The purpose of this study is to report the overall infection control rate and prognostic factors associated with acute, hematogenous and chronic PJIs treated with DAIR. All DAIR procedures performed at 2 institutions from 2009 to 2018 (n=104) were reviewed and numerous data were recorded, including demographics, preoperative laboratory tests, Charleston Comorbidity Index, surgical information and organism culture results. Treatment success was defined according to the criteria reported by Diaz-Ledezma. A multivariable analysis was utilized to identify prognostic factors associated with treatment and a Kaplan-Meier survival analysis was used to depict infection control rate as a function of time.Aim
Methods
Primary robotic-arm assisted total hip arthroplasty (THA) yields more accurate and reproducible acetabular cup placement, nonetheless, data is scarce in terms of outcomes. The purpose of the present study was to report on patient-reported outcomes (PROMs) in a large group of patients who underwent robotic-arm assisted THA. The authors hypothesized that (1) patients who underwent robotic-arm assisted primary THA would achieve favorable and significant improvement in PROMs, (2) an accurate and reproducible acetabular cup placement with respect to the defined SafeZones would be obtained, and (3) a low rate of THA dislocation would be observed. Prospectively collected data were retrospectively reviewed between April 2012 to May 2017. Primary THA using Mako Robotic-Arm [Mako Surgical Corp. (Stryker), Fort Lauderdale, FL, USA] with minimum two-year follow-up for the Harris Hip Score (HHS) and the Forgotten Joint Score-12 (FJS-12) were included. Exclusion criteria were: bodymass index (BMI) > 40 kg/m2, age < 21-year old, worker's compensation, or unwilling to participate. Visual analog scale (VAS) for pain and patient satisfaction were obtained. Intraoperative measurements for leg-length, global offset, acetabular inclination and version were documented.Introduction
Methods
Acetabular cup positioning remains a real challenge and component malpositioning after total hip arthroplasty (THA) can lead to increased rates of dislocation and wear. It is a common cause for revision THA. A novel 3D imageless mini-optical navigation system was used during THA to provide accurate, intraoperative, real-time, and non-fluoroscopic data including component positioning to the surgeon. This retrospective comparative single surgeon and single approach study examined acetabular component positioning between traditional mini-posterolateral THA and mini-posterolateral THA using the 3D mini-optical navigation system. A retrospective chart review was conducted of 157 consecutive (78 3D mini-optical navigation and 79 traditional non-navigation methods) THAs performed by the senior author using a mini-posterolateral approach at an ambulatory surgery center and hospital setting. Two independent reviewers analyzed postoperative radiographs in a standardized fashion to measure acetabular component positioning. Demographic, clinical, surgical, and radiographic data were analyzed. These groups were found to have no statistical difference in age, gender, and BMI (Table I). There was no difference between groups in acetabular components in the Lewinnek safe zone, 31.2% vs 26.6% ( For any figures or tables, please contact the authors directly.
Patient-specific instrumentation (PSI) is a novel technique in total knee arthroplasty (TKA) which potentially permits more accurate alignment of the components; however, there is no consensus in literature regarding the accuracy and reliability of PSI as many studies have shown controversial and inconsistent results of various PSI systems. A 24-month follow-up study was carried out to compare perioperative clinical outcomes, radiological limb alignment and component positioning, as well as functional outcomes following TKA between PSI and conventional instrumentation (CI). During September 2011 and August 2012, 90 consecutive patients were scheduled to undergo unilateral TKA with either PSI or CI. TruMatch® Personalised Solutions was used in this study, and a senior surgeon performed all operations. Patients were clinically assessed before, 6-month and 24-month after surgery.Objective
Methods
Failures in total knee arthroplasty (TKA) have been associated with overall lower limb malalignment and component malposition. Although traditional computer navigation systems improve component placement, they require fixation of the femoral and tibial reference arrays for software recognition using anchoring pins. This increases the risk of bony fracture, pin sites infection and osteomyelitis. This study aims to evaluate the accuracy of a new hand held navigation system (BrainLAB® Dash® Navigation system) that will avoid these complications.Introduction
Aim
Standard image-free navigation systems have proven to improve the accuracy of components placement and reduce the proportion of outliers for lower limb mechanical axis in total knee arthroplasty (TKA). However, their disadvantages include a longer duration of surgery and pin-tract related complications. More recently, pinless navigation has been developed to address these shortcomings. This study aims to investigate the effectiveness of a new pinless navigation system (Zimmer® iAssist™ Knee) in TKA. Power analysis was performed. To detect a significant difference in the proportion of outliers for lower limb mechanical axis at a power of 0.80, a sample size of 50 patients would be required. Between May 2013 and April 2014, 50 patients diagnosed with osteoarthritis of the knee were divided into two surgical technique arms: 1) iAssist™; 2) conventional TKA. One Adult Reconstruction surgeon performed all the surgeries. The patients were prospectively followed up and postoperative long leg radiographs were taken at one month post-surgery. Two reviewers blinded to the surgical method performed the measurements on radiographic films. Five radiographic measurements were measured: 1) Hip-Knee-Ankle Angle (HKA); 2) Coronal Femoral-Component Angle (CFA); 3) Coronal Tibia-Component Angle (CTA); 4) Sagittal Femoral-Component Angle (SFA); and 5) Sagittal Tibia-Component Angle (STA), The Mann-Whitney U test was used to compare the two groups for quantitative variables while the Fisher's exact test was used for categorical variables.Introduction
Methods
Total knee arthroplasty (TKA) has proven to be cost-effective and efficative in the treatment of osteoarthritic knees. Although traditional computer navigation systems improve implant placement, they require fixation of the femoral and tibial reference arrays for software recognition using anchoring pins. This increases the risk of bony fracture, pin sites infection and osteomyelitis. Our study aims to investigate the accuracy of a new inless navigation system (Brainlab VectorVision Knee 2.5 Navigation System) that would avoid these complications. 119 patients were prospectively recruited over a year. These patients all underwent a primary TKA by a senior surgeon who performs more than 200 TKAs per annum. They were divided into two surgical technique arms. In Group 1, 74 patients underwent TKA using conventional techniques. In Group 2, 45 patients underwent TKA using a pinless navigation system. Post-operative films were taken and three radiographic measurements were measured: 1) Hip-Knee-Ankle Angle (HKA); 2) Coronal Femoral-Component Angle (CFA); 3) Coronal Tibia-Component Angle (CTA) (Figure 1). Two reviewers blinded to the surgical method performed the measurements on the radiographic films on two separate occasions.Introduction
Methods
