Robot‐assisted total hip arthroplasty: Clinical outcomes and complication rate The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint Subacute pain and function after fast‐track hip and knee arthroplasty Groningen orthopaedic exit strategy: Validation of a support program after total hip or knee arthroplasty. Small Increase of Actual Physical Activity 6 Months After Total Hip or Knee Arthroplasty Effects of Tourniquet Use on Quadriceps Function and Pain in Total Knee Arthroplasty Functional capacity and actual daily activity do not contribute to patient satisfaction after total knee arthroplasty
BACKGROUND The purpose of this study was to report minimum 2-year outcomes and complications for robotic-arm-assisted total hip arthroplasty ( THA )  . METHODS Data were prospect ively collected and retrospectively review ed between June 2011 and April 2014 . Inclusion criteria were primary robotic-arm-assisted THAs treating idiopathic osteoarthritis with ≥ 2-year follow-up .  Demographics , operating time , complications , 2-year outcome scores and satisfaction , and subsequent surgeries were recorded . RESULTS There were 181 cases eligible for inclusion , of which 162 ( 89.5 % ) had minimum 2-year follow-up . At the latest follow-up , the mean visual analogue scale was 0.7 , satisfaction was 9.3 , Harris hip score was 91.1 and forgotten joint score was 83.1 . Six ( 3.7 % ) intraoperative complications and six ( 3.7 % ) postoperative complications were reported . No leg length discrepancies ( LLDs ) or dislocations were reported . CONCLUSIONS Robotic-arm-assisted THA demonstrates favourable short-term outcomes and does not result in a higher complication rate compared to non-robotic THA as reported by the literature OBJECTIVE To evaluate the relationship between patient expectations of  total joint arthroplasty ( TJA ) and health related quality of life plus satisfaction 6 months after surgery . Methods . This prospect i ve cohort study included patients undergoing primary total hip ( THA ) and knee arthroplasty ( TKA ) .  Patients were evaluated with  self-report question naires prior to surgery and 6 months post-surgery . Medical Outcomes Study Short Form 36 ( SF-36 ) , the Western Ontario McMaster Universities Osteoarthritis Index ( WOMAC ) , and a satisfaction scale were used to evaluate outcomes at final followup . Multivariate regression models were used to evaluate the impact of expectations on outcomes . RESULTS There were 102 patients with THA and 89 with TKA . Mean age was 66 years . All patients achieved significant improvements in their WOMAC and SF-36 scores following surgery . Patient expectations regarding surgery were not associated with their age , gender , index joint of surgery , marital status , or race . Expectations were not correlated with pre-operative functional health status . Expectation of complete pain relief after surgery was an independent predictor of better physical function and improvement in level of pain at 6 months post-surgery . Expectation of low risk of complications from TJA was an independent predictor of greater satisfaction . CONCLUSIONS Patient expectations were important independent predictors of improved functional outcomes and satisfaction following TJA . Greater underst and ing of the relationship between expectations and outcomes may improve the process of care and outcomes of TJA Purpose Despite reduction in radiological outliers in previous r and omized trials comparing robotic-assisted versus conventional total knee arthroplasty ( TKA ) , no differences in short-term functional outcomes were observed . The aim of this study was to determine whether there was improvement in functional outcomes and quality -of-life ( QoL ) measures between robotic-assisted and conventional TKA . Methods All 60 knees ( 31 robotic-assisted ; 29 conventional ) from a previous r and omized trial were available for analysis . Differences in range of motion , Knee Society ( KSS ) knee and function scores , Oxford Knee scores ( OKS ) , SF-36 subscale and summative ( physical PCS/mental component scores MCS ) were analysed . In addition , patient satisfaction , fulfilment of expectations and the proportion attaining a minimum clinical ly important difference ( MCID ) in KSS , OKS and SF-36 were studied . Results Both robotic-assisted and conventional TKA displayed significant improvements in majority of the functional outcome scores at 2 years . Despite having a higher rate of complications , the robotic-assisted group displayed a trend towards higher scores in SF-36 QoL measures , with significant differences in SF-36 vitality ( p = 0.03 ) , role emotional ( p = 0.02 ) and a larger proportion of patients achieving SF-36 vitality MCID ( 48.4 vs 13.8 % , p = 0.009 ) . No significant differences in KSS , OKS or satisfaction/expectation rates were noted . ConclusionS ubtle improvements in patient QoL measures were observed in robotic-assisted TKA when compared to conventional TKA . This finding suggests that QoL measures may be more sensitive and clinical ly important than surgeon-driven objective scores in detecting subtle functional improvements in  robotic-assisted TKA  patients .Level of evidence II OBJECTIVE To quantify the magnitude of change seen with pain , function , and quality of life outcomes 6 months after  total hip and knee arthroplasties ( THA , TKA )  within a community based cohort of a regional health district . METHODS An inception cohort of 504 patients who received primary THA ( 228 ) or TKA ( 276 ) was prospect ively followed . All patients resided in the community and were assessed within one month prior to surgery and 6 months postoperatively . Health related quality of life measures were evaluated with the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index and the Medical Outcome Survey Short Form SF-36 . Perioperative factors were extracted from medical charts . Health services utilization data were collected from regional health data bases . RESULTS Over 75 % of patients reported improvement in joint-specific pain and function , regardless of the type of joint replaced . Other health dimensions such as social function , bodily pain , physical function , vitality , and general health showed significant improvement after surgery . Those psychosocial dimensions with modest changes had baseline values comparable to age and sex adjusted normal values ; whereas , bodily pain and physical function , which had large changes , had values lower than the normal values . Ninety-one percent of patients receiving THA were satisfied with their surgery , whereas 77 % were satisfied with their TKA . The average length of stay was 7 days and the in-hospital complication rate was 0.34 per patient . CONCLUSION Large improvements were reported for pain and function after joint arthroplasties , while small to moderate changes were seen in other areas related to quality of life .  Patients with hip arthroplasties showed greater improvement in pain and function and were more satisfied with their outcomes than patients with knee arthroplasties . Although pain and function show large improvements , bodily pain and physical function were less than the values reported in the general population Background Hip replacement ( arthroplasty ) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint . For older patients , several design s of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money . However , in younger more active patients , there is approximately a 50 % failure rate at 25 years for traditional implants . Hip resurfacing is a relatively new arthroplasty technique . In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified , including the risk of femoral neck fracture and collapse of the head of the femur . The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty . Secondary aims include assessment of complication rates for both procedures as well cost effectiveness . Methods / design All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study . A r and omisation sequence will be produced and administered independently . After consenting , all patients will be clinical ly review ed and hip function , quality of life and physical activity level will be assessed through question naires . The allocated surgery will then be performed with the preferred technique of the surgeon . Six weeks post-operation hip function will be assessed and complications recorded . Three , six and 12 months post-operation hip function , quality of life and physical activity level will be assessed . Additional information about patients ' out-of-pocket expenses will also be collected . Trial registration Current Controlled Trials IS RCT N33354155UKCLRN portfolio ID In a well‐defined fast‐track setup for total hip and knee arthroplasty , with a multimodal analgesic regimen consisting of intra‐operative local anaesthetic infiltration and oral celecoxib , gabapentin and paracetamol for 6 days postoperatively , we conducted a prospect i ve , consecutive , observational study . The purpose was to describe the prevalence and intensity of subacute postoperative pain and opioid related side effects , use of analgesics and functional ability 1–10 and 30 days postoperatively . Fast‐track total hip and knee arthroplasty with early discharge ( < 3 days ) result ed in acceptable levels of pain and postoperative nausea and vomiting with concomitant low use of opioids in > 95 % of patients after discharge before day 10 after total hip arthroplasty . However , after total knee arthroplasty 52 % patients reported moderate pain ( VAS 30–59 mm ) , and 16 % severe pain ( VAS ≥ 60 mm ) when walking 1 month after surgery with a concomitant increase in the use of strong opioids . These results emphasise the need for improvement in analgesia after discharge following total knee arthroplasty , to facilitate rehabilitation OBJECTIVE Validation of the program theory of the Groningen orthopaedic exit strategy ( GOES ) , a theory-driven program aim ing to improve the rehabilitation of total hip and knee arthroplasty patients after shortened hospital stay . First part of the program theory is the action theory , hypothesising that the GOES treatment positively influences the mediating variables ( self-efficacy , social support , pain-coping ) . The second part , the conceptual theory , hypothesis a positive relationship between these variables and the outcome variables ( ADL functioning , physical activity behaviour , quality of life ) . METHODS Patients were r and omly assigned to the GOES or control groups .  Question naires were used to assess mediating and outcome variables in 103 patients ( 50 GOES , 53 controls ) pre-operatively , and 6 and 26 weeks post-operatively . RESULTS No difference was seen between the two groups in terms of changes between pre-operative and post-operative mediating variables ( action theory ) . Moderate-to-large correlations explaining reasonable amount of variance ( 22 % , 25 % , 56 % ) were found between the mediating and outcome variables ( conceptual theory ) . CONCLUSION The conceptual theory is supported ; however , as the treatment did not influence the mediating variables ( action theory ) , it has no added value in its current form . PRACTICE IMPLICATION S The treatment needs to be adjusted ; it is discussed that individualised treatment could be more effective Abstract Limitation in daily physical activity is one of the reasons for total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) . However , studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning . We determined the effect of THA or TKA on patients ’ actual physical activity and body function ( pain , stiffness ) , capacity to perform tasks , and self-reported physical functioning . We also assessed whether there are differences in the effect of the surgery between patients undergoing THA or TKA  and whether the improvements vary between these different outcome measures . We recruited patients with long-st and ing end-stage osteoarthritis of the hip or knee awaiting THA or TKA .  Measurements were performed before surgery and 3 and 6 months after surgery . Actual physical activity improved by 0.7 % . Patients ’ body function , capacity , and self-reported physical functioning also improved . The effects of the surgery on these aspects of physical functioning were similar for THA and TKA . The effect on actual physical activity ( 8 % ) was smaller than on body function ( 80%–167 % ) , capacity ( 19%–36 % ) , and self-reported physical functioning ( 87%–112 % ) . Therefore , in contrast to the large effect on pain and stiffness , patients ’ capacity , and their self-reported physical functioning , the improvement in actual physical activity of our patients was less than expected 6 months after surgery . Level of Evidence : Level I , prospect i ve study . See the Guidelines for Authors for a complete description of levels of evidence Purpose A pneumatic tourniquet is commonly used in total knee arthroplasty ( TKA ) to improve surgical field visualisation but may result in quadriceps muscle ischaemia . We performed this study to analyse the effect of the tourniquet on recovery following TKA . Material s and Methods A prospect i ve r and omised single-blinded trial was undertaken to examine the effect of the tourniquet on post-operative pain , swelling , blood loss , quadriceps function and outcome following TKA . Twenty patients with osteoarthritis of the knee were r and omised to tourniquet or no tourniquet groups . Quadriceps function was assessed using surface electromyography ( EMG ) during active knee extension . Results The no tourniquet group had significantly less pain in the early post-operative period compared to the tourniquet group . There was no difference in Oxford knee score , range of motion , or thigh and knee swelling up to 12 months post-operatively . Quadriceps function , measured by surface EMG , was compromised for the first six months post-surgery by tourniquet use . The radiological cement mantle at the bone prosthesis interface at 12-month follow-up was not affected by the absence of a tourniquet . Conclusions We believe that it is safe and beneficial for our patients to routinely perform TKA without a tourniquet Background After total knee arthroplasty ( TKA ) only 75 - 89 % of patients are satisfied . Because patient satisfaction is a prime goal of all orthopaedic procedures , optimization of patient satisfaction is of major importance . Factors related to patient satisfaction after TKA have been explored , but no studies have included two potentially relevant factors , i.e. the functional capacity of daily activities and actual daily activity . This present prospect i ve study examines whether functional capacity and actual daily activity ( in addition to an extensive set of potential factors ) contribute to patient satisfaction six months after TKA . Methods A total of 44 patients were extensively examined preoperatively and six months post surgery . Functional capacity was measured with three capacity tests , focusing on walking , stair climbing , and chair rising . Actual daily activity  was measured in the patient 's home situation by means of a 48-hour measurement with an Activity Monitor . To establish which factors were related to patient satisfaction six months post surgery , logistic regression analyses were used to calculate odds ratios . Results Preoperative and postoperative functional capacity and actual daily activity had no relation with patient satisfaction . Preoperatively , only self-reported mental functioning was positively related to patient satisfaction . Postoperatively , based on multivariate analysis , only fulfilled expectations regarding pain and experienced pain six months post surgery were related to patient satisfaction . Conclusions Functional capacity and actual daily activity do not contribute to patient satisfaction after TKA . Patients with a better preoperative self-reported mental functioning , and patients who experienced less pain and had fulfilled expectations regarding pain postoperatively , were more often satisfied
R and om-effects meta-analyses showed that post-operative functional outcomes were comparable between active robotic and conventional total hip and knee arthroplasty at the short- , medium- and long-term follow-up .
Conclusions This systematic and meta-analyses indicates that functional outcomes for patients undergoing active robotic total hip and knee arthroplasty were comparable to conventional surgery .
Whether semi-active or active robotic hip or knee arthroplasty is effective in improving post-operative pain , quality of life and satisfaction with surgery is unclear .
Purpose The purpose of the study is to determine the effectiveness of semi-active and active robotic hip and knee arthroplasty on post-operative patient-reported outcomes of function , pain , quality of life and satisfaction with surgery .