Purpose Our systematic review and meta-analysis sought to assess how technology-assistance impacts (1) post-operative pain and (2) opioid use in patients undergoing primary total knee arthroplasty (TKA). Methods Four online databases were queried for studies published up to October 2021 that reported on pain and opioid usage between technology-assisted and manual TKA (mTKA) patients. Mantel-Haenszel (M-H) models were utilized to calculate pooled mean diference (MDs) and 95% conidence interval (CIs). Subgroup analyses were conducted to isolate robotic-arm assisted (RAA) and computed-assisted navigation (CAN) cohorts. Risk of bias was assessed for all included non-randomized studies with the Methodological Index for Non-Randomized Studies (MINORS) tool. For the randomized control trials included in our study, the Detsky scale was applied. Results Our analysis included 31 studies, reporting on a total of 761,300 TKAs (mTKA: n = 753,554; Computer-Assisted Navigation (CAN): n = 1,309; Robotic-Arm Assisted (RAA): n = 6437). No diferences were demonstrated when evaluating WOMAC (MD: 0.00, 95% CI − 0.69 to 0.69; p = 1.00), KSS (MD: 0.01, 95% CI − 1.46 to 1.49; p = 0.99), KOOS (MD − 2.91, 95% CI − 6.17 to 0.34; p = 0.08), and VAS (MD − 0.54, 95% CI − 1.01 to − 0.007; p = 0.02) pain scores between cohorts. There was mixed evidence regarding how opioid consumption difered between TKA techniques. Conclusion The present analysis demonstrated no diference in terms of pain across a variety of utilized patient-reported pain measurements. However, there were mixed results regarding how opioid consumption varied between manual and technology-assisted cohorts, particularly in the immediate post-operative period. Level of evidence III.
Purpose: Cervical disk arthroplasty (CDA) has emerged as a promising alternative to anterior cervical discectomy and fusion for the management of cervical disk degeneration causing neurological symptoms. This manuscript and accompanying digital content demonstrate the senior author’s preferred surgical technique for a single-level CDA. Methods: CDA is performed using a standard, left-sided Smith Robinson approach. A complete discectomy is performed, with resection of the posterior longitudinal ligament and decompression of the neuroforamina bilaterally. Careful endplate preparation and trial is performed, and the final implant is impacted under a combination of direct visualization and fluoroscopy. Postoperatively, a soft collar is worn for comfort, and the patient is discharged on postoperative day 1 or 2. Results: This video, Supplemental Digital Content 1, http://links.lww.com/CLINSPINE/A254 presents the case of a 43-year old woman with mild cervical spondylosis with a paracentral disk herniation causing left C6 radiculopathy refractory to conservative measures. A C5-6 cervical disk arthroplasty was performed. Conclusions: CDA presents a motion-sparing alternative to anterior cervical discectomy and fusion and has the potential to reduce adjacent segment disease, though further studies are needed to fully determine its benefits and expanding indications. Careful patient selection and proper surgical technique, as demonstrated here, remain crucial in optimizing outcomes.
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