Early Functional Outcomes Research Articles

Early Functional Outcomes and Complications of the First Carpometacarpal Arthroplasty: A Single-Institution Experience

Early Functional Outcomes and Complications of the First Carpometacarpal Arthroplasty: A Single-Institution Experience

Recruitment of pial collaterals and carotid occlusive disease in large-vessel occlusion ischemic stroke

Background and purposeDespite the fundamental role of pial collateral vessels in limiting the progression of ischemic tissue injury in acute stroke with large vessel occlusion (LVO), in addition to the fact that collateral vessel abundance varies naturally from person to person for genetic reasons, there is limited knowledge regarding potential factors contributing to inherent interindividual variation in pial collateral supply. As it has been repeatedly hypothesized that chronic carotid occlusive disease may favor pial collateralization, we aimed to investigate the association between quantitatively assessed leptomeningeal collateral supply and pre-existing carotid stenosis in patients with acute stroke due to LVO.Materials and methodsPatients with proximal middle cerebral artery (MCA) occlusion with or without additional internal carotid artery (ICA) occlusion were included. The degree of collateral supply was quantitatively assessed based on signal variance in T2*-weighted time series in perfusion-weighted magnetic resonance imaging (PWI). Patients were stratified into two groups according to quantitative collateral status (poor and fair to good collateral supply). The prevalence of high-grade ICA stenosis (≥70%) was evaluated in both groups.ResultsA total of 98 patients (mean age 68.8 ± 16.1 years, n = 52 (53.1%) of whom were female individuals) with MCA and/or ICA occlusion were included in the final analysis. Out of these patients, 42 had poor collateral supply, while 56 exhibited fair to good collateral supply. Additionally, 18 patients showed ipsilateral high-grade ICA stenosis. After classifying the entire cohort based on their collateral status (poor vs. fair to good collateral supply), there was no significant difference in the proportion of the patients with ipsilateral high-grade ICA stenosis between the two groups. Specifically, 6 (14.3%) patients had poor collateral supply, and 12 (21.1%) patients had fair to good collateral supply. The odds ratio (OR) was 1.58, with a 95% confidence interval (CI) of 0.490–5.685 and the p-value of 0.440. In the entire patient cohort, signal variance-based collateral supply was significantly correlated with initial stroke severity (r = −0.360, p < 0.001), baseline ischemic core volume (r = −0.362, p < 0.001), and functional outcomes (score on the modified Rankin Scale) at discharge (r = −0.367, p < 0.01).ConclusionIn this study, we performed a quantitative and observer-independent MRI-based collateral assessment in patients with LVO. We found no significant difference in the prevalence of pre-existing high-grade ICA stenosis between patients with fair to good collateral supply and those with poor collateral supply. The potential influence of demographic and clinical variables on pial collateral supply in patients with acute stroke warrants further exploration in future studies. MRI-based collateral supply is significantly related to initial stroke severity, ischemic core volume, and early functional outcomes.

3D-Printed Prosthesis with an Articular Interface for Anatomical Acetabular Reconstruction After Type I + II (+ III) Internal Hemipelvectomy

Background: Pelvic reconstruction after type I + II (or type I + II + III) internal hemipelvectomy with extensive ilium removal is a great challenge. In an attempt to anatomically reconstruct the hip rotation center (HRC) and achieve a low mechanical failure rate, a custom-made, 3D-printed prosthesis with a porous articular interface was developed. The aim of this study was to investigate the clinical outcomes of patients treated with this prosthesis. Methods: This retrospective cohort study included 28 patients with type I + II (+ III) internal hemipelvectomy through the articular interface of the sacroiliac joint and managed with a prosthesis at a single center between August 2016 and August 2021. Complications and oncological outcomes were analyzed. The position of the reconstructed HRC was assessed and lower-limb function was evaluated. Biomechanical analyses of different fixation modes of the prosthesis were conducted using finite element analysis. Results: The displacement distance of the HRC from preoperatively to postoperatively was a mean (and standard deviation) of 14.12 ± 8.75 mm. The rate of implant-related complications was 14.3% (4 of 28) for prosthetic breakage, 14.3% (4 of 28) for aseptic loosening, 7.1% (2 of 28) for dislocation, and 7.1% (2 of 28) for deep infection. The mean Musculoskeletal Tumor Society (MSTS)-93 score was 18.2. The aseptic loosening rate was significantly greater for prostheses fixed with 3 sacral screws (4 of 10, 40.0%) than for those fixed with 4 (0 of 10, 0%) or 5 screws (0 of 8, 0%) (p = 0.024). The prosthetic breakage rate was lower in patients who underwent lumbosacral fixation (0 of 13, 0%) than in those who did not (4 of 15, 26.7%), although the difference did not reach significance (p = 0.102). Biomechanical analyses suggested that the addition of lumbosacral fixation or increasing the number of sacral screws from 3 to 4 or 5 visibly reduced the peak stress of the sacral screws. Conclusions: The use of a 3D-printed prosthesis with an articular interface for pelvic reconstruction demonstrated stable prosthetic fixation, anatomical acetabular reconstruction, and acceptable early functional outcomes. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The impact of surgical technique on very early functional outcomes after radical prostatectomy.

To determine the very early functional as well as oncological outcomes after robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) at a single institution. We identified patients who underwent RARP or ORP at our institution between August 2021 and July 2023. The main criterion for surgical technique selection was patient preference. Primary endpoints included anastomosis leakage rate, very early continence rate reported by standardized pad-test, and positive surgical margin rate. Furthermore, we analyzed operation time, hospital stay, postoperative analgesia, and complication rates. In this prospective study, we analyzed data from 222 radical prostatectomies (111 RARP and 111 ORP). There were no significant differences in preoperative age, prostate size, and risk stratification among the groups. Patients who underwent RARP had lower anastomosis leakage rates (8.1% vs. 18.9%) and slightly lower early continence rates (76.6% vs. 78.4%) when compared to patients who underwent ORP. Positive surgical margin rates were similar, and complication rates were also comparable. Operation time was similar for both techniques, but the hospital stay was significantly shorter in the RARP group (6.3 vs. 9.1 days, p=0.03). The ORP group experienced significantly higher opioid administration postoperatively (p<0.001). From a functional and oncological point of view, both techniques are safe and provide excellent outcomes when performed by experienced surgeons. Nevertheless, patients are likely to benefit from a shortened hospital stay and reduced postoperative pain after RARP.

MRI-based Quantitative Collateral Assessment in Acute Stroke : AComparison with Single-phase CTA in Drip-and-ship Patients with Serial Imaging.

In acute ischemic stroke with large-vessel occlusion (LVO), collateral assessment with single-phase computed tomography angiography (CTA) might underestimate pial collateral supply in aconsiderable proportion of patients. We aimed to compare time-resolved magnetic resonance imaging (MRI)-based quantitative collateral mapping to conventional collateral imaging with CTA. This retrospective single-center study covering aperiod of 6years (2012-2018) included drip-and-ship LVO patients who underwent MR imaging after initial imaging evaluation with CT. For MRI-based collateral assessment, T2*-weighted time series from perfusion-weighted imaging (PWI) were processed to compute aquantitative collateral vessel index (CVIPWI) based on the magnitude of signal variance across the entire acquisition time. CTA-based collateral scores (Tan and Maas) and CVIPWI were investigated in terms of inter-modality associations between collateral measures, as well as their relationships with stroke severity, infarct volume and early functional outcome. The final analysis included n = 56patients (n = 31female, mean age69.9 ± 14.21 years). No significant relationship was found between MR-based quantitative collateral supply (CVIPWI) and CT-based collateral scores (r = -0.00057, p = 0.502 and r = -0.124, p = 0.797). In contrast to CVIPWI, CTA-based collateral scores showed no significant relationship with clinical stroke severity and infarct volume. While MR-based CVIPWI was independently associated with favorable early functional outcome in multivariate analysis (OR 1.075, 95% CI 1.001-1.153, p = 0.046), CTA-based collateral scores were not significantly associated with outcome. Since collateral scores based on single-phase CTA do not accurately reflect infarct progression and might underestimate pial collateralization in arelevant proportion of patients, they are not associated with early functional outcome in LVO patients. In contrast, CVIPWI represents arobust imaging parameter of collateral supply and is independently associated with functional outcome.

Posterolateral Versus Posteromedial Approach for Posterior Malleolus Fixation in Trimalleolar Fractures of the Ankle.

Background Ankle fractures, particularly those involving the posterior malleolus, are prevalent injuries that can lead to significant functional impairment if not managed appropriately. The choice of surgical approach for posterior malleolus fixation - posteromedial (PM) or posterolateral (PL) - remains a debate among orthopedic surgeons. The PM approach is a traditional technique involving extensive soft tissue dissection, while the PL approach offers improved visualization and precision with potentially less soft tissue disruption. Materials and methods This prospective comparative study was conducted at the Department of Orthopedics, Dr. D. Y. Patil Hospital and Research Centre, Pune, between February 2022 and August 2024.Atotal of 42 patients with trimalleolar fractures involving the posterior malleolus were randomly assigned to either the PL or PM surgical groups, with 21 patients in each group. Surgical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scores, articular surface step-off, range of motion (ROM), and complications such asosteoarthritis, infection, neurovascular injury, nonunion, and deep vein thrombosis at six months, 12 months, and final follow-up. Results Patients in the PL group demonstrated superior clinical outcomes with higher mean AOFAS scores at six-month(87.52 ± 2.92) and 12-month(90.28 ± 1.72) follow-ups compared to the PM group (84.95 ± 3.25 at six months; 88.86 ± 2.41 at 12 months), with statistically significant differences favoring the PL approach. However, as per the final follow-up, the difference in AOFAS scores between the two groups was not statistically significant. The PL group also had more patients with excellent ROM and fewer complications, such as arthritis, than the PM group. Conclusion The PL approach for posterior malleolus fixation in trimalleolar fractures offers superior early functional outcomes and fewer complications than the PM approach. However, the long-term outcomes between the two approaches show no significant difference, indicating that both techniques can be effective depending on the specific fracture pattern and patient characteristics.

VE14 Robot-assisted Y-V plasty for bladder neck stricture repair: Description of the technique and early functional outcomes

VE14 Robot-assisted Y-V plasty for bladder neck stricture repair: Description of the technique and early functional outcomes

PE032 Initial series of 132 robot-assisted radical prostatectomies using the Hugo™ RAS system: Surgical, early functional, and oncological outcomes from a single tertiary robotic center

PE032 Initial series of 132 robot-assisted radical prostatectomies using the Hugo™ RAS system: Surgical, early functional, and oncological outcomes from a single tertiary robotic center

Early Functional Outcome After Anterior Cruciate Ligament Reconstruction in Patients Using Post-Operative Brace or No Brace: A Prospective Observational Case–Control Study

Early Functional Outcome After Anterior Cruciate Ligament Reconstruction in Patients Using Post-Operative Brace or No Brace: A Prospective Observational Case–Control Study

A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL COMPARING THE DIRECT SUPERIOR APPROACH WITH THE POSTERIOR APPROACH FOR TOTAL HIP ARTHROPLASTY

The direct superior approach (DSA) is a modification of the posterior approach (PA) that preserves the iliotibial band and short external rotators except for the piriformis or conjoined tendon during total hip arthroplasty (THA). The objective of this study was to compare postoperative pain, early functional rehabilitation, functional outcomes, implant positioning, implant migration, and complications in patients undergoing the DSA versus PA for THA.This study included 80 patients with symptomatic hip arthritis undergoing primary THA. Patients were prospectively randomised to receive either the DSA or PA for THA, surgery was undertaken using identical implant designs in both groups, and all patients received a standardized postoperative rehabilitation programme. Predefined study outcomes were recorded by blinded observers at regular intervals for two-years after THA. Radiosteriometric analysis (RSA) was used to assess implant migration.There were no statistical differences between the DSA and PA in postoperative pain scores (p=0.312), opiate analgesia consumption (p=0.067), and time to hospital discharge (p=0.416). At two years follow-up, both groups had comparable Oxford hip scores (p=0.476); Harris hip scores (p=0.293); Hip disability and osteoarthritis outcome scores (p=0.543); University of California at Los Angeles scores (p=0.609); Western Ontario and McMaster Universities Arthritis Index (p=0.833); and European Quality of Life questionnaire with 5 dimensions scores (p=0.418). Radiographic analysis revealed no difference between the two treatment groups for overall accuracy of acetabular cup positioning (p=0.687) and femoral stem alignment (p=0.564). RSA revealed no difference in femoral component migration (p=0.145) between the groups at two years follow-up.There were no differences between patients undergoing the DSA versus PA for THA with respect to postoperative pain scores, functional rehabilitation, patient-reported outcome measurements, accuracy of implant positioning, and implant migration at two years follow-up. Both treatment groups had excellent outcomes that remained comparable at all follow-up intervals.

Understanding Kinesiophobia: Predictors and Influence on Early Functional Outcomes in Patients with Total Knee Arthroplasty.

This observational study aimed to identify predictors of kinesiophobia and examine its correlation with early functional outcomes in TKA recipients. On the first and fifth postoperative days (POD1 and POD5), we evaluated pain using the International Pain Outcomes Questionnaire (IPO-Q) and created multidimensional pain composite scores (PCSs). The Total Pain Composite Score (PCStotal) assesses the overall impact of pain, taking into account outcomes of pain intensity, pain-related interference with function, and emotions and side effects. Functional status on POD 5 was determined by the Barthel index, 6 min walking test, and knee range of motion. Kinesiophobia was assessed on POD5 using the Tampa Scale for Kinesiophobia (TSK). Among 75 TKA patients, 27% exhibited kinesiophobia. The final regression model highlighted PCStotal on POD5 (OR = 6.2, CI = 1.9-19.9), PCStotal (OR = 2.1, CI = 1.2-3.8) on POD1, and the intensity of chronic pain before surgery (OR = 1.4, CI = 1.1-2.1) as significant kinesiophobia predictors. On POD5, those with kinesiophobia showed increased dependency, slower gait, and poorer knee extension recovery. This study emphasizes the need to identify and address kinesiophobia in TKA patients for better functional outcomes and recovery. Additionally, it is vital to assess different domains of pain, not just pain intensity, as it can lead to kinesiophobia development.

Comparative clinical and functional results of microfracture and mosaicoplasty in medial talus osteochondral lesions

Introduction: This study aimed to compare the early clinical and functional outcomes of two surgical interventions, microfracture and mosaicplasty, for the treatment of medial talus osteochondral lesions (OCLs). Materials and Methods: This retrospective study included patients treated at the Medical Faculty Orthopedics and Traumatology Department of XXX University from January 2016 to January 2022. Patients were divided into two groups: those who underwent microfracture (Group 1, n=20) and those who underwent mosaicplasty (Group 2, n=17). Preoperative and postoperative follow-up data at baseline, 6 months, and 12 months included visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores. Statistical analysis was conducted using NCSS software, with a significance level set at p

No difference in early functional outcome between the direct anterior approach and posterior approach in patients following total hip arthroplasty.

Objective and subjective outcomes in the direct anterior approach (DAA) and posterior approach (PA) in total hip arthroplasty (THA) were assessed in this study, using the Oxford Hip Score (OHS) as primary outcome. Pain, 3 objective performance-based tests, surgical time, blood loss and length of stay were assessed as secondary outcomes. Patients with primary end-stage osteoarthritis were prospectively enrolled by shared decision making for the DAA (32 patients) or PA (26 patients). Baseline data were collected preoperatively and outcomes postoperatively at 2-, 6-, 9- and 12-month follow-up. There is no significant difference (p < 0.05) between the DAA and PA on primary outcome (OHS). There was a main effect of time which indicated an increase of OHS over time independent of group (p < 0.01). In the current study, no significant differences in postoperative functional outcome were found between DAA and PA in all follow-up moments.

Plasma Levels of Neuron/Glia-Derived Apoptotic Bodies, an In Vivo Biomarker of Apoptosis, Predicts Infarct Growth and Functional Outcome in Patients with Ischemic Stroke.

Evidence demonstrating the involvement of apoptosis in the death of the potentially salvageable area (penumbra zone) in patients during stroke remains limited. Our aim was to investigate whether apoptotic processes occur in penumbral brain tissue by analyzing circulating neuron- and glia-derived apoptotic bodies (CNS-ApBs), which are vesicles released into the bloodstream during the late stage of apoptosis. We have also assessed the clinical utility of plasma neuronal and glial apoptotic bodies in predicting early neurological evolution and functional outcome. The study included a total of 71 patients with acute hemispheric ischemic stroke (73 ± 10years; 30 women). Blood samples were collected from these patients immediately upon arrival at the hospital (within 9h) and at 24 and 72h after symptom onset. Subsequently, isolation, quantification, and phenotypic characterization of CNS-ApBs during the first 72h post-stroke were performed using centrifugation and flow cytometry techniques. We found a correlation between infarct growth and final infarct size with the amount of plasma CNS-ApBs detected in the first 72h after stroke. In addition, patients with neurological worsening (progressive ischemic stroke) had higher plasma levels of CNS-ApBs at 24h after symptom onset than those with a stable or improving course. Circulating CNS-ApB concentration was further associated with patients' functional prognosis. In conclusion, apoptosis may play an important role in the growth of the cerebral infarct area and plasma CNS-ApB quantification could be used as a predictive marker of penumbra death, neurological deterioration, and functional outcome in patients with ischemic stroke.

Treatment outcome of chronic patellar tendon rupture using autogenous semitendinosus graft: a retrospective case series.

This study highlights the pattern of presentation, treatment, early functional outcome, and complications observed in the management of chronic patellar tendon ruptures using our preferred technique of autogenous semitendinosus graft reconstruction. This was a retrospective case series involving consecutive patients who underwent patellar tendon reconstruction and met the inclusion criteria. The outcome measures were determined by thepost-operative knee range of motion (R.O.M), thepost-operative International Knee Documentation Committee (IKDC) score, and pattern of post-operative complications. Nine patients were included in this case series. The mean age of the patients was 35.4 ± 6.8years (range 27-44years). Trauma to the knee accounted for majority of the cases (62.5%). Six (66.7%) of the nine patients suffered a patellar tendon rupture from contact injury during sporting activities. The mean length of time from injury to presentation was 20.5 ± 11.2weeks (range 6-69.5weeks). Normal knee function in a case (11.1%), nearly normal knee function in 7 cases (77.8%), and abnormal knee function in a case (11.1%) were recorded as a measure of outcome of surgery. The mean post-operative IKDC score was 70.0 ± 6.1 (range 55-77), which was higher than the mean pre-operative score of 26.4 ± 5.1 (range 18-32). The post-operative knee R.O.M averaged 97.2 ± 16.2° (range 70-120°) with a single case with a 10° extension lag noted. Normal to near-normal knee function was obtained with the treatment of chronic patellar tendon rupture in the majority of cases using autogenous semitendinosus graft for patellar tendon reconstruction in our series.

Early Functional Outcomes and Complications of Tibial and/or Peroneal Sesamoidectomy Utilizing a Burr Through a Medial Approach.

Sesamoid pathology can lead to significant pain and disability both with activities of daily living and high-impact athletic movements. Sesamoidectomy is a widely used procedure for patients who fail conservative treatment measures. Traditional dorsal or plantar approaches for sesamoidectomy have shown to successfully alleviate pain, but complications were reported. A proposed alternative medial approach using a burr may provide many advantages compared with traditional approaches. This study presents patient outcomes and complications for this technique. This was a retrospective chart review of patients undergoing sesamoidectomy (tibial, peroneal, or both) using a burr through a medial approach to the sesamoid metatarsal articulation. Data collected included patient demographics, radiographic analysis, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), patient satisfaction, and complications. Twenty-seven patients (29 feet) were included. The mean age was 38.4 years followed up for a mean of 30.9 months. VR-12 physical component improved from 35.98 ± 7.86 to 51.34 ± 8.01 (P < .001), FAAM ADL and sport improved from 58.33 ± 16.61 to 83.27 ± 18.28 (P < .001) and 26.37 ± 20.31 to 63.75 ± 29.74 (P < .001), respectively. Patient satisfaction with the treatment was 80.59% ± 27.06%. The overall complication rate was 11 (37.9%) whereas the overall reoperation rate was 4 (13.7%) of 29 feet. Complications included 1 arthrofibrosis, 1 flexor hallucis longus subacute rupture, and 1 asymptomatic hallux valgus. There were no sesamoid excision revisions. Sesamoidectomy using a medial approach with a burr provided significantly improved short-term functional outcomes, 80% patient satisfaction rate, with a relatively acceptable complications rate including 20% persistent pain. The medial approach is familiar to orthopaedic foot and ankle surgeons, provides adequate exposure, and eliminates the possibility of a painful plantar scar while avoiding disruption of the plantar plate, flexor hallucis brevis tendon, and ligamentous structures attached to the sesamoids. Larger studies with long-term follow-up from other centers are needed.

Diameter of Quadrupled Semitendinosus Autograft in Primary Anterior Cruciate Ligament Reconstruction Did Not Impact Early Revision Rate or Functional Outcome in a Large Cohort of Patients

To determine whether the diameter of the quadrupled semitendinosus tendon (ST) graft in primary anterior cruciate ligament reconstruction (ACLR) is related to the risk of revision ACLR within 2 years of primary ACLR, postoperative knee laxity and patient reported knee outcome. Furthermore, to investigate whether smaller graft than estimated is related to revision ACLR. Patients who underwent primary ACLR with a quadrupled ST autograft at our institution, from January 2005 to December 2017 were identified. Data from the Swedish National Knee Ligament Registry (SNKLR) were collected up to two years or until revision surgery was registered within two years after primary ACLR. Knee laxity was assessed, pre-operatively and at 6-months follow up using the KT-1000 arthrometer (134 N anterior tibial load). The Knee injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and at two years postoperatively from SNKLR. Based on anthropometric measurements (body height and weight) and sex the estimated quadrupled ST graft diameter was calculated. A total of 4,519 patients who underwent ACLR with a quadrupled ST autograft were included. The mean graft diameter was 8.3 mm± 0.7 mm; 8.0 mm± 0.6 mm for women and 8.6 mm ± 0.7 mm for men. The quadrupled ST graft diameter was not significantly correlated to revision ACLR. There was no significant difference in the ST graft diameter regarding post-operative knee laxity. The correlations between ST graft diameter and KOOS were weak, except for the "Sport and Recreation" subscale (P=.012). The quadrupled ST graft diameter was not significantly related to the need for early revision ACLR nor was related to postoperative knee laxity or patient reported outcome except for the KOOS "Sport and Recreation" subscale. Smaller ST graft than estimated was not a risk factor for revision ACLR. The outcome after ACLR is multifactorial and ST graft diameter is of no significant importance.

Early functional recovery outcomes and return to work after primary total hip arthroplasty: a novel patient reported outcomes questionnaire

PurposeClinical and patient reported outcomes are often collected before and after the procedure to benchmark and study outcomes for patients. These outcomes and scores are useful for tracking patient outcomes after surgery, however, the fact that these commonly used measures typically provide information about a patient’s level of pain and function at a single point in time is a limitation.MethodsWe present early functional recovery and return to work outcomes after primary THA from a novel questionnaire administered in a global, multi-center, prospective clinical study.ResultsBy 6 and 12 weeks post-op, a large proportion of study subjects were able to perform functional recovery outcomes after their THA: walk without an aid (74%; 94%); drive (76%; 97%); basic activities of daily living (94%; 99%); perform light household duties (91%; 96%); perform moderate-to-heavy household duties (54%; 86%); go up and down a flight of stairs (92%; 99%); put on socks/stockings (77%; 93%); bend down to pick up an object from the floor (87%; 97%); stand up from a chair (96%; 99%); perform leisure recreational activities (54%; 84%); perform primary goal identified pre-THA (69%; 86%). 60% were able to return to work by 12 weeks post-op. These questions showed strong association with the Forgotten Joint Score.ConclusionExcellent patient reported early functional recovery outcomes and satisfaction were observed at 6- and 12-weeks post-op in this cohort and is the first reported data using a novel PRO.Clinical trial registrationNCT03189303, registered June 14, 2017.

Robotic arm-assisted conversion of unicompartmental knee arthroplasty to total knee arthroplasty.

Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up. This prospective study included 16 patients undergoing robotic arm-assisted revision of UKA to TKA versus 35 matched patients receiving robotic arm-assisted primary TKA. In all study patients, the following data were recorded: operating time, polyethylene liner size, change in haemoglobin concentration (g/dl), length of inpatient stay, postoperative complications, and hip-knee-ankle (HKA) alignment. All procedures were performed using the principles of functional alignment. At most recent follow-up, range of motion (ROM), Forgotten Joint Score (FJS), and Oxford Knee Score (OKS) were collected. Mean follow-up time was 21 months (6 to 36). There were no differences between the two treatment groups with regard to mean change in haemoglobin concentration (p = 0.477), length of stay (LOS, p = 0.172), mean polyethylene thickness (p = 0.065), or postoperative complication rates (p = 0.295). At the most recent follow-up, the primary robotic arm-assisted TKA group had a statistically significantly improved OKS compared with the revision UKA to TKA group (44.6 (SD 2.7) vs 42.3 (SD 2.5); p = 0.004) but there was no difference in the overall ROM (p = 0.056) or FJS between the two treatment groups (86.1 (SD 9.6) vs 84.1 (4.9); p = 0.439). Robotic arm-assisted revision of UKA to TKA was associated with comparable intraoperative blood loss, early postoperative rehabilitation, functional outcomes, and complications to primary robotic TKA at short-term follow-up. Robotic arm-assisted surgery offers a safe and reproducible technique for revising failed UKA to TKA.

Superior versus anterior plating of midshaft clavicle fractures: 6 months follow up (union rates, risks, and complications: hardware irritation and need for removal)

Background Operative management of midshaft clavicle fractures is gaining popularity. The clavicle is a tubular bone with a flat lateral end. Open reduction and internal fixation could be achieved by the application of plates and screws either to the superior or anterior surface of the clavicle. However, there is no consensus in the literature to support one technique over the other. This study aims to compare the early functional and radiographic outcomes of anterior versus superior plating for the treatment of midshaft clavicle fractures. Patients and methods From March 2021 to November 2022, a prospective randomized clinical trial was conducted at our institute. We included all patients with isolated midshaft clavicle fractures. Thirty-six patients were randomized by the closed envelope technique, 18 were managed with superior plating (superior group), and the other 18 patients were managed using anterior plating (anterior group). All patients were followed up for 6 months. All patients were assessed clinically for union, range of motion, and functional scores. The secondary outcome measures included operative time, complications, hardware irritation, and the need for hardware removal or secondary procedure. Results The mean time to full union was 11.28 weeks in the anterior group and 11.72 weeks in the superior group. Mean constant shoulder score for the anterior group was 84.11 while for the superior group it was 82.67. No patients had skin and wound complications in the anterior group versus one patient in the superior group that got superficial infection successfully managed by repeated dressing and antibiotics. There was no statistically significant difference between superior and anterior plating regarding union, functional scores, return to ADLs, hardware problems, or complications. Conclusion Both superior and anterior plating of the clavicle fractures are safe treatment options for displaced midshaft clavicle fractures, and they lead to similar functional outcomes, functional scores, and complication rates. Moreover, the selection of the technique of plating depends on surgeon preferences.