Robotic-assisted total hip arthroplasty utilizing a fluoroscopy-guided system produced similar cup accuracy and precision relative to a computerized tomography-based robotic platform.

Robotic assistance for total hip arthroplasty (THA) has been demonstrated to improve accuracy of acetabular cup placement relative to manual, unassisted technique. The purpose of this investigation was to compare the accuracy and precision between a fluoroscopy-based robotic total hip arthroplasty platform (FL-RTHA) and a computerized tomography-based (CT-RTHA) platform. The study included 98 consecutive FL-RTHA and 159 CT-RTHA procedures performed via direct anterior approach (DAA).

Use of a fluoroscopy-based robotic-assisted total hip arthroplasty system resulted in greater improvements in hip-specific outcome measures at one-year compared to a CT-based robotic-assisted system.

Background: The purpose of this study was to compare one-year patient reported outcome measures between a novel fluoroscopy-based robotic-assisted (FL-RTHA) system and an existing computerised tomography-based robotic assisted (CT-RTHA) system.

Methods: A review of 85 consecutive FL-RTHA and 125 consecutive CT-RTHA was conducted. Outcomes included one-year post-operative Veterans RAND-12 (VR-12) Physical (PCS)/Mental (MCS), Hip Disability and Osteoarthritis Outcome (HOOS) Pain/Physical Function (PS)/Joint replacement, and University of California Los Angeles (UCLA) Activity scores.

Are orthopedic clinical trials representative? An analysis of race and ethnicity reported in clinical trials between 2007 and 2022 : Running title: representation of clinical trials in orthopedic surgery.

Introduction: Prior studies investigating the racial and ethnic representation of orthopedic trial participants have found low rates of reporting, but these studies are dated due to the passing of the National Institutes of Health Final Rule in 2017 requiring the reporting of racial and ethnic data among clinical trials. Therefore, we evaluated the representativeness of orthopedic clinical trials before and after the Final Rule.

Methods: A cross-sectional survey of orthopaedic clinical trials registered at ClinicalTrials.

Use of a fluoroscopy-based robotic-assisted total hip arthroplasty system produced greater improvements in patient-reported outcomes at one year compared to manual, fluoroscopic-assisted technique.

Introduction: The adoption of new technology should be supported by improvements in patient-reported outcomes (PROMs). The purpose of this study was to assess the one-year PROMs of patients who underwent total hip arthroplasty (THA) using a novel, fluoroscopy-based, robotic-assisted (RA-THA) system when compared to a manual, fluoroscopic-assisted technique (mTHA).

Materials And Methods: A review of 91 consecutive mTHA and 85 consecutive RA-THA via a direct anterior approach was conducted.

Fluoroscopy-based robotic assistance for total hip arthroplasty improves acetabular cup placement accuracy for obese patients compared to the manual, fluoroscopic- assisted technique.

Background: Patient obesity is a risk factor for poor acetabular cup positioning in total hip arthroplasty (THA).

Objective: To assess the impact of using a novel, fluoroscopy-based robotic THA system on acetabular cup placement in obese versus non-obese patients.

Methods: A review of 105 consecutive manual unassisted (mTHA) (47 Obese/58 Non-obese) and 102 robotic-assisted (RA-THA) (50 Obese/52 Non-obese) primary, direct anterior approach THA procedures was conducted.

Cost-effectiveness of a novel, fluoroscopy-based robotic-assisted total hip arthroplasty system: A Markov analysis.

Background: The purpose of this study was to assess the cost-effectiveness of a novel, fluoroscopy-based robotic-assisted total hip arthroplasty (RA-THA) system compared to a manual unassisted technique (mTHA) up to 5 years post-operatively.

Methods: A Markov model was constructed to compare the cost-effectiveness of RA-THA and mTHA. Cost-effectiveness was defined as an Incremental Cost-Effectiveness Ratio (ICER) <$50 000 or $100 000 per Quality Adjusted Life Year (QALY).

Robotic-assisted total hip arthroplasty utilizing a fluoroscopy-guided system resulted in improved intra-operative efficiency relative to a computerized tomography-based platform.

Robotic-assisted total hip arthroplasty (THA) using a computerized-tomography (CT) based workflow increases surgical time relative to traditional manual technique. The purpose of this investigation was to compare the intra-operative efficiencies of two robotic THA systems: a fluoroscopy-based platform (FL-RTHA) and a contemporary, CT-based (CT-RTHA) platform. A review of 107 consecutive FL-RTHA and 159 CT-RTHA primary, direct anterior approach (DAA) THA procedures was conducted.

Re-initiation of elective total knee arthroplasty with an adapted pathway during the 2020 COVID-19 pandemic was safe and effective.

Introduction: In June 2020 when elective total knee arthroplasty (TKA) resumed after the initial COVID-19 surge, we adapted our TKA pathway focusing on a shorter hospitalization, increased home discharge, and use of post-discharge telemedicine and telerehabilitation. The purpose of this study was to evaluate if changes in postoperative care affected early TKA outcomes.

Materials And Methods: Five hundred and fifty-four patients who underwent elective primary unilateral TKA for primary osteoarthritis between June and August 2020 (study group) were matched 1:1 for age, sex, body mass index, and Charlson comorbidity index with control patients who underwent surgery between August and November 2019.

Nonagenarians and Octogenarians Undergoing THA and TKA: A 10-Year Age Difference Increases Rates of In-Hospital Complications But Does Not Affect 90-Day Outcomes.

Background: The population of nonagenarians undergoing total joint arthroplasty (TJA) of the hip or knee is expected to increase, but this population may be reluctant to consider elective surgery because of their advanced age.

Purpose: We sought to compare TJA outcomes between nonagenarians and octogenarians with an exact 10-year age difference.

Methods: We performed a retrospective chart review, including 129 nonagenarians who underwent primary unilateral TJA for osteoarthritis in a 4-year period at a single institution and who were matched with 381 octogenarians based on sex, body mass index, Charlson Comorbidity Index, replaced joint (hip or knee), and a 10-year age difference.

Preoperative cannabis use does not increase opioid utilization following primary total hip arthroplasty in a propensity matched analysis.

Purpose: The recreational and medical use of cannabis is being legalized worldwide. Its use has been linked to an increased risk of developing opioid use disorders. As opioids continue to be prescribed after total hip arthroplasty (THA), the influence that preoperative cannabis use may have on postoperative opioid consumption remains unknown.

Use of a novel imageless navigation system reduced fluoroscopy exposure and improved acetabular positioning in anterior approach total hip arthroplasty: a case-control study.

Introduction: Direct anterior approach (DAA) for total hip arthroplasty (THA) frequently utilizes fluoroscopy. The purpose of this study is to assess the impact of using a novel, imageless THA navigation system on radiation exposure and acetabular cup placement consistency.

Materials And Methods: This was a retrospective, single-surgeon cohort study of a consecutive group of patients who underwent DAA THA for osteoarthritis.

Does Body Mass Index Influence the Outcomes and Survivorship of Modern Cementless Total Knee Arthroplasty?

Background: Higher body mass index (BMI) has been associated with higher rates of aseptic loosening following cemented total knee arthroplasty (TKA). However, there is a paucity of evidence on the effect of BMI on the durability of modern cementless TKA. We aimed to assess the association between BMI and clinical outcomes following cementless TKA and to determine if there was a BMI threshold beyond which the risk of revision significantly increased.

COVID-19 disruptions to elective postoperative care did not adversely affect early complications or patient reported outcomes of primary TKA.

Introduction: Elective orthopedic care, including in-person office visits and physical therapy (PT), was halted on March 16, 2020, at a large, urban hospital at the onset of the local COVID-19 surge. Post-discharge care was provided predominantly through a virtual format. The purpose of this study was to assess the impact of postoperative care disruptions on early total knee arthroplasty (TKA) outcomes, specifically 90-day complications, 120-day rate of manipulation under anesthesia (MUA) and 1-year patient-reported outcome measures (PROMs).

Redefining Indications for Modern Cementless Total Knee Arthroplasty: Clinical Outcomes and Survivorship in Patients >75 Years Old.

Background: Most studies on cementless total knee arthroplasty (TKA) have excluded patients >75 years due to concerns that older patients have poorer bone mineral density and osteogenic activity. This study compared the midterm outcomes and survivorship of cemented and cementless TKA of the same modern design performed in patients >75 years.

Methods: We identified a consecutive series of 120 primary cementless TKA performed in patients >75 years.

Ceramic-on-polyethylene hip arthroplasty reduces the risk of postoperative periprosthetic joint infection.

Metal-on-polyethylene (MoP) total hip arthroplasty (THA) prostheses are known to release metal debris. Basic science studies suggest that metal implants induce a pro-inflammatory response that ultimately chemoattracts leukocytes including macrophages and neutrophils to the surgical site. This raises concern of higher risk of infection with these prostheses through the "trojan horse" mechanism by which neutrophils and macrophages transport intracellular pathogens from a remote site.

"Uncontrolled" Hypertension Is Not an Independent Risk Factor for Adverse Short-Term Outcomes Following Total Joint Arthroplasty.

Background: Uncontrolled hypertension (HTN) is a risk factor for mortality following elective surgery and poor hemodynamic control during total joint arthroplasty (TJA). However, the relationship between uncontrolled HTN and TJA outcomes remains poorly understood. The purpose of this study is to better define HTN parameters that are predictive of adverse arthroplasty outcomes.

The Hospital Frailty Risk Score is Not an Accurate Predictor of Treatment Costs for Total Joint Replacement Patients in a Medicare Bundled Payment Population.

Background: Medically complex patients require more resources and experience higher costs within total joint arthroplasty (TJA) bundled payment models. While risk adjustment would be beneficial for such patients, no tool currently exists which can reliably identify these patients preoperatively. The purpose of this study is to determine if the Hospital Frailty Risk Score (HFRS) is a valid predictor of high-TJA treatment costs.