Shreepal Munot

Abstract

Background: Robotic assisted total knee arthroplasty is one the recent advance to improve its outcome especially to address the issue of precision. Longetivity of TKA primarily depends on proper implant alignment. The Aim of this study is to compare the precision of robotic assisted TKA with the ideally planned mechanical parameters in TKA. Materials and Methods: A total of 50 robotic assisted TKA patients were included retrospectively in the study. Patient’s post operative mechanical femorotibial angle (mFTA), Lateral distal femoral angle (LDFA), medial proximal tibial angle (mPTA) in AP radiogram.and anterior femoral offset ratio, posterior condylar offset ratio, femoral component flexion, posterior tibial slope in lateral radiograms were evaluated with ideal values for specific parameter. Number of outliers were counted separately with values beyond 3 of malalignment. Results: The mean postoperative FTA, LDFA, mPTA recorded is 0.15 ±0.70, 89.78±0.79, 89.80±0.86 respectively. The mean postoperative posterior tibial slope, femoral flexion is 3.03±0.35, 3.14±0.60 respectively. All the parameters when compared with planned ideal values (i.e. mFTA= 0, mPTA=90, LDFA=90, Posterior tibial slope=3, femoral component flexion=3) did not show significant difference. Conclusion: Study shows promising results with near normal execution of planned TKA. Robotic assisted TKA can be a game changer and a handy tool to improve the alignment of mechanical axis in TKAs.   Keywords: Total knee arthroplasty, Robotic assisted knee replacement, Precision, Limb alignment and balancing.

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Abstract

Introduction: Robotic surgery is one of the recent advance in total knee replacement. It aims for accuracy and precision in execution of surgery. This case report shows a patient with osteoarthritis knee with old implants around knee managed with robotic assisted knee surgery to achieve best possible outcome without removal of previous implant. Case Report: We present a case of 70 years old male patient with history of right knee pain, severe deformity and past history of surgery for right femur and tibia fracture 30 years back with previous implants in situ. After investigation and pre-operative planning we did single stage knee replacement surgery using robotic assistance, all deformities corrected and achieved well balanced knee without removal of previous implant and just using primary knee replacement prosthesis. Conclusion: Robotic knee replacement surgery definitely makes surgeons task easy and more précised not only to address difficult cases but also allows to manage severe deformities without using revision implants. Keywords: Robotic knee replacement, Osteoarthritis, Total knee replacement, Deformity correction, Implant around knee.

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Abstract

Introduction: Treatment of intertrochanteric fracture in elderly is not only to mobilise early but also to avoid complications and morbidity. With available treatments it is difficult to address all the issue with same surgical option. A recent advance for treatment of senile unstable intertrochanteric fracture is PFN antirotation which may help in early mobilisation with less complications. The purpose of this study is to compare the outcome of PFNA and hemiarthoplasty and to study advantages, disadvantages, complications of both the groups. Materials and Methods: 20 patients each were included in PFNA group and hemiarthroplasty group from January 2016 to January 2017 who satisfied the inclusion and exclusion criteria. Patient followed up upto 1 year. Patients were evaluated with multiple variables, complications and harris hip score. Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. Both groups had similar medical and orthopaedic complications. PFNA patients can be mobilised early as with hemiarthroplasty group. Hemiarthoplasty groups have better harris hip score in initial 3 months but similar score at the end of 1 year. Conclusion: PFNA provide less morbidity to patients with early mobilisations and good functional outcome. It can definitely be a better option than replacement in elderly intertrochanteric fracture. Keywords: PFNA, Bipolar, Intertrochanteric fracture, Hemiarthroplasty, Harris hip score, Replacement.

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