , and patients who experienced less pain and had fulfilled expectations regarding pain postoperatively , were more often satisfied AIMS Oxidised zirconium was introduced as a material for femoral components in total knee arthroplasty ( TKA ) as an attempt to reduce polyethylene wear . However , the long-term survival of this component is not known . METHODS We performed a retrospective review of a prospect ively collected data base to assess the ten year survival and clinical and radiological outcomes of an oxidised zirconium total knee arthroplasty with the Genesis II prosthesis . The Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , Knee Injury and Osteoarthritis Outcome Score ( KOOS ) and a patient satisfaction scale were used to assess outcome . RESULTS A total of 303 consecutive TKAs were performed in 278 patients with a mean age of 68 years ( 45 to 89 ) . The rate of survival ten years post-operatively as assessed using Kaplan-Meier analysis was 97 % ( 95 % confidence interval 94 to 99 ) with revision for any reason as the endpoint . There were no revisions for loosening , osteolysis or failure of the implant . There was a significant improvement in all components of the WOMAC score at final follow-up ( p < 0.001 ) . The mean individual components of the KOOS score for symptoms ( 82.4 points ; 36 to 100 ) , pain ( 87.5 points ; 6 to 100 ) , activities of daily life ( 84.9 points ; 15 to 100 ) and quality of life ( 71.4 points ; 6 to 100 ) were all at higher end of the scale . DISCUSSION This study provides further supportive evidence that the oxidised zirconium TKA gives comparable rates of survival with other implants and excellent functional outcomes ten years post-operatively . TAKE HOME MESSAGE Total knee arthroplasty with an oxidised zirconium femoral component gives comparable long-term rates of survival and functional outcomes with conventional implants Background and purpose — Criticism of the lateral approach ( LA ) for hip arthroplasty is mainly based on the risk of poor patient-reported outcomes compared to the posterior approach ( PA ) . However , there have been no controlled studies comparing patient-reported outcomes between them . In this r and omized controlled trial , we tested the hypothesis that patient-reported outcomes are better in patients who have undergone total hip arthroplasty ( THA ) with PA  than in those who have undergone THA with LA , 12 months postoperatively . Patients and methods — 80 patients with hip osteoarthritis ( mean age 61 years ) were r and omized to THA  using  PA or the modified direct LA . We recorded outcome measures preoperatively and 3 , 6 , and 12 months postoperatively using the Hip Disability and Osteoarthritis Outcome Score – Physical Function Short Form ( HOOS-PS ) as the primary outcome . Secondary outcomes were HOOS-Pain , HOOS- Quality -Of-Life , EQ-5D , UCLA Activity Score , and limping . Results — We found no statistically significant difference in the improvements in HOOS-PS between the treatment groups at 12-month follow-up . All secondary outcomes showed similar results except for limping , where PA patients improved significantly more than LA patients . Interpretation — Contrary to our hypothesis , patients treated with PA did not improve more than patients treated with LA regarding physical function , pain , physical activity , and quality of life 12 months postoperatively . However , limping was more pronounced in the LA patients Background Despite the widely reported success of total joint arthroplasty ( TJA ) in reducing pain and improving quality of life and function for patients with hip or knee osteoarthritis , rates of TJA use vary widely throughout the United States , with broad disparities based on geographic , racial , and socioeconomic factors . Shared decision-making approaches , which require an exchange of information between patients and their physicians , can be helpful in improving patient satisfaction with their treatment decision and appropriate use of TJA . Questions /hypothesesExpected-value decision analysis models incorporating evidence -based outcome data with individual patient preferences regarding health states and willingness to pay , when used in shared decision-making models , will improve satisfaction among patients with hip or knee osteoarthritis and lead to more appropriate use of TJA.Proposed Program Patients with hip or knee osteoarthritis will be r and omized to usual care or participation in a shared decision-making intervention . Patients in the shared decision-making intervention arm will have their preferences for individual health states related to osteoarthritis and TJA measured using the time trade-off technique , and these values will be incorporated in an expected-value decision analysis model , which also will incorporate the patient ’s willingness to pay for a particular treatment intervention and evidence -based outcome probabilities . The patient ’s decision for operative versus nonoperative care and their level of satisfaction with their decision will be compared using chi square and Mann-Whitney rank-sum tests . Significance Information regarding patient preferences for particular health states and willingness to pay can be combined with evidence -based outcome data in expected-value decision analysis models , which will help inform shared clinical decision making between surgeons and their patients with hip or knee osteoarthritis BACKGROUND Recently , two topical issues in total hip arthroplasty ( THA ) have been robot-assisted surgery and use of a short stem . The purpose of this study was to evaluate the effects of robotic milling on the accuracy of short femoral stem positioning and on the short-term clinical outcome in THA using a prospect i ve , r and omized design . METHODS We r and omized 54 patients into two groups , either robotic milling group or manual rasping group .  The patients were assessed clinical ly and radiographically at 8 weeks , 5 months , 12 months , and 24 months . RESULTS Robotic milling group had a significantly longer operation time , requiring on average 8.9 min for registration and 11.2 min for milling . On the other h and , robotic milling group showed superior results in terms of stem alignment and leg length e quality . Two intraoperative femoral fractures occurred only in manual rasping group . Harris hip scores and WOMAC scores at 24 months postoperatively were similar in both groups . No complications including stem loosening , infection , nerve palsy , or dislocation were encountered in either group during the follow-up period . CONCLUSIONS The present study suggested that robot-assisted short stem THA could increase the accuracy of stem alignment , improve leg length e quality , and help reduce the risk of intraoperative femoral fracture as compared with manual rasping . However , the clinical outcome scores did not differ between the two groups at the time of short-term follow-up . Long-term follow-up is needed to determine whether there will be a long-term clinical relevance of robot-assisted implantation of short femoral stems in THA Background and Purpose Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis ( OA ) , yet there is little research establishing its efficacy for this population . The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA . Subjects A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study . Methods The study was design ed as a r and omized controlled trial in which participants r and omly received 6 weeks of aquatic physical therapy or no aquatic physical therapy . Outcome measures included pain , physical function , physical activity levels , quality of life , and muscle strength . Results The intervention result ed in less pain and joint stiffness and greater physical function , quality of life , and hip muscle strength . Totals of 72 % and 75 % of participants reported improvements in pain and function , respectively , compared with only 17 % ( each ) of control participants . Benefits were maintained 6 weeks after the completion of physical therapy , with 84 % of participants continuing independently . Discussion and Conclusion Compared with no intervention , a 6-week program of aquatic physical therapy result ed in significantly less pain and improved physical function , strength , and quality of life . It is unclear whether the benefits were attributable to intervention effects or a placebo response Abstract Background : Recently , two topical issues in total hip arthroplasty ( THA ) have been robot-assisted surgery and use of a short stem . The purpose of this study was to evaluate the effects of robotic milling on the accuracy of short femoral stem positioning and on the short-term clinical outcome in THA using a prospect i ve , r and omized design . Methods : We r and omized 54 patients into two groups , either robotic milling group or manual rasping group .  The patients were assessed clinical ly and radiographically at 8 weeks , 5 months , 12 months , and 24 months . Results : Robotic milling group had a significantly longer operation time , requiring on average 8.9 min for registration and 11.2 min for milling . On the other h and , robotic milling group showed superior results in terms of stem alignment and leg length e quality . Two intraoperative femoral fractures occurred only in manual rasping group . Harris hip scores and WOMAC scores at 24 months postoperatively were similar in both groups . No complications including stem loosening , infection , nerve palsy , or dislocation were encountered in either group during the follow-up period . Conclusions : The present study suggested that robot-assisted short stem THA could increase the accuracy of stem alignment , improve leg length e quality , and help reduce the risk of intraoperative femoral fracture as compared with manual rasping . However , the clinical outcome scores did not differ between the two groups at the time of short-term follow-up . Long-term follow-up is needed to determine whether there will be a long-term clinical relevance of robot-assisted implantation of short femoral stems in THA Both continuous spinal anaesthesia and continuous epidural anaesthesia are supposed to provide adequate post-operative pain relief . The purpose of this r and omized , prospect i ve study was to compare the quality of analgesia , occurrence of side effects and patient satisfaction between spinal and epidural administration of bupivacaine during the first post-operative 72 h. One hundred and two patients scheduled for hip arthroplasty were r and omly assigned to one of two groups : Group 1 received continuous spinal anaesthesia for intra-operative and post-operative management , Group 2 received continuous epidural anaesthesia . Immediately after surgery , the continuous spinal anaesthesia-group received a 1-mL bolus ( bupivacaine 0.25 % ) , followed by a continuous infusion of 10 mL over 24 h. The continuous epidural anaesthesia-group received a 10-mL bolus ( bupivacaine 0.25 % ) , followed by 2 mL h-1 . The level of pain was gauged from a verbal rating score and from a visual analogue scale ; the degree of motor blockade was recorded using the Bromage score . In the continuous spinal anaesthesia-group 90.2 % reported complete analgesia on the verbal rating scale , but only 21.6 % of the continuous epidural anaesthesia-group did . The visual analogue scale scores given by the continuous spinal anaesthesia-group were significantly lower than those of the continuous epidural anaesthesia-group . The percentage of patients with a motor block was significantly higher in the continuous spinal anaesthesia-group on the day of surgery and at the first post-operative day . During the first 24 h , nausea and vomiting occurred more often in the continuous epidural anaesthesia-group . The satisfaction was considered excellent in 92.2 % of the continuous spinal anaesthesia-group and in 70.6 % of the continuous epidural anaesthesia-group . It is concluded that continuous spinal anaesthesia and continuous epidural anaesthesia are effective and safe for post-operative pain relief after hip replacement . Compared with continuous epidural anaesthesia , continuous spinal anaesthesia provides faster onset of pain relief , ensures better analgesia and results in more satisfied patients Introduction : A functional total knee replacement has to be well aligned , which implies that it should lie along the mechanical axis and in the correct axial and rotational planes . Incorrect alignment will lead to abnormal wear , early mechanical loosening , and patellofemoral problems . There has been increased interest of late in total knee arthroplasty with robotic assistance . This study was conducted to determine whether robot-assisted total knee arthroplasty is superior to the conventional surgical method with regard to the precision of implant positioning . Material s and Methods : Twenty knee replacements , comprising ten robot-assisted procedures and ten conventional operations , were performed on ten cadavers . Two experienced surgeons performed the surgeries . Both procedures on each cadaver were performed by the same surgeon . The choice of which procedure was to be performed first was r and omized . Following implantation of the prosthesis , the mechanical axis deviation , femoral coronal angle , tibial coronal angle , femoral sagittal angle , tibial sagittal angle , and femoral rotational alignment were measured via 3D CT scanning . These variables were then compared with the preoperatively planned values . Results : In the knees that underwent robot-assisted surgery , the mechanical axis deviation ranged from −1.94 ° to 2.13 ° ( mean : −0.21 ° ) , the femoral coronal angle from 88.08 ° to 90.99 ° ( mean : 89.81 ° ) , the tibial coronal angle from 89.01 ° to 92.36 ° ( mean : 90.42 ° ) , the tibial sagittal angle from 81.72 ° to 86.24 ° ( mean : 83.20 ° ) , and the femoral rotational alignment from 0.02 ° to 1.15 ° ( mean : 0.52 ° ) in relation to the transepicondylar axis . In the knees that underwent conventional surgery  , the mechanical axis deviation ranged from −3.19 ° to 3.84 ° ( mean : −0.48 ° ) , the femoral coronal angle from 88.36 ° to 92.29 ° ( mean : 90.50 ° ) , the tibial coronal angle from 88.15 ° to 91.51 ° ( mean : 89.83 ° ) , the tibial sagittal angle from 80.06 ° to 87.34 ° ( mean : 84.50 ° ) , and the femoral rotational alignment from 0.32 ° to 4.13 ° ( mean : 2.76 ° ) in relation to the transepicondylar axis . In the conventional knee replacement group , there were two instances of outliers outside the range of 3 ° varus/valgus for the mechanical axis deviation . The robot-assisted knee replacements showed significantly superior femoral rotational alignment results compared with conventional surgery ( p = 0.006 ) . There was no statistically significant difference between robot-assisted and conventional total knee arthroplasty with regard to the other variables . All the measurements showed high intra-observer and inter-observer reliability . Conclusion : Robot-assisted total knee arthroplasty showed excellent precision in the sagittal and coronal planes of the 3D CT scan . In particular , the robot-assisted technique showed better accuracy in femoral rotational alignment compared to the conventional surgery , despite the fact that the surgeons who performed the operations were more experienced and familiar with the conventional method than with robot-assisted surgery . It can thus be concluded that robot-assisted total knee arthroplasty is superior to conventional total knee arthroplasty BACKGROUND Capacity to ambulate represents an important milestone in the recovery process after total knee arthroplasty ( TKA ) . The purpose of this study was to determine the analgesic effect of two analgesic techniques and their impact on functional walking capacity as a measure of surgical recovery . METHODS Forty ASA II-III subjects undergoing TKA were enrolled in a r and omized , double-blind , single-centre study receiving 48 h postoperative analgesia with either periarticular infiltration of local anaesthetic ( Group I ) or continuous femoral nerve block ( Group F ) . Breakthrough pain relief was achieved with patient-controlled analgesia ( PCA ) morphine . The main outcome was postoperative morphine consumption . Early ( postoperative days 1 - 3 ) and late ( 6 weeks ) functional walking capacity ( 2 and 6 min walk tests , 2MWT and 6MWT , respectively ) , degree of physical activity ( CHAMPS ) , health-related quality of life ( SF-12 ) , and clinical indicators of knee function ( WOMAC , Knee Society evaluation , and range of motion ) were measured . RESULTS Patients in Group F used the PCA less ( P=0.02 ) to achieve adequate analgesia . Postoperative 2MWT was similar in both groups ( P=0.27 ) . Six weeks after surgery , recovery of 6MWT , physical activity , and knee function were significantly improved in Group F ( P<0.05 ) . Preoperative walking capacity , physical activity and early total walking time were the independent predictors of early recovery . Distance and time spent walking were the predictors of functional walking exercise capacity at 6 weeks after surgery . CONCLUSIONS Femoral block is associated with lower opioid consumption and a better recovery at 6 weeks than periarticular infiltration . Early postoperative activity measures ( 2MWT and walking time ) were proved to be possible indicators of knee function recovery at 6 weeks after surgery Background Component alignment can influence implant longevity as well as perhaps pain and function after unicompartmental knee arthroplasty ( UKA ) , but correct alignment is not consistently achieved . To increase the likelihood that good alignment will be achieved during surgery , smart tools such as robotics or patient-specific instrumentation ( PSI ) have been introduced . Questions / purpose sWe hypothesized that UKA performed with PSI would result in improved level gait as ascertained with three-dimensional analysis , implant positioning , and patient-reported outcomes measured by a vali date d scoring system when compared with conventional instrumentation 3 months and 1 year after surgery . Methods We r and omized 60 patients into two groups using either the PSI technique or a conventional technique .  All patients were operated on using the same technique and the same cemented metal-backed implant . Mean age of the patients was 63 ± 4 years ( range , 54–72 years ) and mean body mass index was 28 ± 3 kg/m2 . Patients were evaluated preoperatively , at 3 months , and 1 year after surgery by an independent observer blind to the type of technique . Gait parameters were assessed with three-dimensional analysis during level walking preoperatively and at 1 year , frontal and sagittal position of the implant was evaluated on full-length radiographs at 3 months , and subjective functional outcome and quality of life using routine question naires ( SF-12 , new Knee Society Score [ KSS ] , Knee Injury and Osteoarthritis Outcome Score ) at 3 months and 1 year . This study had 80 % power to detect a 15 % difference in walking speed at the p < 0.05 level . Results One year after surgery , there were no differences between the two groups in the analyzed gait spatiotemporal parameters , respectively , for PSI UKA and conventional UKA : double limb support 31 % ( 25%–54 % ) versus 30 % ( 23%–56 % ; p = 0.67 ) and walking speed ( 1.59 m/s [ 0.86–1.87 m/s ] versus 1.57 m/s [ 0.71–1.96 m/s ] ; p = 0.41 ) . No difference was observed between the two groups in terms of lower limb alignment  ( PSI group 178 ° ± 3 ° , conventional group 178 ° ± 4 ° ; p = 0.24 ) or implant positioning on mediolateral and anteroposterior radiographs . There were no differences in the functional score between the PSI and conventional TKA groups at 3 months and 1 year after surgery : KSS objective knee scores ( PSI : 85 ± 8 points at 3 months , 87 ± 5 points at 1 year and conventional instrumentation : 82 ± 8 points at 3 months 83 ± 6 points at 1 year ; p = 0.10 ) and functional activity scores were similar in both group ( PSI : 71 ± 12 points at 3 months and 74 ± 7 points at 1 year versus conventional group : 73 ± 11 points at 3 months and 75 ± 6 at 1 year ; p = 0.9 ) . Conclusions Our observations suggest that PSI may confer small , if any , advantage in alignment , pain , or function after UKA . This argument can therefore not be used to justify the extra cost and uncertainty related to this technique . Level of Evidence Level I , therapeutic study Background Concurrent head-to-head comparisons of healthcare interventions regarding cost-utility are rare . The concept of favorable cost-effectiveness of total hip or knee arthroplasty is thus inadequately verified . Patients and methods In a trial involving several thous and patients from 10 medical specialties , 223 patients who were enrolled for hip or knee replacement surgery  were asked to fill in the 15D health-related quality of life ( HRQoL ) survey before and after operation .  Results Mean ( SD ) HRQoL score ( on a 0–1 scale ) increased in primary hip replacement patients ( n = 96 ) from 0.81 ( 0.084 ) preoperatively to 0.86 ( 0.12 ) at 12 months ( p < 0.001 ) . In revision hip replacement ( n = 24 ) the corresponding scores were 0.81 ( 0.086 ) and 0.82 ( 0.097 ) respectively ( p = 0.4 ) , and in knee replacement ( n = 103 ) the scores were 0.81 ( 0.093 ) and 0.84 ( 0.11 ) respectively ( p < 0.001 ) . Of 15 health dimensions , there were statistically significant improvements in moving , usual activities , discomfort and symptoms , distress , and vitality in both primary replacement groups . Mean cost per quality -adjusted life year ( QALY ) gained during a 1-year period was € 6,710 for primary hip replacement , € 52,274 for revision hip replacement , and € 13,995 for primary knee replacement . Interpretation Hip and knee replacement both improve HRQoL. The cost per QALY gained from knee replacement is twice that gained from hip replacement BACKGROUND Postoperative analgesia with the use of parenteral opioids or epidural analgesia can be associated with troublesome side effects . Good perioperative analgesia facilitates rehabilitation , improves patient satisfaction , and may reduce the hospital stay . We investigated the analgesic effect of locally injected drugs around a total knee prosthesis . METHODS Sixty-four patients undergoing total knee arthroplasty were r and omized either to receive a periarticular intraoperative injection containing ropivacaine , ketorolac , epimorphine , and epinephrine or to receive no injection . The perioperative analgesic regimen was st and ardized . All patients in both groups received patient-controlled analgesia for twenty-four hours after the surgery , and this was followed by st and ard analgesia .  Visual analog scores for pain , during activity and at rest , and for patient satisfaction were recorded preoperatively and postoperatively and at the six-week follow-up examination . The consumption of patient-controlled analgesia at specific postoperative time-points and the overall analgesic requirement were measured . RESULTS The patients who had received the injection used significantly less patient-controlled analgesia at six hours , at twelve hours , and over the first twenty-four hours after the surgery . In addition , they had higher visual analog scores for patient satisfaction and lower visual analog scores for pain during activity in the post-anesthetic-care unit and four hours after the operation . No cardiac or central nervous system toxicity was observed . CONCLUSIONS Intraoperative periarticular injection with multimodal drugs can significantly reduce the requirements for patient-controlled analgesia and improve patient satisfaction , with no apparent risks , following total knee arthroplasty OBJECTIVE : To compare conventional laparoscopic and robotic-assisted laparoscopic sacrocolpopexy for vaginal apex prolapse . METHODS : This single-center , blinded r and omized trial included participants with stage 2–4 posthysterectomy vaginal prolapse . Participants were r and omized to laparoscopic or robotic sacrocolpopexy .  The primary outcome was total operative time from incision to closure . Secondary outcomes were postoperative pain , functional activity , bowel and bladder symptoms , quality of life , anatomic vaginal support , and cost from a health care system perspective . RESULTS : A total of 78 patients enrolled and were r and omized ( laparoscopic n=38 ; robotic n=40 ) .  Total operative time was significantly longer in the robotic group compared with the laparoscopic group ( + 67-minute difference ; 95 % confidence interval [ CI ] 43–89 ; P<.001 ) . Anesthesia time , total time in the operating room , total sacrocolpopexy time , and total suturing time were all significantly longer in the robotic group . Participants in the robotic group also had significantly higher pain at rest and with activity during weeks 3 through 5 after surgery and required longer use of nonsteroidal anti-inflammatory drugs ( median , 20 compared with 11 days , P<.005 ) . The robotic group incurred greater cost than the laparoscopic group ( mean difference + $ 1,936 ; 95 % CI $ 417–$3,454 ; P=.008 ) . Both groups demonstrated significant improvement in vaginal support and functional outcomes 1 year after surgery with no differences between groups . CONCLUSION : Robotic-assisted sacrocolpopexy results in longer operating time and increased pain and cost compared with the conventional laparoscopic approach . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00551993 . LEVEL OF EVIDENCE :
R and om-effects meta-analyses showed that post-operative functional outcomes were comparable between active robotic and conventional total hip and knee arthroplasty at the short- , medium- and long-term follow-up .
Conclusions This systematic and meta-analyses indicates that functional outcomes for patients undergoing active robotic total hip and knee arthroplasty were comparable to conventional surgery .
Whether semi-active or active robotic hip or knee arthroplasty is effective in improving post-operative pain , quality of life and satisfaction with surgery is unclear .
Purpose The purpose of the study is to determine the effectiveness of semi-active and active robotic hip and knee arthroplasty on post-operative patient-reported outcomes of function , pain , quality of life and satisfaction with surgery .