Medicine and Health Sciences Commons^™

A Clinical Review Of Robotic Navigation In Total Knee Arthroplasty: Historical Systems To Modern Design., Ahmed Siddiqi, Timothy Horan, Robert M Molloy, Michael R Bloomfield, Preetesh D Patel, Nicolas S Piuzzi

Orthopedic Surgery Resident Research

Robotic-assisted total knee arthroplasty (RA-TKA) has shown improved reproducibility and precision in mechanical alignment restoration, with improvement in early functional outcomes and 90-day episode of care cost savings compared to conventional TKA in some studies. However, its value is still to be determined.Current studies of RA-TKA systems are limited by short-term follow-up and significant heterogeneity of the available systems.In today's paradigm shift towards an increased emphasis on quality of care while curtailing costs, providing value-based care is the primary goal for healthcare systems and clinicians. As robotic technology continues to develop, longer-term studies evaluating implant survivorship and complications will determine …

Reducing Length Of Stay After Total Hip And Knee Arthroplasty: Assessing Cost-Effectiveness, Caregiver Involvement And Surgical Approach, Bryn O. Zomar

Electronic Thesis and Dissertation Repository

Purpose

The overall purpose of this dissertation was to evaluate factors related to reducing length of stay after total hip and knee arthroplasty (THA and TKA).

Methods

Study 1 was a randomized controlled trial (RCT) to investigate the cost-effectiveness of outpatient THA compared to standard overnight stay. Study 2 was a prospective cohort study to assess patient- and caregiver-related factors and how they may relate to caregiver strain and level of assistance when caring for patients undergoing THA and TKA. Finally, Study 3 was a 2x2 factorial RCT to compare the trajectory of early functional recovery between the medial parapatellar …

Biomechanical Analysis Of Total Knee Arthroplasty Performed On A 6 Degree Of Freedom Joint Motion Simulator Linked To A Virtual Ligament Model In Mechanical And Kinematic Alignments, Jance Mcgale

Electronic Thesis and Dissertation Repository

Total knee arthroplasty (TKA) is a very successful surgery providing many patients with increased quality of life. Despite this, some patients are dissatisfied. There are also complications with total knee arthroplasty that lead to the need for revision surgery. Improvements in stability, soft tissue balance, joint kinematics and overall patient satisfaction may lead to a decrease in TKA revisions. It is still unclear what the optimal soft tissue tension, balance or alignment is to provide superior patient outcomes. Computational models provide a means to effectively parameterize ligaments and simulate multiple scenarios of TKA. This work implemented a sophisticated 6-degree of …

The Impact Of Surgical Technique On Coronal Plane Motion In Total Knee Arthroplasty, Kevin I. Perry

Electronic Thesis and Dissertation Repository

There are two predominant techniques used by most surgeons to perform total knee arthroplasty: gap balancing and measured resection. The purpose of the current study was to observe if surgical technique has an effect on post-operative coronal plane balance throughout range of motion and to observe if surgical technique has an effect on tibial and femoral component migration. This was a randomized, prospective controlled trial. Twenty-three patients (24 knees) were enrolled: twelve knees in each group. All knees showed migration of their components from the initial RSA to their RSA at 6 months. Migration was similar for both groups, but …

The Association Between Soft Tissue Releases And Bony Resections Performed During Total Knee Arthroplasty And Patients' Pain And Satisfaction Postoperatively, Matt Carter

Electronic Thesis and Dissertation Repository

Total knee arthroplasty (TKA) is a surgical treatment of degenerative knee conditions such as osteoarthritis to reduce pain and increase function. Intraoperative soft tissue releases (STRs) and bony resections (BRs) are necessary for a balanced and aligned TKA. It is possible that the degree of STRs and BRs is related to final outcome following TKA and thus there may be implications for patient rehabilitation, patient expectations, pain medications, and timelines for recovery. Thus, our primary objective was to examine the association between the number of STRs and BRs performed intraoperatively and patients’ satisfaction and pain at three months. We performed …

Ultrasound Guided Motor Sparing Knee Blocks For Postoperative Analgesia Following Total Knee Arthroplasty, Olawale A. Sogbein

Electronic Thesis and Dissertation Repository

Postoperative total knee arthroplasty (TKA) pain is severe and can inhibit patients’ rehabilitation. We devised a single injection motor sparing knee block (MSB) by targeting the adductor canal and lateral femoral cutaneous nerve with a posterior knee infiltration under ultrasound. Our primary objective was to evaluate the duration of the MSB compared to a standard periarticular infiltration (PAI) using time to first rescue analgesia as the end point. We randomized 82 patients undergoing TKA to receive either preoperative MSB or intraoperative periarticular infiltration. Duration of analgesia was significantly longer in the MSB group with a mean difference of 8.8 hours. …

Predictors Of Appropriate Referral To Total Knee Arthroplasty: A Validation Study, Samuel J. Malian

Electronic Thesis and Dissertation Repository

Approximately 45% of referrals from primary care physicians to arthroplasty surgeons are inappropriate. Currently, Canadians are waiting over three months for consultation with an arthroplasty surgeon. Reducing the proportion of inappropriate referrals will reduce the wait time to first consultation with an arthroplasty surgeon. This study’s objective was to validate a model that identified patient-reported predictors of appropriate referrals to arthroplasty. We screened 258 patients attending their first consultation with an arthroplasty surgeon. Participants completed the questionnaires prior to their appointment and the surgeon detailed each consultation outcome on a standardized form. We constructed our validation model using the same …