bluuebunny/crossref_metadata_2025_split huggingface dataset:
Robotic-arm assisted total knee arthroplasty improves precision and delivers early outcomes superior to manual approach
Authors: Zhang Jenny , Sodhi Nipun , Dushaj Kristina , Mont Michael , Hepinstall Matthew 
Published: October 2019

Haptic robotic-arm assisted technology improves accuracy in unicompartmental knee replacement through utilizing a preoperative 3-D plan, optical navigation for real-time intraoperative feedback on soft tissue laxity, and robotic arm for precise bone preparation. This technology became clinically available for total knee arthroplasty (TKA) in 2016. We present outcomes from the early adoption of this technique.A retrospective chart review compared data from the first 120 robotic-arm assisted TKAs performed December 2016 through July 2018 to the last 120 manually instrumented TKAs performed May 2015 to December 2016, prior to robotic technology adoption.Robotic surgery was associated with significantly increased anesthesia (212 vs 187 mins, p &lt; 0.01) and operative (135 vs 112 minutes, p &lt; 0.01) time. The robotic group had a lower hospital length-of-stay (2.7 vs. 3.4 days, p &lt; 0.001). Discharge to home was not statistically different between robotic and manual groups (89% vs. 83%, p = 0.2). Robotic technology was associated with decreased variability in implant positioning, with smaller variances in the lateral distal femoral angle (LDFA; 3.5 vs 6.6 degrees, p &lt; 0.01) and posterior tibial slope (1.8 vs. 5.3 degrees, p &lt; 0.01). Mean limb alignment, as measured by tibiofemoral angle, was slightly less valgus in the robotic group (3.9 vs 4.4 degrees, p = 0.09). Postoperative range of motion was significantly increased for robotic-arm assisted TKA patients, with less flexion contracture at 2-weeks (1.8 vs. 3.3 degrees, p &lt; 0.01), 7-weeks (1.0 vs. 1.8 degrees, p &lt; 0.01), and 3-months (0.6 vs 2.1 degrees, p = 0.02) post-surgery. Postoperative Knee Society scores were similar between groups.Preliminary findings demonstrate robotic-arm assisted TKA is safe and efficacious with outcomes comparable, if not superior, to that of manually instrumented TKA.
Does the Use of a CT Based 3D Plan Improve Joint Balancing in Total Knee Arthroplasty? A Multi-Center Study
Authors: Zhang Jingwei , Bhowmik-Stoker Manoshi , Scholl Laura , Condrey Caitlin , Hitt Kirby , Marchand Kevin , Marchand Robert 
Published: October 2019

Studies have shown that dissatisfaction following TKA may stem from poor component placement and iatrogenic factors related to variability in surgical execution. A CT-based robotic assisted system allows surgeons to dynamically balance the joint prior to bone resection. This study aimed to determine if this system could improve TKA planning, reduce soft tissue releases, minimize bone resection, and accurately predict component size.Six hundred and sixty-six cases undergoing primary robotic assisted TKA we enrolled in a prospective, multicenter study. Seven surgeons participated from seven US centers. Patient demographics and intraoperative surgical details were collected. Initial and final 3-dimensional alignment, component position, bone resection depths, use of soft tissue releases, knee balancing gaps, and component size were collected intraoperatively. Descriptive statistics were applied to determine the changes in these parameters between initial and final values.In this study, 513 varus knees, 86 valgus knees, and 26 neutral knees were captured and stratified for analysis. Native deformity ranged from 12 degrees of valgus to 19 degrees of varus. 85% of all patients in this study did not require a soft tissue release. Complex deformities who required a soft tissue release were corrected on average to 3.36 degrees while cases without releases were corrected to 1.1 degree on average. All surgeons achieved their planned sizes on the tibia and femur more than 97.5% of the time within one size, and 100% of the time within two sizes. Flexion and extension gaps during knee balancing were within 2mm (mean 1mm) for all knees.New tools may allow for enhanced execution and predictable balance for TKA, which may improve patient outcomes. In this study, preoperative planning via CT scan allowed surgeons to assess bony deformities and subtly adjust component position to reduce soft tissue trauma. Patient follow up is needed to determine clinical outcomes.
Gap Deviation after Cementation in Computer Assisted Navigation TKA
Authors: Leelasestaporn Chumroonkiet , Tarnpichprasert Tomorn 
Published: October 2019

INTRODUCTIONThe outcome of knee replacement depended on alignment, balancing of soft tissue, symmetrical andrectangular gaps adjustment, and accurate implant placement. Many techniques have been used toimprove these factors including navigator assisted knee replacement, which has precise bone cutand accurate soft tissue balancing. However, cementation may change gaps and alignment that canaffect outcome of knee replacement.OBJECTIVETo compare gaps and alignment after cementation in computer assisted total knee replacementMATERIAL AND METHODSProspective collecting data all cases performed computer assisted total knee replacement withcruciate retaining - mobile bearing implant design. Gaps and mechanical axis was collected andcompered between complete trial prosthesis and final cementation.RESULTLateral extension gap and flexion contracture significantly increase after cementation whencompared with trial implantation [0.6 mm (P = 0.021), 2.7o (P = 0.00)]. The mechanical axis was notdeviated after cementation (P = 1.00).CONCLUSIONCementation is able to influence gap and alignment. It may be useful to control and recheck gap andalignment with navigation system during cementation. Clinical correlation needs furtherinvestigation.
Robotic-assisted Total Hip Arthroplasty May Reduce the Risk of Complications in Patients Younger than 35
Authors: Novikov David , Luthringer Tyler , Cizmic Zlatan , Mahure Siddharth , Eftekhary Nima , Davidovitch Roy , Vigdorchik Jonathan 
Published: October 2019

Purpose: In younger patients during total hip arthroplasty, the presence of morphologic deformities, previous surgeries, and retained hardware, can pose technical challenges making reconstruction difficult. The purpose of our study is to assess the outcome of robotic-assisted THA compared to conventional THA in patients younger than 35 years old.Methods: A retrospective analysis of 123 patients younger than 35 years old that underwent primary unilateral THA between January 2013 and April 2018 was conducted. Patients were divided into two cohorts: (1) robotic-assisted THA and (2) conventional-THA (c-THA). Demographics, operative details, and postoperative outcomes were carefully studied. Radiographic analysis included measurement of postoperative acetabular anteversion and inclination angles as well as postoperative leg length discrepancies. Chi square and unpaired student t-tests were performed for all categorical and continuous variables, respectively.Results: Of the total 123 patients, 30 patients (32 hips) were in the robotic-THA cohort, and 93 patients (100 hips) were in the conventional-THA cohort. Patients in the robotic-THA cohort were younger (26.6±6.2 vs. 29.0±5.3; p=0.03), had a higher mean BMI (29.8±8.2 vs. 25.7±5.9; p=0.03) at surgery. The most common indication for THA was DDH and osteonecrosis. The acetabular component was positioned within Lewinnek’s safe zone more often in the robotic-THA cohort compared to the c-THA cohort (94% vs 65%; p&lt;0.01) (Figures 1 and 2). Leg length discrepancies were similar between both cohorts. Patients in the c-THA group were more likely to experience clinically significant higher rates of dislocation (2.9% vs. 0), revision (6.8%), any postoperative complication (7.8%), and 90-day readmission (2.9) following THA.Conclusion: Robotic THA can help improve outcomes in younger THA recipients. Future studies with larger cohorts and longer follow-up times should evaluate outcomes in this historically technically demanding patient population.
What factors influence surgeon cervical posture and perceived workload during TKA?
Authors: Scholl Laura , Kolisek Frank , Chen Antonia , Bhave Anil , Freedhand Adam , Hampp Emily , Alipit Vincent , Mont Michael 
Published: October 2019

Orthopaedic surgery is a mentally and physically demanding procedure for surgeons. Studies reported 44-66% of surgeons surveyed have had a work-related injury attributed to poor surgeon posture. The purpose of this study was to understand how surgical variables may affect a surgeon’s posture and workload when performing TKA. Variables included: influence of level of surgical experience, type of surgical procedure, and specific surgical tasks.Two experienced surgeons, with a median 22-years surgical experience, and 2 surgeons, currently in their fellowship training, each performed 3 manual TKAs (MTKA) and 3 robotic assisted TKAs (RATKA) using a cadaveric setup. Kinematic sensors were placed on the occiput and T3 to measure flexion of the head and neck. Surgeons were surveyed to assess their physical and mental effort using a 1-10 scale (1 being least effort).Compared to the fellows, experienced surgeons had reduced occiput and T3 angles for MTKA (28.0 vs. 38.7°, 4.2 vs. 15.7°) and RATKA (18.0 vs. 29.2°, 4.8 vs. 13.2°) as well as reduced mental and physical effort. Considering surgical procedure, all surgeons had reduced occiput angles for RATKA compared to MTKA. Considering surgical task, surgical application (MTKA vs. RATKA) had greater influence on cervical angles for the fellows group.All three factors influenced the surgeon’s posture and workload. Occiput angle was reduced by approximately 10° during RATKA, which is attributed to the surgeon standing in a more upright position, to visualize the robotic screen during cutting and trialing. Robotics may help newer surgeons better visualize knee balancing during TKA, easing the process of balancing and trialing.
Robotic Arm Assisted Total Knee Arthroplasty: Addressing 1-12 Degrees Valgus Knees
Authors: Zhang Jingwei , Bhowmik-Stoker Manoshi , Scholl Laura , Condrey Caitlin , Marchand Kevin , Marchand Robert 
Published: October 2019

The purpose of this work was to determine the number of soft tissue releases and component orientation of valgus cases performed with Robotic-Arm Assisted total knee arthroplasty (RATKA).This study was a retrospective chart review of cases performed by a single surgeon from July 2016 to December 2017. 72 RATKA cases were defined as having a valgus deformity pre-operatively. Patient demographics and intraoperative surgical details were collected, including initial and final 3D component alignment, knee balancing gaps, full or partial releases. Post- operatively, radiographs, adverse events, and reduced WOMAC pain and KOOS Jr scores were collected at 6 months post-operatively.Pre-operatively, knee deformities ranged from 1o to 12° with fixed flexion contracture. All knees were corrected within 2.5 degrees of mechanical neutral. Medial and lateral gaps were balanced in extension 100% of cases and flexion 93% of cases.Radiographic evidence suggested well seated and well-fixed components. No revision and re- operation is reported. Patient reported outcomes measures collected at 6-month follow up indicated an improvement in WOMAC pain score from 9.6 to 3.2 and improvement in KOOS Jr from 44.7 to 74.4 points.In this retrospective case review, soft tissue releases were not needed to address valgus knees ranging from 1-12° of deformity. The surgeon was able to balance the knee with bone resections and avoid disturbing the soft tissue envelope. While this study has a number of limitations, RATKA for valgus knees should continue to be investigated in a multicenter study.
The Impact of Workflow on Cutting Time for Partial Knee Arthroplasty
Authors: Hampp Emily , Scholl Laura , Haque Md , Wu Chunyan , Westrich Geoffrey , Mont Michael 
Published: October 2019

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&gt;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.
Does the use of Robotic Technology Improve Surgeon Ergonomic Safety during TKA?
Authors: Scholl Laura , Hampp Emily , Alipit Vincent , Chen Antonia , Mont Michael , Bhave Anil 
Published: October 2019

Surgeon physical stress in the operating room is a known potential cause of musculoskeletal overuse injuries, specifically in surgeons who perform total knee arthroplasty (TKA). Injuries have been attributed to ergonomically challenging postures. This study compared surgeon lower back and shoulder posture between manual TKA (MTKA) and robotic assisted TKA (RATKA).Two surgeons performed a total six MTKA and six RATKA on a set of cadaveric knees. Movement and EMG sensors were secured to each surgeon to monitor lower back and shoulder movements, as well as muscle activities. Data was analyzed and activities were assessed as low, medium, or high risk, providing a score between 0-lowest and 16-highest. Risk data was compared between MTKA and RATKA for three separate surgical tasks: 1-bone cut preparation &amp; cutting (MTKA = placement of cutting jigs, bone cutting, RATKA = array placement, bone registration, bone cutting), 2-knee balancing and 3-trialing.Overall, there were more high-risk shoulder than lower back activities in MTKA and RATKA. More high-risk movement and EMG stimulation were measured in the dominant shoulder than the non-dominant. When lower back and shoulder data were combined, highest risk task was bone cut preparation &amp; cutting (MTKA: 13 vs. 6 vs. 6 and RATKA: 11 vs. 8 vs. 6), with a higher risk for MTKA than RATKA.Poor posture can be a potential cause for surgeon work-related injuries. This study evaluated which tasks presented highest risk to surgeon ergonomic safety while performing TKA, and found lower overall ergonomics risk for performing RATKA vs. MTKA. Although this study provides data indicating reduced ergonomic risk with RATKA, additional studies in the operating room need to be performed.
Healthcare Utilization and Payer Cost Analysis of Robotic-Arm Assisted Total Knee Arthroplasty at 30-, 60-, and 90-Days
Authors: Coppolecchia Andrea , Cool Christina , Jacofsky David , Gregory David , Sodhi Nipun , Mont Michael 
Published: October 2019

IntroductionThis study performed a healthcare utilization analysis between robotic-arm assisted and manual TKA techniques at three intervals to better understand intra-episode trends that can lead to optimized care pathways. Specifically, we compared: (1) index costs; and (2) discharge dispositions; as well as (3) 30-; (4) 60-; and (5) 90- day: a) total episode-of-care costs, b) post-operative healthcare utilization, and c) readmissions.MethodsThe Medicare 100% Standard Analytical Files was queried for robotic and manual TKAs (rTKA and mTKA) performed between January 1, 2016 and March 31, 2017. Based on strict inclusion and exclusion criteria, and 1:5 propensity score matching, 519 robotic and 2,595 manual TKA patients were analyzed. Total episode payments, healthcare utilization, and readmissions, at 30-, 60-, and 90-day time points were compared between cohorts with a generalized Linear Model, Binomial Regression, log link, Mann-Whitney, and Pearson's Chi Squared tests with p&lt;0.05 for statistical significance.ResultsThe robotic vs. manual cohort average total episode payment was $17,768 vs. $19,899 (p&lt;0.0001) at 30-days; $18,174 vs. $20,492 (p&lt;0.0001) at 60-days; and $18,568 vs. $20,960 (p&lt;0.0001) at 90-days. At 30 days, 47% fewer rTKA patients utilized SNF services (13.5 vs. 25.4%, p&lt;0.0001 and had lower SNF costs at 30- ($6,416 vs. $7,732; p = 0.0040), 60- ($6,678 vs. $7,901, p=0.0072), and 90-days ($7,201 vs. $7,947, p=0.0230). rTKA patients also utilized fewer home-health visits and costs at each time point (p&lt;0.05). Additionally, 31.3% fewer rTKA patients utilized emergency room services at 30-days postoperatively. The robotic cohort had significantly fewer 90-day readmissions (5.20 vs. 7.75%; p=0.0423).DiscussionRobotic TKA is associated with significantly lower 30-, 60-, and 90-day post- operative costs and healthcare utilization. These results are of marked importance given the emphasis to contain and reduce healthcare costs for total joints arthroplasties. This analysis provides initial economic insight into robotic-arm assisted TKA with promising results.
The Sensitivity of Balancing in Total Knee Surgery
Authors: Zapata Gabriela , Sanz-Pena Inigo , Verstraete Matthias , Meere Patrick , Walker Peter 
Published: October 2019

Background: Balancing is important to outcomes, but has been difficult to achieve due to the high sensitivity of the condylar forces to even small changes in ligament lengths. The first goal was to measure the effects of alignment and component placement errors on balancing. The second goal was to study equivalence between the collateral ligament forces, distraction forces, and condylar contact forces.Methods: The test rig flexed and extended synthetic knees, while condylar forces and ligament forces were measured. For ideal femoral component placement, the sagittal contours exactly matched anatomic. 2mm placement errors relative to anatomic were distal (too little distal femoral resection), proximal, anterior, and posterior. Condylar forces for anatomic placement were defined as reference, while forces for the different placement errors were measured relatively.Results: Condylar forces were significantly influenced by 2mm errors in femoral component placement. For distal placement error in combination with kinematic alignment, there were only small changes in the contact forces. Other placement errors produced large contact errors. For mechanical alignment medial forces were similar to kinematic, but lateral forces reduced to almost zero. The medial and lateral ligament and contact forces, distraction forces, and lift-off moments were highly correlated.Conclusions: The ideal situation was kinematic alignment, which could reproduce the condylar contact forces seen in intact anatomic knees. The least condylar force errors occurred when the femoral component was placed too distally, for the kinematic alignment bone cuts. Different balancing parameters can be used interchangeably.
Cláusulas de mediação obrigatória em contratos (convenção de mediação) - o dilema entre a voluntariedade da mediação e a obrigação de cumprimento do contrato
Authors: Campanella Sancha Carvalho 
Published: October 2019

O presente artigo tem a modesta pretensão de efetuar uma abordagem geral sobre a problemática das Cláusulas de Mediação de conflitos insertas em contratos - Convenção de Mediação - e a sua compatibilização entre o princípio da voluntariedade da mediação e o principio geral de direito do pontual cumprimento dos contratos.
A escolha do tema prende-se com a vontade de demonstrar que ambos os princípios são compatíveis, e que fazem parte de um regime jurídico que protege ambos.
A função jurisdicional do Estado está definida no artº 202 da CRP, sendo a mesma atribuída aos tribunais, os quais administram a justiça em nome do povo. Incumbe aos tribunais assegurar a defesa dos direitos e interesses legalmente protegidos dos cidadãos, reprimir a violação da legalidade democrática e dirimir os conflitos de interesses públicos e privados. Os tribunais podem ser coadjuvados por outras autoridades.
A Constituição permite igualmente no artº 202 nº 4 a criação de instrumentos e formas de resolução alternativo de litígios ou seja formas não jurisdicionais de composição de conflitos. Com base neste principio foram implementados todos os meios alternativos de resolução de conflitos, onde se inclui a mediação.
Análise sobre os processos especiais "pré-insolvência" criados no âmbito do programa revitalizar
Authors: Menezes Carla 
Published: October 2019

Com a expansão da “sociedade de consumo” têm surgido novos tipos de conflitualidade social aos quais os tribunais nem sempre conseguem dar respostas satisfatórias. A resolução dos problemas derivados do sobre-endividamento das famílias e das empresas, é um fenómeno que tem surgido nos últimos anos na sequência da difusão e diversificação dos hábitos de consumo e o Governo Português para dar resposta a este fenómeno e conseguir obter resultados mais céleres e menos dispendiosos, tem vindo a “tentar” implementar medidas extrajudiciais (como foi o caso do SIREVE mas que ficou aquém as expectativas), uma vez que os processos judiciais, geralmente, levam a um caminho com muitas delongas e, normalmente, quando se obtém uma decisão esta já produz poucos efeitos práticos.
As experiências de diversas ordens jurídicas revela-nos que o tratamento destas situações é mais bem conseguida se estiverem disponíveis de forma articulada procedimentos extrajudiciais, com soluções voluntárias e consensualizadas.
Este artigo pretende dar a conhecer os principais processos especiais “pré-insolvência” criados, na legislação portuguesa, bem como propor uma breve reflexão sobre as suas características e finalidades, evidenciando as suas principais diferenças.
Para cumprimento dos objetivos a que nos propusemos, tivemos presente a legislação nacional, os princípios subjacentes à recuperação extrajudicial e os ensinamentos da doutrina a este respeito.
Preempção
Authors: Alves Eduardo 
Published: October 2019

Conhecer amplamente os limites competenciais da Região Autónoma da Madeira, na área da autonomia, administração e gestão escolar, implica necessariamente estudar as intervenções que o Tribunal Constitucional seguiu nesta matéria.
Particularmente, obriga a analisar a posição tomada por aquele Tribunal, em 2006, a propósito da alteração do modelo regional da Madeira de organização das escolas, datado de 2000, e a posição discutível tomada de inconstitucionalidade declarada de normas deste e que fica próxima daquilo que é considerar existir em Portugal, na repartição competencial entre Estado e Regiões, uma ocupação de espaço normativo pela legislação nacional, coartando assim a possibilidade de intervenção do legislador regional, decisão jurisprudencial em contraciclo com a revisão da Constituição ocorrida em 2004.