Non-traumatic osteonecrosis of the femoral head is a potentially devastating condition, the prevalence of which is increasing. Many joint-preserving forms of treatment, both medical and surgical, have been developed in an attempt to slow or reverse its progression, as it usually affects young patients. However, it is important to evaluate the best evidence that is available for the many forms of treatment considering the variation in the demographics of the patients, the methodology and the outcomes in the studies that have been published, so that it can be used effectively. The purpose of this review, therefore, was to provide an up-to-date, evidence-based guide to the management, both non-operative and operative, of non-traumatic osteonecrosis of the femoral head. Cite this article: 2017;99-B:1267-79.

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Robotic arm-assisted total knee arthroplasty (RATKA) presents a potential, new added value for orthopedic surgeons. In today's health care system, a major determinant of value can be assessed by patient satisfaction scores. Therefore, the purpose of the study was to analyze patient satisfaction outcomes between RATKA and manual total knee arthroplasty (TKA). Specifically, we used the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to compare (1) pain scores, (2) physical function scores, and (3) total patient satisfaction outcomes in manual and RATKA patients at 6 months postoperatively. In this study, 28 cemented RATKAs performed by a single orthopedic surgeon at a high-volume institution were analyzed. The first 7 days were considered as an adjustment period along the learning curve. Twenty consecutive cemented RATKAs were matched and compared with 20 consecutive cemented manual TKAs performed immediately. Patients were administered a WOMAC satisfaction survey at 6 months postoperatively. Satisfaction scores between the two cohorts were compared and the data were analyzed using Student's t-tests. A p-value < 0.05 was used to determine statistical significance. The mean pain score, standard deviation (SD), and range for the manual and robotic cohorts were 5 ± 3 (range: 0–10) and 3 ± 3 (range: 0–8, p < 0.05), respectively. The mean physical function score, SD, and range for the manual and robotic cohorts were 9 ± 5 (range: 0–17) and 4 ± 5 (range, 0–14, p = 0.055), respectively. The mean total patient satisfaction score, SD, and range for the manual and robotic cohorts were 14 points (range: 0–27 points, SD: ± 8) and 7 ± 8 points (range: 0–22 points, p < 0.05), respectively. The results from this study further highlight the potential of this new surgical tool to improve short-term pain, physical function, and total satisfaction scores. Therefore, it appears that patients who undergo RATKA can expect better short-term outcomes when compared with patients who undergo manual TKA.

As with most new surgical technologies, there is an associated learning curve with robotic-assisted total knee arthroplasty (TKA) before surgeons can expect ease of use to be similar to that of manual cases. Therefore, the purpose of this study was to (1) assess robotic-assisted versus manual operative times of two joint reconstructive surgeons separately as well as (2) find an overall learning curve. A total of 240 robotic-assisted TKAs performed by two board-certified surgeons were analyzed. The cases were sequentially grouped into 20 cases and a learning curve was created based on mean operative times. For each surgeon, mean operative times for their first 20 and last 20 robotic-assisted cases were compared with 20 randomly selected manual cases performed by that surgeon as controls prior to the initiation of the robotic-assisted cases. Each of the surgeons first 20 robotic assisted, last 20 robotic assisted, and 20 controls were then combined to create 3 cohorts of 40 cases for analysis. : First and last robotic cohort operative times were 81 and 70 minutes ( < 0.05). Mean operative times for the first 20 robotic-assisted cases and manual cases were 81 versus 68 minutes ( < 0.05). Mean operative times for the last 20 robotic-assisted cases and manual cases were 70 versus 68 minutes ( > 0.05). : First and last robotic cohort operative times were 117 and 98 minutes ( < 0.05). Mean operative times for the first 20 robotic-assisted cases and manual cases were 117 versus 95 ( < 0.05). Mean operative times for the last 20 robotic-cohort cases and manual cases were 98 versus 95 ( > 0.05). A similar trend occurred when the times of two surgeons were combined. The data from this study effectively create a learning curve for the use of robotic-assisted TKA. As both surgeons completed their total cases numbers within similar time frames, these data imply that within a few months, a board-certified orthopaedic joint arthroplasty surgeon should be able to adequately perform robotic TKA without adding any operative times.

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