Background: As robot-assisted equipment is continuously being used in orthopaedic surgery, the past few decades have seen an increase in the usage of robotics for total knee arthroplasty (TKA). Thus, the purpose of the present study is to investigate the differences between robotic TKA and nonrobotic TKA on perioperative and postoperative complications and opioid consumption. Methods: An administrative database was queried from 2010 to Q2 of 2017 for primary TKAs performed via robot-assisted surgery vs nonerobot-assisted surgery. Systemic and joint complications and average morphine milligram equivalents were collected and compared with statistical analysis. Results: Patients in the nonrobotic TKA cohort had higher levels of prosthetic revision at 1-year after discharge (P < .05) and higher levels of manipulation under anesthesia at 90 days and 1-year after discharge (P < .05). Furthermore, those in the nonrobotic TKA cohort had increased occurrences of deep vein thrombosis, altered mental status, pulmonary embolism, anemia, acute renal failure, cerebrovascular event, pneumonia, respiratory failure, and urinary tract infection during the inpatient hospital stay (all P < .05) and at 90 days after discharge (all P < .05). All of these categories remained statistically increased at the 90-days postdischarge date, except pneumonia and stroke. Patients in the nonrobotic TKA cohort had higher levels of average morphine milligram equivalents consumption at all time periods measured (P < .001). Conclusions: In the present study, the use of robotics for TKA found lower revision rates, lower incidences of manipulation under anesthesia, decreased occurrence of systemic complications, and lower opiate consumption for postoperative pain management. Future studies should look to further examine the long-term outcomes for patients undergoing robot-assisted TKA.

Background Proximal humerus fractures are the third most common fracture in older adults. Because of the aging population, the incidence of these fractures and their impact will continue to grow. With advancement in treatment options for proximal humeral fractures, the aim of this study was to evaluate the trends in acute management of proximal humerus fractures to determine how definitive treatment has changed over the past decade in patients older than 65 years. Methods Using a commercially available database, patient records were queried from 2010 to 2019 for the incidence of proximal humerus fractures. For each individual year, data were queried to identify the incidence of closed reduction percutaneous pinning (CRPP), hemiarthroplasty (HA), intramedullary nailing (IMN), open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), or nonoperative treatment for acute proximal humeral fractures. A Cochran-Armitage trend test was used to determine significant changes in the trends of proximal humerus fracture management. Logistic regression analyses were performed to generate odds ratios (OR) with associated 95% confidence intervals comparing each individual procedure performed in 2019 to 2010. Results A total of 160,836 patients at least 65 years of age and older were diagnosed with a proximal humerus fracture. Of this total, 28,503 (17.72%) patients received operative treatment and 132,333 (82.28%) received nonoperative treatment. From 2010 to 2019, operative treatment trends of proximal humerus fractures changed such that CRPP decreased by 60.0%, HA decreased by 81.4%, IMN decreased by 81.9%, ORIF decreased by 25.7%, TSA decreased by 80.5%, and RSA increased by 1841.4% (all P < .0001). Overall, nonsurgical management increased from 80% to 85% during the examined study period ( P < .0001). Patients in 2019 were significantly more likely to receive an RSA (OR 22.65) and were significantly less likely to receive CRPP (OR 0.45), HA (OR 0.20), IMN (OR 0.20), ORIF (OR 0.82), and TSA (OR 0.22) than patients in 2010. In addition, patients in 2019 were significantly more likely to receive nonoperative treatment than patients in 2010 (OR 1.10). Conclusion Over the past decade, most of older adults who sustain proximal humerus fractures continue to receive nonoperative treatment. Although CRPP, IMN, HA, ORIF, and TSA have decreased, RSA has recently become more widely utilized, which is consistent with what has been noted in other countries. Continued examination of the mid- and long-term outcomes of the increasing percentages in RSA should be performed in this population.

This study was performed to analyze the effect that coronavirus 2019 (COVID-19) has had on orthopedic surgeons' practices, their patients, and orthopedic surgeons themselves through a survey distributed to members of the Louisiana Orthopaedic Association (LOA). An anonymous 22-question online survey was created and distributed to 323 LOA members. Of the 323 recipients of the survey, 99 (30.7%) responded. As a part of a multiple response set, in which respondents could choose more than one answer, the majority reported delayed care for routine orthopedic injuries (81 of 97, 83.5%). Almost every surgeon (n=95, 96.0%) reported stopping or delaying elective surgery because of COVID-19 and an increase in pain/disability/deformity in patients due to delay in elective procedures (73 of 97, 75.3%) and delay in seeking care (66 of 97, 68.0%). The majority reported an increased use of telehealth visits (68 of 97, 70.1%), a decrease in patient volume (88 of 97, 90.7%), and a reduction in income (79 of 98, 80.6%) during the past 6 months. A majority of surgeons (58 of 98, 59.2%) reported that they had applied for government assistance or took out loans. Via a multiple response set, respondents indicated that as a result of the pandemic, telehealth will become more widespread (64 of 98, 65.3%) and hospitals will exert a stronger influence over health care (64 of 98, 65.3%). The COVID-19 pandemic has had lasting effects on orthopedic surgeons in Louisiana and their practices, with a substantial decrease in the number of patients treated (90.5%), surgical volume, and revenue (80.6%). Orthopedic surgeons affected by the pandemic could use these data to further understand future challenges with patient care and changing orthopedic practice dynamics during this unique time. [ Orthopedics . 2020;43(6):351–355.]

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