Background:Robotic-assisted (RA) technology is becoming increasingly popular in total knee arthroplasty (TKA) due to its improved alignment, accuracy, and precision compared with the conventional TKA. Despite reported benefits, disagreements exist regarding patientreported outcomes and complication rates comparing RA TKA and conventional TKA. Thus, the purpose of the study is to report differences in patient outcomes and complication rates between patients who underwent RA versus conventional TKA. Methods:The authors retrospectively reviewed 239 primary knee arthroplasty cases (n = 137 robot-assisted and n = 102 conventional TKA) performed by a single fellowship-trained orthopaedic surgeon from January 1, 2016 to February 26, 2019. The electronic medical record and patient outcomes database were reviewed for demographic characteristics (age, sex, body mass index, and comorbidities), patient-reported outcomes (Short Form Health Survey and Oxford Knee Score), 90-day complications, and revision rates. Results:There was no statistically significant difference in patient-reported outcomes between conventional versus RA groups at two time points: preoperative and 2-year. Differences remained insignificant after controlling for age, sex, body mass index, and comorbidities. There was no statistically significant difference between the conventional and RA groups in revision rates (0.7% and 1%, respectively; P = 1.00) or complication rates (1.5% and 3.9%, respectively; P = 0.406). Conclusions:There were no differences in 90-day complications, revisions, and patient-reported outcome scores between RA TKA and conventional TKA groups at short-term follow-up. Surgeons can expect similar clinical outcomes without an increase in complications while taking advantage of increased accuracy in alignment and component placement. Further long-term study of RA TKA outcomes is warranted.

Standard multimodal pain management for anterior cruciate ligament reconstruction typically includes a combination of local anesthetics, nonsteroidal anti-inflammatory drugs, and opioids. Opioids present a substantial risk, and there is a rising number of prescription opioid-related overdoses in the United States. The goal of this study was to evaluate the quantity of opioids prescribed to patients who received liposomal bupivacaine as a component of their multi-modal pain regimen. The electronic medical records of patients who underwent anterior cruciate ligament reconstruction by a single surgeon at an urban hospital during a 2-year period were evaluated. Patients in the case group received liposomal bupivacaine and those in the control group did not. Statistical analysis of the number of pills prescribed and numeric pain rating scale scores was performed with a 2-tailed unequal variance t test. Statistical analysis of opioid prescription refills was performed with a chi-square test. A total of 67 patients were included. The mean number of 5-mg oxycodone tablets prescribed to the case group (9.29±10.29 tablets) was significantly lower ( P <.01) compared with the number prescribed to the control group (66.26±37.13 tablets). Patients in the case group also were less likely to require an opioid prescription refill at the first follow-up appointment ( P <.01; absolute risk reduction, 50%; number needed to treat, 2). Mean numeric pain rating scale score at 2 weeks was 2.8±2.1 in the case group and 3.8±2.4 in the control group ( P =.09). Patients who received liposomal bupivacaine as part of multimodal pain management had significantly fewer opioid prescriptions. Despite the reduction in opioids prescribed, patients in the case group only showed a trend toward a reduction in pain at 2-week follow-up. [ Orthopedics . 2021;44(2):e229–e235.]

No abstract

Background:With projected increases in total knee arthroplasties (TKA), patient outcomes without complications are essential. Arthrofibrosis, a potential complication after TKA that may impact longterm patient outcome, may be remedied by manipulation under anesthesia (MUA); however, it is not risk-free. This study investigated the association between manipulation and newer implants and sophisticated techniques, which hold promise for preventing arthrofibrosis and improving patient outcomes. Methods:The authors retrospectively reviewed 1260 primary knee arthroplasty cases (717 conventional, 217 customized, and 326 robot-assisted) performed by an orthopaedic surgeon from January 1, 2016 to May 31, 2020. Patient records were reviewed for manipulation and demographics (type of implant, sex, body mass index [BMI], smoking status, and prior surgery). Results:Overall manipulation rate was 1.3% (n = 17). Manipulation rates for conventional customized and robot-assisted TKAs did not vary significantly (1.84%, n = 6; 0.46%, n = 1; 1.39%, n = 10, respectively; P = 0.466). Multivariable logistic regression showed no statistically significant difference in the odds of manipulation depending on the type of implant. However, those who smoked were 4 times more likely to have a manipulation (OR: 4.187, 95% CI: 1.119 to 15.673) when controlling for covariates (type of implant, sex, BMI, and prior surgery). Additionally, those with prior surgery were 2.8 times as likely to have a manipulation (OR: 2.808, 95% CI: 1.039 to 7.589) when controlling for covariates. Conclusions:There were no statistically significant differences in manipulation rates among conventional, customized, and robot-assisted TKAs. However, current smoking status and prior surgery were associated with higher risk of manipulation.

No abstract