Accurate assessment of pelvic orientation is essential for acetabular cup placement during total hip arthroplasty (THA). Conventional pelvic tracking systems generally rely on dedicated tracking hardware and optical tracking infrastructure. We developed a smartwatch-based pelvic tracking system integrated with an augmented reality (AR) navigation platform and evaluated its preliminary clinical performance. This retrospective study included 30 hips of 27 consecutive patients who underwent primary THA using a smartwatch-based pelvic tracking navigation system between May 2025 and April 2026. The system utilizes a commercially available smartwatch fixed to the iliac crest as a pelvic tracking device and communicates orientation information to a smartphone-based AR navigation platform via Bluetooth. Acetabular cup orientation was evaluated using postoperative CT. Absolute radiographic inclination (RI) and anteversion (RA) errors were calculated as absolute differences between the final intraoperative navigation measurements and postoperative CT measurements. The mean absolute RI error was 2.8° ± 2.1°, and the mean absolute RA error was 3.6° ± 2.2°. Postoperative CT measurements were within 5° of the final intraoperative navigation measurements for RI and RA in 86.7
Intraosseous regional administration (IORA) of antibiotics can achieve higher local tissue concentrations than intravenous administration in conventional total knee arthroplasty (TKA). This study aimed to evaluate the tissue concentration and systemic concentration of preoperative stand-alone intraosseous cefuroxime in robotic-assisted total knee arthroplasty (RA-TKA) and identify a candidate dose for further evaluation. Thirty-nine patients undergoing MAKO RA-TKA were randomly allocated in a 1:1:1 ratio to receive intraosseous cefuroxime 750 mg (R750IO), intraosseous cefuroxime 1,500 mg (R1500IO), or intravenous cefuroxime 1,500 mg (R1500IV). No additional intravenous antibiotics were administered before incision or during surgery. During surgery, nine tissue samples were collected: bone samples from the femur or tibia, synovial and fat samples from the surgical area, and systemic blood samples twice for cefuroxime level detection. Intraoperative vital signs, inflammatory markers on days 1 and 3 postoperative, and complications within 3 months were recorded. The final analysis included 38 patients: 13 in the R750IO group, 13 in the R1500IO group, and 12 in the R1500IV group. Compared with the R1500IV group, both R1500IO and R750IO groups showed significantly higher tissue concentrations (p < 0.05) but lower initial blood concentrations (p < 0.05). While the R1500IO group had higher tissue concentrations than the R750IO group, its post-tourniquet-release blood concentration was significantly higher (p = 0.005). No significant differences were found in postoperative inflammatory markers and intraoperative vital signs among the three groups (p > 0.05), and no complications occurred within 3 months. Despite multiple intramedullary pins and longer operative time in robot-assisted TKA, a single intraosseous dose of cefuroxime still achieved high tissue concentrations. Compared to conventional intravenous infusion of 1,500 mg cefuroxime, preoperative stand-alone intraosseous administration of either 750 mg or 1,500 mg cefuroxime achieved higher local tissue concentrations. Moreover, the 750 mg intraosseous regimen was associated with a lower post-tourniquet-release systemic concentration than the 1,500 mg intraosseous regimen, supporting its further clinical evaluation as a candidate dose in RA-TKA.
Abstract Background Robot-assisted THA (RATHA) has been associated with greater component-positioning accuracy, but surgeon workload during RATHA remains unclear. This study compared objective physiologic stress and perceived workload during conventional THA (CTHA) and RATHA. Methods This exploratory, hypothesis-generating study prospectively evaluated 60 elective primary THAs, comprising 30 CTHAs and 30 RATHAs, as repeated procedural observations from a single high-volume, fellowship-trained arthroplasty surgeon. All procedures were performed through a standardized posterolateral approach. RATHA used the MAKO system for acetabular preparation and cup implantation only. Intraoperative physiologic data were collected using a Hexoskin smart garment. Whole-case outcomes included heart rate, stress index, root mean square of successive differences (RMSSD), respiratory rate, minute ventilation, and energy expenditure rate. Perceived workload was assessed using the Surgery Task Load Index (SURG-TLX). Phase-specific stress index and RMSSD were analyzed across exposure, acetabular preparation, femoral preparation, and wound closure. Results Baseline patient characteristics were comparable between groups. Operative time was significantly longer during RATHA than CTHA (141.50 ± 30.76 vs 116.86 ± 21.88 min, p < 0.001). Despite this, RATHA was associated with a lower SURG-TLX composite score (adjusted mean difference, − 0.47; 95% CI − 0.85 to − 0.09; p = 0.039), with lower scores for task complexity and situational stress. Whole-case stress index was lower during RATHA (adjusted mean difference, − 2.52; 95% CI − 4.21 to − 0.83; p = 0.004), whereas the between-group difference in whole-case RMSSD was not statistically significant (geometric mean ratio, 1.35; 95% CI 0.98–1.86; p = 0.067). Heart rate, respiratory rate, minute ventilation, and energy expenditure rate did not differ significantly between groups. Phase-specific analysis showed lower stress index during RATHA in exposure, acetabular preparation, and femoral preparation, but higher stress index during wound closure. RMSSD was higher during RATHA in exposure and acetabular preparation. Conclusions In this single-surgeon cohort, the acetabular-only RATHA workflow was associated with lower perceived workload and a lower mean whole-case stress index than the CTHA workflow despite longer operative time. These hypothesis-generating findings warrant validation in multisurgeon studies.
Abstract Background Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty requiring surgical and antibiotic management. One-stage revision has gained attention because it reduces the number of procedures while yielding acceptable outcomes. Intra-articular (IA) antibiotic delivery has been investigated to enhance local antimicrobial exposure and address biofilm-related challenges. However, a focused systematic review of IA antibiotic delivery combined with one-stage revision for PJI is lacking. This systematic review evaluated the techniques, safety, and outcomes of this strategy. Methods A literature search was conducted up to 30 November 2025 across PubMed (including MEDLINE), Web of Science, Embase, and the Cochrane Library. Studies enrolling adults with PJI treated by one-stage revision combined with IA antibiotic delivery and reporting clinical outcomes with at least 12 months of follow-up were included. Study characteristics, treatment protocols, outcomes, and safety data were extracted and descriptively synthesized. Results Ten studies were identified. IA antibiotic delivery combined with one-stage revision showed satisfactory infection-control outcomes across individual studies. Antibiotics were selected according to microbiological findings and administered via catheter infusion or direct intra-articular injection for 14–42 days. Reported complications were descriptively summarized and included catheter-related, local, surgical, and systemic adverse events. Renal-related adverse events were reported, with no documented long-term renal impairment in the included studies. Heterogeneity in treatment protocols and study designs was noted across studies. Conclusion Intra-articular antibiotic delivery combined with one-stage revision for PJI was associated with satisfactory reported infection-control outcomes and safety findings. While the current evidence is largely retrospective and heterogeneous, further prospective comparative studies with standardized protocols would help clarify its clinical role.
Patients undergoing elective joint replacement are mostly elderly individuals with multiple chronic diseases. These patients have a higher risk, so preoperative assessment for joint replacement is vital for surgical safety but remains challenging for junior physicians. This study aimed to evaluate the decision-making performance of different versions of DeepSeek (Chat and R1) and their knowledge base (KB)-enhanced schemes in perioperative risk assessment and their impact on junior physicians’ decision-making quality. A total of 292 anonymized medical records from joint replacement patients were retrospectively analyzed. A professional knowledge base was constructed using 21 perioperative management guidelines and retrieval-augmented generation (RAG) technology. The performance of four models (DeepSeek-Chat, DeepSeek-Chat + KB, DeepSeek-R1, and DeepSeek-R1 + KB) was compared in ASA scoring, RCRI scoring, surgical tolerance judgment, and risk prediction. These indicators are related to specific decisions in joint replacement surgery, including preoperative optimization before elective TKA/THA, mitigation of infection risk, planning of VTE prophylaxis, and indication for postponing elective arthroplasty, etc. Senior physicians evaluated model performance using a Likert scale. A 5 × 5 balanced Latin square crossover design was used to assess the impact of model assistance on junior physicians’ clinical decision-making. No significant difference was found in ASA scoring accuracy (p > 0.05). For RCRI scoring and risk stratification, DeepSeek-R1 models (79.1
