Reliable Outcomes Provided by a Rotating Hinge Knee Arthroplasty for Patients Who Have Moderate-To-Severe Arthrofibrosis.

Background: Idiopathic arthrofibrosis after total knee arthroplasty (TKA) is a challenging complication resulting in stiffness and pain. Modern rotating-hinge (RH) prostheses have gained popularity for managing arthrofibrosis during revision TKA. The primary aim of this study was to evaluate the effectiveness of revision TKA using an RH prosthesis on improving range of motion (ROM) for patients who have moderate and severe arthrofibrosis.

Integrating Artificial Intelligence and Virtual Reality in Orthopedic Surgery: A Comprehensive Review.

Artificial intelligence (AI) and virtual reality (VR) are being used in orthopedic surgery, with goals of enhancing surgical precision, trainee education, patient engagement, and personalized surgical strategies. AI-based predictive modeling, automated computer vision and image analytics, and robotic surgery are changing orthopedic preoperative planning and intraoperative decision-making, with the ultimate aim of improving postoperative outcomes through reduced variability in surgery. VR technologies are being used in orthopedic surgical simulations to provide safe environments for skill development in surgical trainees, helping them practice complex procedures before performing live surgeries.

Insights From Inputs: Enhancing Revision Total Joint Arthroplasty Resource Allocation With Machine Learning Prediction.

Background: Revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) are among the most resource-intensive orthopaedic procedures. The primary aim of this study was to compare the accuracy of machine learning models between administrative and institutional datasets for predicting duration of surgery, length of stay, and 30-day hospital readmission for rTKA and rTHA based on preoperative factors and identify significant predictive features.

Methods: A national quality improvement database was queried from 2014 to 2019, and a local institutional arthroplasty database was queried from 2012 to 2022 for rTKAs and rTHAs.

Safety of Same-Day Total Joint Replacement: A Population-Based Cohort Study.

Purpose: Total joint arthroplasty (TJA) has seen a rapid increase in same-day surgery (SDS), particularly since the COVID-19 pandemic. One limitation of prior research on this topic is that data derived from single (usually high volume) centers whose experience may not be generalizable. The purpose of this study was to analyze the success rates of same-day TJA using population level data in Canada's most populous province.

Successful Management of Periprosthetic Joint Infection Following Total Joint Arthroplasty, as Defined by the Patient: A Qualitative Study.

Background: The literature on the subjective experience of patients undergoing treatment for periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) is scarce, and treatment success is defined without consideration of patient values. The primary objective of this study was to characterize the experience of patients undergoing PJI management. The secondary and tertiary aims were to identify factors that patients associate with successful treatment and to assess alignment with a 2019 outcome-reporting tool (ORT) by the Musculoskeletal Infection Society (MSIS).

Impact of low body mass index on reoperation risk and complications after joint arthroplasty: a cohort study.

Purpose: The risks associated with low body mass index (BMI) in arthroplasty patients are underexplored. While outcomes of patients with elevated BMI are well-documented, low BMI patients may also face unique challenges, including malnutrition, osteopenia, and increased surgical risks and postoperative complications. To evaluate the impact of low BMI on reoperation risk and other complications compared with normal BMI among patients undergoing total hip or knee arthroplasty.

Patients prefer In-Office Needle Arthroscopy (IONA) over traditional surgical arthroscopy.

Purpose: In-Office Needle Arthroscopy (IONA) is an emerging technology that has been primarily studied as a diagnostic tool. Recent evidence shows that it is a cost-effective alternative to hospital- and community-based MRI with comparable accuracy. Although exciting for surgeons and administrators, little is known about patients' perceptions of IONA.

Total Knee Arthroplasty With Robotic and Augmented Reality Guidance: A Hierarchical Task Analysis.

Background: Total knee arthroplasty (TKA) is a commonly performed procedure that has traditionally utilized reproducible steps using a set of mechanical instruments. The number of TKAs performed using robotic assistance is increasing, and augmented reality (AR) navigation systems are being developed. Hierarchical task analysis (HTA) aims to describe the steps of a specific task in detail to reduce errors and ensure reproducibility.

Intraoperative and Postoperative Outcomes of Patients Undergoing Total Knee Arthroplasty With Prior Anterior Cruciate Ligament Reconstruction: A Matched Cohort Analysis.

Background: Previous anterior cruciate ligament (ACL) injury is a risk factor for the development of knee osteoarthritis. Despite advances in ACL reconstruction (ACLR) techniques, many patients with history of ACLR develop end-stage osteoarthritis necessitating total knee arthroplasty (TKA). The purpose of this study was to investigate the impact of prior ACLR on intraoperative and postoperative outcomes of TKA.

Total Knee Arthroplasty Periprosthetic Joint Infection With Concomitant Extensor Mechanism Disruption and Soft-Tissue Defect: The Knee Arthroplasty Terrible Triad.

Background: Periprosthetic infection (PJI) with concomitant extensor mechanism disruption (EMD) and soft-tissue defect-hereinafter termed the "Terrible Triad"-is a devastating complication following total knee arthroplasty. The purpose of this study was to define the surgical and clinical outcomes following management of a cohort of patients who have the Terrible Triad.

Methods: From 2000 to 2022, 127 patients underwent operative management for PJI alone, 25 for PJI with soft-tissue defects (defined as defects requiring flap reconstruction or being a factor contributing to the decision of performing above-knee amputation or arthrodesis), 14 for PJI with EMD, and 22 for the Terrible Triad.

Association between immigration status and total knee arthroplasty outcomes in Ontario, Canada: a population-based matched cohort study.

Background: Immigrants and refugees face unique challenges navigating the health care system to manage severe arthritis, because of unfamiliarity, lack of awareness of surgical options, or access. The purpose of this study was to assess total knee arthroplasty (TKA) uptake, surgical outcomes, and hospital utilization among immigrants and refugees compared with Canadian-born patients.

Methods: We included all adults undergoing primary TKA from January 2011 to December 2020 in Ontario.

Fluoroscopy Versus Imageless Optical Navigation in Direct Anterior Approach Total Hip Arthroplasty.

Background: Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has risen in popularity. Accurate implant placement is a critical factor that influences patient outcomes. The goal of this study was to compare the accuracy and precision of fluoroscopy with imageless optical navigation in DAA THA.

The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery.

Aims: This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures.

Methods: Using the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from 1 January to 31 December 2021 were extracted. Patient preoperative COVID-19 status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed.

In-office needle arthroscopy is a cost-effective alternative for operating room diversion in medial meniscectomy: a financial analysis.

Background: In-office needle arthroscopy (IONA) has been described as a diagnostic alternative to magnetic resonance imaging (MRI) for intra-articular pathology. However, few studies have analyzed its impact on cost and wait times when used as a therapeutic intervention. The purpose of this study was to investigate the impact on cost and wait times associated with offering IONA for partial medial meniscectomy as an alternative to traditional operating room (OR) arthroscopy for patients with irreparable medial meniscus tears on MRI.

Complications and early recovery following hip hemiarthroplasty through the direct anterior approach: a systematic review and meta-analysis.

Purpose: Minimizing complications is an important focus in hip hemiarthroplasty (HHA) for femoral neck fracture (FNF) patients given the associated high morbidity and mortality rates. This systematic review and meta-analysis aimed to compare the clinical and functional outcomes associated with the direct anterior approach (DAA) compared to other surgical approaches used for HHA.

Methods: Studies evaluating HHA-treated FNFs using the DAA were compared through meta-analysis to all other surgical approaches combined and as distinct subgroups.

Immersive Virtual Reality and Cadaveric Bone are Equally Effective in Skeletal Anatomy Education: A Randomized Crossover Noninferiority Trial.

Objective: Immersive virtual reality (IVR) technology is transforming medical education. Our aim was to compare the effectiveness of IVR with cadaveric bone models in teaching skeletal anatomy.

Design: A randomized crossover noninferiority trial was conducted.

Optimizing spine surgery instrument trays to immediately increase efficiency and reduce costs in the operating room.

Background: Over-crowded surgical trays result in perioperative inefficiency and unnecessary costs. While methodologies to reduce the size of surgical trays have been described in the literature, they each have their own drawbacks. In this study, we compared three methods: (1) clinician review (CR), (2) mathematical programming (MP), and (3) a novel hybrid model (HM) based on surveys and cost analysis.

Improving Resource Utilization for Arthroplasty Care by Leveraging Machine Learning and Optimization: A Systematic Review.

Background: There is a growing demand for total joint arthroplasty (TJA) surgery. The applications of machine learning (ML), mathematical optimization, and computer simulation have the potential to improve efficiency of TJA care delivery through outcome prediction and surgical scheduling optimization, easing the burden on health-care systems. The purpose of this study was to evaluate strategies using advances in analytics and computational modeling that may improve planning and the overall efficiency of TJA care.

Artificial Intelligence for Hip Fracture Detection and Outcome Prediction: A Systematic Review and Meta-analysis.

Importance: Artificial intelligence (AI) enables powerful models for establishment of clinical diagnostic and prognostic tools for hip fractures; however the performance and potential impact of these newly developed algorithms are currently unknown.

Objective: To evaluate the performance of AI algorithms designed to diagnose hip fractures on radiographs and predict postoperative clinical outcomes following hip fracture surgery relative to current practices.

Data Sources: A systematic review of the literature was performed using the MEDLINE, Embase, and Cochrane Library databases for all articles published from database inception to January 23, 2023.

An automated, web-based triage tool may optimise referral pathways in elective orthopaedic surgery: A proof-of-concept study.

Introduction: Knee pain is caused by various pathologies, making evaluation in primary-care challenging. Subsequently, an over-reliance on imaging, such as radiographs and MRI exists. Electronic-triage tools represent an innovative solution to this problem.

Use of virtual reality for the management of phantom limb pain: a systematic review.

Purpose: To summarize the research on the effectiveness of virtual reality (VR) therapy for the management of phantom limb pain (PLP).

Methods: Three databases (SCOPUS, Ovid Embase, and Ovid MEDLINE) were searched for studies investigating the use of VR therapy for the treatment of PLP. Original research articles fulfilling the following criteria were included: (i) patients 18 years and older; (ii) all etiologies of amputation; (iii) any level of amputation; (iv) use of immersive VR as a treatment modality for PLP; (v) self-reported objective measures of PLP before and after at least one VR session; (vi) written in English.

Clinical applications of augmented reality in orthopaedic surgery: a comprehensive narrative review.

Purpose: The development of augmented reality (AR) technology allows orthopaedic surgeons to incorporate and visualize surgical data, assisting the execution of both routine and complex surgical operations. Uniquely, AR technology allows a surgeon to view the surgical field and superimpose peri-operative imaging, anatomical landmarks, navigation guidance, and more, all in one view without the need for conjugate gaze between multiple screens. The aim of this literature review was to introduce the fundamental requirements for an augmented reality system and to assess the current applications, outcomes, and potential limitations to this technology.