Background:
Use of computer-assisted navigation (CAN) and robotic-assisted (RA) surgery in total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) both necessitate the use of tracking pins rigidly fixed to the femur and tibia. Although periprosthetic fractures through tracking pin sites are rare, there is a paucity of literature on this potential complication. Therefore, the purpose of this study was to perform a systematic review of the current literature to assess the incidence and clinical outcomes of periprosthetic fractures through tracking pin sites following CAN and RA TKA and UKA.
Methods:
A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using the PubMed, MEDLINE, and Cochrane databases in April 2020. Studies were assessed for the presence of pin site fractures, fracture characteristics, and clinical outcomes.
Results:
Seventeen clinical studies (5 case series, 1 cohort study, and 11 case reports) involving 29 pin-related fractures were included for review. The overall incidence ranged from 0.06% to 4.8%. The mean time from index arthroplasty to fracture was 9.5 weeks (range, 0 to 40 weeks). The majority of fractures occurred in the femoral diaphysis (59%). Nineteen fractures (66%) were displaced and 10 (34%) were nondisplaced or occult. The majority of cases were atraumatic in nature or involved minor trauma and were typically preceded by persistent leg pain. A transcortical pin trajectory, large pin diameter (>4 mm), diaphyseal fixation, multiple placement attempts, and the use of non-self-drilling, non-self-tapping pins were the most commonly reported risk factors for pin-related periprosthetic fractures following CAN or RA TKA.
Conclusions:
Surgeons should maintain a high index of suspicion for pin-related fractures in patients with ongoing leg or thigh pain after CAN or RA TKA in order to avoid fracture displacement and additional morbidity. As CAN and RA TKA have unique complication risks, the debate regarding the value of technology-assisted TKA and its cost-effectiveness continues.
Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Purpose
To investigate clinical outcomes after superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears treated with either allograft or autograft.
Methods
Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, in April 2020 a systematic review was performed using PubMed, MEDLINE, EMBASE, and Cochrane databases. Clinical studies were assessed for patient-reported outcomes and range of motion, comparing dermal allografts to fascia lata autografts, with a minimum follow-up of 12 months.
Results
A total of 16 clinical studies involving 598 patients (606 shoulders) were included for data analysis, with a weighted mean follow-up of 36.9 months (range 12 to 60). Visual analogue scale (VAS) pain scores decreased from 4.0 to 6.9 mm preoperatively to 0 to 2.5 mm postoperatively. American Shoulder & Elbow Surgeons score increased from 20.3 to 54.5 preoperatively to 73.7 to 97.0 postoperatively. Forward flexion increased from 27.0° to 142.7° preoperatively to 134.5° to 167.0° postoperatively. External rotation increased from 13.2° to 41.0° preoperatively to 30.0° to 59.0° postoperatively. Acromiohumeral distance increased from 3.4 to 7.1 mm preoperatively to 6.0 to 9.7 mm postoperatively. The total rates of complications, graft failure, and revision surgery were 5.6%, 13.9%, and 6.9%, respectively.
Conclusions
Irrespective of tissue source, SCR serves as a reasonable joint-preserving option for massive, irreparable rotator cuff tears, with favorable short- to midterm improvements in patient-reported outcomes and range of motion.
Level of Evidence
IV, systematic review of level III and IV studies.
» Improperly balanced total knee arthroplasties are at increased risk for complications including residual pain and/or instability, which are often corrected by a revision surgical procedure.» Because of the morbidity and financial burden associated with revision total knee arthroplasty, different technological applications, such as tibial insert sensors and computer-assisted gap balancing, are being used to assist with soft-tissue balancing during primary total knee arthroplasty.» Computer-assisted gap balancing increases the accuracy of mechanical alignment and improves the precision of balancing flexion and extension gaps during total knee arthroplasty. It is unclear whether this translates to improved short-term or long-term outcome measures. Considerations of this technology include increased cost, increased operative time, and a steep learning curve.» Intraoperative sensors increase the accuracy of balancing by quantifying the mediolateral intercompartmental load distribution through the range of motion, which may lead to improved outcome scores, patient satisfaction, higher activity levels, and decreased pain. The advantages of this technology compared with computer assistance include decreased cost and no disruption of operative time or workflow. Limited availability with constrained implants, limited implant choices, and a lack of long-term follow-up data have reduced utilization of intraoperative sensors.» Computer-assisted gap balancing and intraoperative sensors are not yet universally accepted, and the cost-benefit ratio associated with their use remains a consideration in today’s cost-conscious health-care environment. Future research should focus on longer-term follow-up to evaluate implant survivorship, cost-effectiveness, and clinical outcomes.
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