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Long X, Chen J, Li J, Luo Z. The current status and global trends of clinical trials related to robotic surgery: a bibliometric and visualized study. J Robot Surg 2024; 18:193. [PMID: 38693446 DOI: 10.1007/s11701-024-01940-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
Conducting clinical trials can evaluate the effectiveness and safety of surgical robots. To promote the advancement of academic robotic programs in surgery, this study captures the development trend and research hotspots of clinical trials related to surgical robots by bibliometric analysis. Bibliometrix package in R software was used to analyze the publication year, authors, countries, institutes, and journals. The visualization maps of keywords were formed using VOSviewer. The keywords with the strongest citation bursts and the institutional collaboration map were created by CiteSpace. Urology dominates with 31.3% of publications and the controlled clinical trials in urology and orthopedic accounted for the highest proportion, reaching 73%. North America, the USA, and Seoul National University lead in productivity. The most productive country, region and institution are North America, USA and Seoul National University, respectively. The trend of collaboration is regional instead of international. Keyword and burst keyword analysis revealed a primary focus in clinical research on robotic surgery: evaluating process improvements, comparing robotic and traditional surgery, and assessing feasibility. Long-term clinical trials assess surgical robots not only intraoperative performance but also postoperative complications and overall surgical outcomes. The development in the field is unbalanced between regions and countries. To promote multi-center clinical trials, governments can streamline review procedures and establish international consensus review standards, while academic institutions can form academic alliances. Also, the study offers recommendations for the development of academic robotic programs and regional collaboration units in robotic surgery, which may provide researchers with a strong reference for future research.
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Affiliation(s)
- Xinrui Long
- Department of Dermatology, Xiangya Hospital, Central South University, Hunan, China
- Xiangya School of Medicine, Central South University, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China
- Furong Lab, Central South University, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Jiaqi Chen
- Xiangya School of Medicine, Central South University, Hunan, China
| | - Jiaqi Li
- Xiangya School of Medicine, Central South University, Hunan, China
| | - Zhonglin Luo
- Department of Dermatology, Xiangya Hospital, Central South University, Hunan, China.
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.
- Furong Lab, Central South University, Hunan, China.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China.
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Patel R, Mcconaghie G, Webb J, Laing G, Philpott M, Roach R, Wagner W, Rhee SJ, Banerjee R. Five historical innovations that have shaped modern orthopaedic surgery. J Perioper Pract 2024; 34:84-92. [PMID: 37596805 DOI: 10.1177/17504589231179302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Throughout history, many innovations have contributed to the development of modern orthopaedic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern orthopaedic surgery: X-ray imaging, bone cement, the Thomas splint, the Pneumatic tourniquet and robotic-assisted surgery. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of orthopaedic surgery and their ongoing relevance in contemporary and perioperative practice.
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Affiliation(s)
- Ravi Patel
- Department of Trauma and Orthopaedics, The Princess Royal Hospital, The Shrewsbury and Telford Trust, Telford, UK
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Greg Mcconaghie
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Jeremy Webb
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Georgina Laing
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Matthew Philpott
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Richard Roach
- Department of Trauma and Orthopaedics, The Princess Royal Hospital, The Shrewsbury and Telford Trust, Telford, UK
| | - Wilhelm Wagner
- Department of Trauma and Orthopaedics, The Princess Royal Hospital, The Shrewsbury and Telford Trust, Telford, UK
| | - Shin-Jae Rhee
- Department of Trauma and Orthopaedics, The Princess Royal Hospital, The Shrewsbury and Telford Trust, Telford, UK
| | - Robin Banerjee
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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Potluri AS, Arza RA, Rullán PJ, Pasqualini I, Ng M, Piuzzi NS. Forty-Six Years of Technological Innovation in Musculoskeletal Medicine: An Analysis of a Patent Database (1973 to 2018). J Am Acad Orthop Surg 2024; 32:130-138. [PMID: 37793147 DOI: 10.5435/jaaos-d-23-00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Technological innovation in orthopaedics is key to advancing patient care. As emerging technologies near maturity, clinicians must be able to objectively assess where and when these technologies can be implemented. Patent databases are an underappreciated resource for quantifying innovation, especially within orthopaedic surgery. This study used a patent database to assess patent activity and relative growth of technologies in musculoskeletal medicine and orthopaedics over a period of 46 years. METHODS A total of 121,471 patent records were indexed from Lens.org , a patent database. These patents were grouped into subspecialty clusters and technology clusters using patent codes. Five-year (2014 to 2018), 10-year (2009 to 2018), and 30-year (1989 to 2018) compound annual growth rates were calculated and compared for each cluster. RESULTS Annual patent activity increased from one patent in 1973 to 4,866 patents in 2018. Of the eight subspecialty clusters, the largest number of patents were related to 'Inflammation' (n = 63,128; 40.57%). The 'Elbow', 'Shoulder', and 'Knee' clusters experienced increased annual patent activity since 2000. Of the 12 technological clusters, the largest number of patents were related to 'Drugs' (n = 55,324; 39.75%). The 'Custom/patient-specific instrumentation, 'Computer Modeling', 'Robotics', and 'Navigation' clusters saw growth in the average annual patent activity since 2000. DISCUSSION Innovation, as measured by patent activity in musculoskeletal medicine and orthopaedics, has seen notable growth since 1973. The 'Robotics' cluster seems poised to experience exponential growth in industry investment and technological developments over the next 5 to 10 years. The 'Diagnostics', 'Computer Modeling', 'Navigation', and 'Design and Manufacturing' clusters demonstrate potential for exponential growth in industry investment and technological developments within the next 10 to 20 years.
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Affiliation(s)
- Ajay S Potluri
- From the Case Western Reserve University School of Medicine, Cleveland, OH (Potluri and Arza), Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH (Rullán, Pasqualini, and Piuzzi), Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY (Ng), and the Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH (Piuzzi)
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Qi H, Li Z, Ma T, Jiang Y, Ren C, Xu Y, Huang Q, Zhang K, Lu Y, Li M. Robot Navigation System Assisted PFNA Fixation of Femoral Intertrochanteric Fractures in the Elderly: A Retrospective Clinical Study. Clin Interv Aging 2024; 19:11-19. [PMID: 38204959 PMCID: PMC10777025 DOI: 10.2147/cia.s412397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
Objective The incidence of hip fracture in the elderly is increasing. Robot navigation technology has the advantages of minimally invasive and accurate. To explore the difference between the clinical effects of proximal femoral anti-rotation intramedullary nail (PFNA) assisted by robot navigation in the treatment of femoral intertrochanteric fracture and traditional PFNA in the treatment of femoral intertrochanteric fracture in the elderly; analyze the advantages and feasibility of PFNA assisted by robot navigation in the treatment of femoral intertrochanteric fracture in the elderly. Patients and Methods From February 2021 to October 2022, the elderly (>65 years old) with femoral intertrochanteric fracture underwent surgery in our center. Divided the patients included in the study into 2 groups based on the surgical method. The surgical method of robot group was PFNA fixation assisted by robot navigation, while the surgical method of traditional group was classic PFNA fixation, Baseline data (general condition, Evans classification, time from injury to operation, preoperative hemoglobin) and observation indicators (intraoperative bleeding, operation time, the length of incision for mail nail insertion, postoperative hemoglobin drop, blood transfusion rate and the Harris score of hip joint 1 year after operation) of the two groups were collected to compare whether there were differences between the two groups. Results There was no statistical difference in baseline data between the two groups (P>0.05). The intraoperative bleeding in the robot group was 68.17±10.66 mL, the intraoperative bleeding in the traditional group was 174±8.11mL (P<0.001). The operation time in the robot group was 68.81 ± 6.89 min, in the traditional group, the operation time was 76.94 ± 8.18 min (P<0.001). The length of incision for mail nail insertion in the robot group was 3.53 ± 0.63 cm, the length of the incision for mail nail insertion in the traditional group was 4.23 ± 0.71 cm (P<0.001). 5 patients (13.9%) in the robot group received blood transfusion treatment, and 13 patients (36.1%) in the traditional group received blood transfusion treatment (P=0.029). The hemoglobin in the robot group decreased by 14.81 ± 3.27 g/l after operation compared with that before operation, while that in the traditional group decreased by 16.69 ± 3.32 g/l (P=0.018). The Harris score of the hip joint of the affected limb in the robot group was excellent in 25 cases, good in 8 cases and poor in 3 cases one year after the operation; In the traditional group, Harris scores were excellent in 18 cases, good in 11 cases and poor in 7 cases (P=0.021). Conclusion PFNA fixation of femoral intertrochanteric fracture with robot navigation assistance has the advantages of minimally invasive and accurate, shorter operation time, less bleeding and lower blood transfusion rate than traditional surgical methods, and has certain advantages in reducing postoperative complications of elderly patients.
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Affiliation(s)
- Hongfei Qi
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Zhong Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Teng Ma
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Yangyang Jiang
- Xi’an Medical College, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Cheng Ren
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Yibo Xu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Qiang Huang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Kun Zhang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Yao Lu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Ming Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
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Saad A, Mayne AIW, Pagkalos J, Ollivier M, Botchu R, Davis ET, Sharma AD. An evaluation of factors influencing the adoption and usage of robotic surgery in lower limb arthroplasty amongst orthopaedic trainees: a clinical survey. J Robot Surg 2024; 18:2. [PMID: 38175317 DOI: 10.1007/s11701-023-01811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The rise of robotics in orthopaedic training, driven by the demand for better training outcomes and patient care, presents specific challenges for junior trainees due to its novelty and steep learning curve. This paper explores how orthopaedic trainees perceive and adopt robotic-assisted lower limb arthroplasty. METHODS The study utilised the UTUAT model questionnaire as the primary data collection tool, employing targeted questions on a five-point Likert scale to efficiently gather responses from a large number of participants. Data analysis was conducted using partial least squares (PLS), a well-established method in previous technology acceptance research. RESULT The findings indicate a favourable attitude amongst trainees towards adopting robotic technology in orthopaedic training. They acknowledge the potential advantages of improved surgical precision and patient outcomes through roboticassisted procedures. Social factors, including the views of peers and mentors, notably influence trainees' decision-making. However, the availability of resources and expert mentors did not appear to have a significant impact on trainees' intention to use robotic technology. CONCLUSION The study contributes to the understanding of factors influencing trainees' interest in robotic surgery and emphasises the importance of creating a supportive environment for its adoption.
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Affiliation(s)
- Ahmed Saad
- Department of Trauma & Orthopaedics, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK.
| | - Alistair I W Mayne
- Department of Trauma & Orthopaedics, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - Joseph Pagkalos
- Department of Trauma & Orthopaedics, Lower Limb Reconstruction Unit, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - Matthieu Ollivier
- Institute Movement Science, Aix Marseille University, CNRS, Marseille, France
| | - Rajesh Botchu
- Department of MSK Radiology, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - Edward T Davis
- Department of Trauma & Orthopaedics, Lower Limb Reconstruction Unit, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - Akash D Sharma
- Department of Trauma & Orthopaedics, Lower Limb Reconstruction Unit, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
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Suarez-Ahedo C, Lopez-Reyes A, Martinez-Armenta C, Martinez-Gomez LE, Martinez-Nava GA, Pineda C, Vanegas-Contla DR, Domb B. Revolutionizing orthopedics: a comprehensive review of robot-assisted surgery, clinical outcomes, and the future of patient care. J Robot Surg 2023; 17:2575-2581. [PMID: 37639163 DOI: 10.1007/s11701-023-01697-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
Robotic-assisted orthopedic surgery (RAOS) is revolutionizing the field, offering the potential for increased accuracy and precision and improved patient outcomes. This comprehensive review explores the historical perspective, current robotic systems, advantages and limitations, clinical outcomes, patient satisfaction, future developments, and innovation in RAOS. Based on systematic reviews, meta-analyses, and recent studies, this article highlights the most significant findings and compares RAOS to conventional techniques. As robotic-assisted surgery continues to evolve, clinicians and researchers must stay informed and adapt their practices to provide optimal patient care. Evidence from published studies corroborates these claims, highlighting superior component positioning, decreased incidence of complications, and heightened patient satisfaction. However, challenges such as costs, learning curves, and technical issues must be resolved to fully capitalize on these advantages.
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Affiliation(s)
- Carlos Suarez-Ahedo
- Instituto Nacional de Rehabilitación, Mexico City, Mexico.
- American Hip Institute, Des Plaines, IL, USA.
| | | | | | | | | | - Carlos Pineda
- Instituto Nacional de Rehabilitación, Mexico City, Mexico
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Nunna B, Parihar P, Wanjari M, Shetty N, Bora N. High-Resolution Imaging Insights into Shoulder Joint Pain: A Comprehensive Review of Ultrasound and Magnetic Resonance Imaging (MRI). Cureus 2023; 15:e48974. [PMID: 38111406 PMCID: PMC10725840 DOI: 10.7759/cureus.48974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Shoulder joint pain is a complex and prevalent clinical concern affecting individuals across various ages and lifestyles. This review delves into the pivotal role of high-resolution imaging techniques, namely ultrasound and magnetic resonance imaging (MRI), in the comprehensive assessment and management of shoulder joint pain. We explore the anatomical foundations of the shoulder, common etiologies of pain, and the significance of precise diagnosis. High-resolution imaging facilitates the identification of various shoulder pathologies and is crucial in treatment planning, surgical interventions, and long-term prognosis assessment. We examine emerging technologies, discuss challenges and limitations, and chart potential future developments, emphasizing the ongoing evolution of imaging in this critical healthcare domain. In conclusion, high-resolution imaging is an indispensable tool, continually advancing to meet the diagnostic and therapeutic needs of individuals grappling with shoulder joint pain.
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Affiliation(s)
- Bhagyasri Nunna
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratap Parihar
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neha Shetty
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikita Bora
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Muacevic A, Adler JR, Pundkar A, Bukhari RR, Chandanwale R. Influence of COVID-19 on Tertiary Orthopaedic Centres. Cureus 2022; 14:e31388. [PMID: 36514646 PMCID: PMC9741971 DOI: 10.7759/cureus.31388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/11/2022] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious lethal infection that has successfully spread all across the world. The novel coronavirus that is behind the menace and spread of COVID-19, is the next in the lineage of the Coronaviridae family of viruses, which had previously given two deadly viruses with limited geographical extent. After sustaining for more than two years, the virus is still active and keeps on mutating to evade human immunity. The impact of COVID-19 is felt not only by patients of COVID-19 who go through the trauma but also by non-COVID-19 patients due to the non-pharmacological interventions (NPIs) enforced. Patients in the orthopedic departments suffered a huge blow as their rehabilitation practices were stalled due to a lack of health professionals and also restrictions imposed. But to soften the blow, usage of telemedicine was done in some instances so that the essential therapies can continue despite the movement restrictions imposed. COVID-19 has disrupted many aspects of human life including clinical practices and this endeavor is to review those aspects and provide conclusions if any. The aim of the study is to review the available resources regarding Indoor orthopedic practice during the COVID-19 pandemic and draw a conclusion that can help further research on the aforementioned topic.
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Ryan HY, Sun GY, Monuja M, Gillespie M, Burns A, Solomon M, Adie S. Adherence by orthopaedic surgeons to AHPRA and Australian Orthopaedic Association advertising guidelines. Med J Aust 2022; 217:240-245. [DOI: 10.5694/mja2.51490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Hannah Y Ryan
- St George and Sutherland Clinical School University of New South Wales Sydney NSW
| | - Geoffrey Y Sun
- St George and Sutherland Clinical School University of New South Wales Sydney NSW
| | - Masiath Monuja
- St. George and Sutherland Centre for Clinical Orthopaedic Research Sydney NSW
| | | | | | | | - Sam Adie
- St. George and Sutherland Centre for Clinical Orthopaedic Research Sydney NSW
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Deckey DG, Verhey JT, Rosenow CS, Doan MK, McQuivey KS, Joseph AM, Schwartz AJ, Clarke HD, Bingham JS. Robotic-Assisted Total Knee Arthroplasty Allows for Trainee Involvement and Teaching Without Lengthening Operative Time. J Arthroplasty 2022; 37:S201-S206. [PMID: 35184933 DOI: 10.1016/j.arth.2021.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Robot-assisted total knee arthroplasty (RA-TKA) is more accurate than mechanical total knee arthroplasty (M-TKA) and can provide real-time feedback about alignment and soft-tissue balancing that may be helpful in trainee education. However, both robotic-assist and trainee involvement potentially increase the surgical time. This study sought to evaluate whether RA-TKA procedures were longer than M-TKA procedures and whether trainee participation added additional surgical time. METHODS This retrospective cohort study reviewed 220 consecutive primary TKAs (110 M-TKA and 110 RA-TKA) performed by an orthopedic trainee under supervision or performed by the consultant surgeon with an assistant present. For M-TKAs, a measured resection technique was used. For all RA-TKAs, the MAKO robotic system (Stryker, USA) was used. Tourniquet time was measured from inflation immediately prior to skin incision to deflation after placement of the final polyethylene insert. Procedures performed by a consulting surgeon with a surgical assist were used as controls for procedures performed by the trainee. In trainee-conducted procedures, the trainee is responsible for performing all critical aspects of the procedure while the consulting surgeon provides supervision and acts as first assist. RESULTS 103 M-TKA and 96 RA-TKA were included. Tourniquet time was significantly longer for RA-TKAs vs M-TKAs (100 vs 89 minutes, P < .0001). However, there were no significant differences in tourniquet times between surgery performed by a trainee vs the consulting surgeon with surgical assist for either M-TKA (P = .3452) or RA-TKA (P = .6724). CONCLUSIONS While RA-TKA takes longer, orthopedic trainees do not add additional time. Trainees at all stages of postgraduate learning can be educated in the use of robotic technology and potentially benefit from real-time feedback without further compromising surgical efficiency or increasing patient risk.
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Affiliation(s)
- David G Deckey
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, AZ
| | - Jens T Verhey
- Alix School of Medicine of Mayo Clinic in Arizona, Scottsdale, AZ
| | | | - Matthew K Doan
- Alix School of Medicine of Mayo Clinic in Arizona, Scottsdale, AZ
| | - Kade S McQuivey
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, AZ
| | - Anna M Joseph
- Division of Clinical Trials and Biostatistics, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Adam J Schwartz
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, AZ; Alix School of Medicine of Mayo Clinic in Arizona, Scottsdale, AZ
| | - Henry D Clarke
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, AZ; Alix School of Medicine of Mayo Clinic in Arizona, Scottsdale, AZ
| | - Joshua S Bingham
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, AZ; Alix School of Medicine of Mayo Clinic in Arizona, Scottsdale, AZ
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St Mart JP, Goh EL, Liew I, Shah Z, Sinha J. Artificial intelligence in orthopaedic surgery: transforming technological innovation in patient care and surgical training. Postgrad Med J 2022:postgradmedj-2022-141596. [PMID: 35379754 DOI: 10.1136/postgradmedj-2022-141596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/19/2022] [Indexed: 12/16/2022]
Abstract
Artificial intelligence (AI) is an exciting field combining computer science with robust data sets to facilitate problem-solving. It has the potential to transform education, practice and delivery of healthcare especially in orthopaedics. This review article outlines some of the already used AI pathways as well as recent technological advances in orthopaedics. Additionally, this article further explains how potentially these two entities could be combined in the future to improve surgical education, training and ultimately patient care and outcomes.
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Affiliation(s)
- Jean-Pierre St Mart
- Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - En Lin Goh
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford Trauma, Kadoorie Centre, University of Oxford, Oxford, UK
| | - Ignatius Liew
- Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Zameer Shah
- Trauma and Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joydeep Sinha
- Trauma and Orthopaedic Surgery, King's College Hospital NHS Foundation Trust, London, UK
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Robot-assisted fracture fixation in orthopaedic trauma surgery: a systematic review. OTA Int 2021; 4:e153. [PMID: 34765903 PMCID: PMC8575426 DOI: 10.1097/oi9.0000000000000153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
Objective: To investigate the applications of robot-assisted surgery and its effect on surgical outcomes in orthopaedic trauma patients. Data Sources: A search was performed in PubMed and Embase for articles in English, Dutch, German, or French, without restrictions on follow-up times, study size, or year of publication. Study Selection: Studies were included if they investigated patients undergoing robot-assisted fracture fixation surgery for orthopaedic trauma. Data Extraction: Outcomes studied were operating time, fluoroscopy time/frequency, complications, functional outcomes, intraoperative blood loss, fracture healing, and screw placement accuracy. Critical appraisal was done by using the Methodological Index for Non-Randomized Studies. Data Synthesis: Narrative review. Conclusions: A total of 3832 hits were identified with the search and 8 studies were included with a combined total of 437 included patients, 3 retrospective cohort studies, 2 prospective cohort studies, 1 cohort study not otherwise specified, 1 case series, and 1 randomized controlled trial. Four studies investigated pelvic ring fractures, 3 studies investigated femur fractures, and 1 study investigated scaphoid fractures. Seven investigated percutaneous screw fixation and 1 studied intramedullary nail fixation. One robotic system was used across all studies, the TiRobot, and all procedures were performed in China. The limited evidence suggests that that robot-assisted orthopaedic trauma surgery may reduce operating time, use of fluoroscopy, intraoperative blood loss, and improve screw placement accuracy, but the overall quality of evidence was low with a high risk of bias. Robot-assisted fracture fixation does not appear to lead to better functional outcomes for the patient. Level of evidence: III
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Gunaratne R, Goncalves J, Monteath I, Sheh R, Kapfer M, Chipper R, Robertson B, Khan R, Fick D, Ironside CN. Wavelength weightings in machine learning for ovine joint tissue differentiation using diffuse reflectance spectroscopy (DRS). BIOMEDICAL OPTICS EXPRESS 2020; 11:5122-5131. [PMID: 33014603 PMCID: PMC7510883 DOI: 10.1364/boe.397593] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 05/03/2023]
Abstract
Objective: To investigate the DRS of ovine joint tissue to determine the optimal optical wavelengths for tissue differentiation and relate these wavelengths to the biomolecular composition of tissues. In this study, we combine machine learning with DRS for tissue classification and then look further at the weighting matrix of the classifier to further understand the key differentiating features. Methods: Supervised machine learning was used to analyse DRS data. After normalising the data, dimension reduction was achieved through multiclass Fisher's linear discriminant analysis (Multiclass FLDA) and classified with linear discriminant analysis (LDA). The classifier was first run with all the tissue types and the wavelength range 190 nm - 1081 nm. We analysed the weighting matrix of the classifier and then ran the classifier again, the first time using the ten highest weighted wavelengths and the second using only the single highest. Our method was applied to a dataset containing ovine joint tissue including cartilage, cortical and subchondral bone, fat, ligament, meniscus, and muscle. Results: It achieved a classification accuracy of 100% using the wavelength 190 nm - 1081 nm (2048 attributes) with an accuracy of 90% being present for 10 attributes with the exception of those with comparable compositions such as ligament and meniscus. An accuracy greater than 70% was achieved using a single wavelength, with the same exceptions. Conclusion: Multiclass FLDA combined with LDA is a viable technique for tissue identification from DRS data. The majority of differentiating features existed within the wavelength ranges 370-470 and 800-1010 nm. Focusing on key spectral regions means that a spectrometer with a narrower range can potentially be used, with less computational power needed for subsequent analysis.
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Affiliation(s)
| | - Joshua Goncalves
- Australian Institute of Robotic Orthopaedics, 2 Centro Avenue, Subiaco 6008, Australia
| | | | - Raymond Sheh
- Curtin University, Kent Street, Bentley 6102, Australia
| | - Michael Kapfer
- Australian Institute of Robotic Orthopaedics, 2 Centro Avenue, Subiaco 6008, Australia
| | - Richard Chipper
- Australian Institute of Robotic Orthopaedics, 2 Centro Avenue, Subiaco 6008, Australia
| | - Brett Robertson
- Australian Institute of Robotic Orthopaedics, 2 Centro Avenue, Subiaco 6008, Australia
| | - Riaz Khan
- Australian Institute of Robotic Orthopaedics, 2 Centro Avenue, Subiaco 6008, Australia
- The Joint Studio, 85 Monash Avenue, Nedlands 6009, Australia
- Department of Medicine, The University of Notre Dame, Fremantle, Australia
| | - Daniel Fick
- Australian Institute of Robotic Orthopaedics, 2 Centro Avenue, Subiaco 6008, Australia
- The Joint Studio, 85 Monash Avenue, Nedlands 6009, Australia
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Burn E, Prieto-Alhambra D, Hamilton TW, Kennedy JA, Murray DW, Pinedo-Villanueva R. Threshold for Computer- and Robot-Assisted Knee and Hip Replacements in the English National Health Service. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:719-726. [PMID: 32540229 DOI: 10.1016/j.jval.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/05/2019] [Accepted: 11/18/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To estimate threshold prices for computer- and robot-assisted knee and hip replacement. METHODS A lifetime cohort Markov model provided the framework for analysis. Linked primary care and inpatient hospital records informed estimates of outcomes under current practice. Outcomes were estimated under a range of hypothetical relative improvements in quality of life if unrevised and in revision risk after computer or robot-assisted surgery. Threshold prices, a price at which the net health benefit from funding the intervention would be zero, for these improvements were estimated for a cost-effectiveness threshold of £20 000 per additional quality-adjusted life-year (QALY) gained. RESULTS For average patient profiles under current knee and hip replacement practice, lifetime QALYs were 10.3 (9.9 to 10.7) and 11.0 (10.6 to 11.4), with costs of £6060 (£5947 to £6203) and £6506 (£6335 to £6710) for knee and hip replacement, respectively. A combined 50% relative reduction in risk of revision and 5% improvement in postoperative quality of life if unrevised would, for example, result in QALYs increasing to 10.9 (10.4 to 11.3) and 11.6 (11.2 to 12.0), and costs falling to £5880 (£5816 to £5956) and £6258 (£6149 to £6376) after knee and hip replacement, respectively. These particular improvements would have an associated threshold price of £11 182 (£10 691 to £11 721) for knee replacement and £12 134 (£11 616 to £12 701) for hip replacement. The 50% reduction in revision rate alone would have associated threshold prices of £1094 (£788 to £1488) and £1347 (£961 to £1842), and the 5% improvement in quality of life alone would have associated threshold prices of £9911 (£9476 to £10 296) and £10 578 (£10 171 to £10 982). CONCLUSIONS At current prices, computer- and robot-assisted knee and hip replacement will likely need to lead to improvements in patient-reported outcomes in addition to any reduction in the risk revision.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/methods
- Cost-Benefit Analysis
- England
- Female
- Humans
- Male
- Markov Chains
- Middle Aged
- Patient Reported Outcome Measures
- Quality of Life
- Quality-Adjusted Life Years
- Robotic Surgical Procedures/economics
- Robotic Surgical Procedures/methods
- Surgery, Computer-Assisted/economics
- Surgery, Computer-Assisted/methods
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Affiliation(s)
- Edward Burn
- Nufield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK
| | - Daniel Prieto-Alhambra
- Nufield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK; GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - Thomas W Hamilton
- Nufield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK
| | - James A Kennedy
- Nufield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK
| | - David W Murray
- Nufield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK.
| | - Rafael Pinedo-Villanueva
- Nufield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK
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