A Novel <scp>Mini‐Invasive</scp> Technique of Arthroscopic‐Assisted Reduction and Robot‐Assisted Fixation for Trans‐Scaphoid Perilunate Fracture Dislocations

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ObjectivesScaphoid nonunion remains a challenging problem to manage with no general consensus on its treatment recommendations. We propose a novel minimally invasive (MIS) technique of arthroscopic bone grafting (ABG) with robot‐assisted fixation for the treatment of scaphoid nonunions.MethodsPatients with radiographically proven scaphoid nonunion treated by this novel surgical technique were included. Following arthroscopic debridement and iliac crest bone grafting, the scaphoid was fixed percutaneously using either multiple Kirschner (K)‐wires or a headless compression screw using a robotic navigation system.ResultsSix male patients with an average age of 29.2 years were enrolled. Four patients had scaphoid waist fractures, and the other two were proximal pole fractures. During wrist arthroscopy, punctate bleeding of the proximal scaphoid fragment was observed in four out of the six patients. Half of the patients were fixed using a headless compression screw and the other half using multiple K‐wires. All the guidewires were placed with a single‐attempt using the robotic navigation system. Postoperatively, all the scaphoid fractures had complete radiographic union by 16 weeks. At a mean follow‐up of 18.3 months, there were significant improvements in wrist range of motion, grip strength, and patient‐rated outcomes. No intraoperative or early postoperative complications were encountered in any of our patients.ConclusionArthroscopic bone grafting with robot‐assisted fixation is a feasible and promising therapeutic option for scaphoid nonunions, regardless of the vascularity of the proximal pole fragment. This novel technique allows for anatomic restoration of the scaphoid alignment and accurate, targeted placement of implants into the scaphoid nonunion site within a single‐attempt using a robotic navigation system.

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Arthroscopic Bone Graftingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Arthroscopic Bone Grafting and Robot‐assisted Fixation for Scaphoid Nonunion

Yi,

Lim,

Chen

et al. 2023

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A Novel Technique of Arthroscopic‐Assisted Four‐Corner Fusion and Robot‐Assisted Fixation for Scaphoid Nonunion Advanced Collapse Wrist: A Single Case Study

Gao,

Lim,

Liu

2023

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ObjectiveScaphoid nonunion advanced collapse (SNAC) is a relatively common and debilitating wrist disorder yet its treatment remains challenging and controversial. We aim to describe a novel technique of a dual arthroscopic and robotic assisted four‐corner fusion (4CF) in the treatment of SNAC wrist.MethodsIn this study, we describe an original arthroscopic and robotic assisted 4CF, which is novel and currently unpublished in literature. The surgical approach included these predefined steps: arthroscopic resection of the scaphoid, radial styloid and of diseased cartilage between the capitate‐lunate joint and triquetrum‐hamate joint, correction of Dorsal Intercalated Segment Instability (DISI) deformity of the wrist and robotic assisted 4CF performed percutaneously with screws. Dynamic fluoroscopic imaging with the mini C‐arm was performed five times and the 3D scanning machine was used once.ResultsOur patient with SNAC II wrist was 57 years old at the time of initial presentation with a history of untreated traumatic wrist injury approximately 20 years ago. Regular wrist X‐rays were performed at the outpatient setting and a computed tomography (CT) of the wrist was performed at the third postoperative month to confirm bony union. The patient's wrist range of motion (ROM), grip strength, Visual Analog Scale (VAS) score, Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, Modified Mayo Wrist Score (MMWS), and Patient Rated Wrist Evaluation (PRWE) were also evaluated during short‐term follow‐up at 6 months. During the patient's review at 6 months, his VAS score was 0 with complete pain relief. His wrist flexion was 20° and wrist extension at 45°. His pronation‐supination was normal and comparable to his uninjured contralateral wrist. His operated wrist which was also his dominant hand had a grip strength of 22 kg as compared with 28 kg of the unaffected hand. He also had a Mayo Wrist Score of 85, QuickDASH score of 2.3 and PRWE of 6, and resumed his occupation as a clerk at 3 months.ConclusionsThis dual arthroscopic and robotic assisted 4CF is a novel surgical method worth considering in the treatment of SNAC II wrists. It is minimally invasive and allows for accurate placement of the screws in a single attempt. There was bony union by the third postoperative month as confirmed by CT imaging and excellent resolution of symptoms.

Safety and Effectiveness of Robotic‐Arm Assisted Total Knee Arthroplasty

Yuan,

Ling,

et al. 2024

ObjectiveWe investigated the advantages of robotic arm‐assisted total knee arthroplasty (raTKA) over conventional manual TKA (cmTKA) by comprehensively comparing patients who received raTKA and cmTKA in terms of postoperative pain, function, imaging assessment, and trauma to the body. This study investigated the efficacy and safety of raTKA in patients using the YUANHUA‐TKA system.MethodsIn a prospective, randomized single‐blind trial, 60 patients undergoing primary unilateral TKA from October 2020 to December 2020 were randomly assigned to either raTKA or cmTKA. Clinical evaluation, including the time of osteotomy and prosthesis model testing, the total operation time, the visual analogue scale at rest, VAS in motion, opioid consumption, white blood cell count, neutrophil ratio, erythrocyte sedimentation rate, C‐reactive protein (CRP), passive and active range of motion (pROM, aROM), Western Ontario and McMaster Universities Arthritis Index (WOMAC [stiffness, pain, and function]) score, gait analysis, keen society score (KSS), adverse events, and blood loss were collected by the project nurse, as well as the imaging evaluation, including the lateral tibia component angle (LTC), frontal femoral component angle, frontal tibia component angle (FTC), lateral femoral component angl, and hip–knee–ankle angle (HKA). The student t‐test (or the Wilcoxon signed‐rank test) and the χ2‐test (or the Fisher exact test) were used to determine differences in categorical variables.ResultsNo significant difference was found between the two groups in pain throughout the whole follow‐up period. On the third day postoperatively, the erythrocyte sedimentation rate in the cmTKA group was significantly higher (p = 0.02), as well as the CRP (p = 0.04). No significant difference was found in the WOMAC stiffnes score or pROM. However, the aROM and the flexion range when walking (FRW) were significantly better in the raTKA group throughout the trial (p < 0.05). The KSS at the 1‐month follow‐up and the WOMAC function score at the 1‐year follow‐up were both significantly better in the raTKA group (p < 0.05). The HKA and the LTC in the raTKA group closer to the ideal angle, and the difference between the groups was significant (p < 0.05). The total operation time of the raTKA group was significantly longer (p = 0.001). The intraoperative blood loss had no significant difference in the two groups.ConclusionCompared with cmTKA, raTKA with the YUANHUA robot not only avoids extra pain and trauma in patients but promises better functional recovery and improves the accuracy of the prosthesis position and axial alignment reconstruction.