Obesity adversely affects outcomes in total knee arthroplasty (TKA), with higher rates of infection, wound complications, and early revision particularly noted in patients with BMI > 35 kg/m2. While BMI is traditionally used to assess surgical risk, recent evidence suggests it may not reliably predict intraoperative challenges or wound healing outcomes. Instead, distribution of adiposity—such as increased limb girth or deep soft tissue thickness—may better correlate with surgical complexity. A shift toward assessing obesity phenotype rather than BMI alone can lead to better perioperative planning and tailored interventions. This approach is especially relevant in resource-constrained settings where the dual burden of obesity and limited healthcare access complicates care. In India, the absence of national guidelines and obesity-specific care pathways creates inconsistency in surgical decision-making. A growing body of evidence supports the need for comprehensive preoperative optimization—including weight reduction, glycemic control, nutritional support, and physiotherapy. Emerging strategies such as robotic-assisted surgery, patient-specific instrumentation, and Enhanced Recovery After Surgery (ERAS) protocols show promise in improving outcomes for obese patients. This review highlights the need for a personalized, evidence-based approach to TKA in obese individuals. A narrative review of contemporary literature was undertaken to assess the impact of obesity on TKA outcomes, alternative measures of adiposity, preoperative optimization strategies, and emerging technologies aimed at improving results in obese patients. This review examines the limitations of BMI-based risk stratification and explores the relevance of obesity phenotype in influencing perioperative complexity and outcomes in TKA, with emphasis on the Indian healthcare context. Current evidence suggests that BMI poorly predicts intraoperative challenges and wound healing complications. Measures reflecting adiposity distribution - such as limb girth and soft tissue thickness demonstrate stronger associations with surgical exposure, Noperative difficulty, and postoperative wound issues. Multimodal preoperative optimization, including weight reduction, glycaemic control, nutritional support, and physiotherapy, has been shown to reduce complication rates. Technological adjuncts such as roboticassisted Nsurgery, patient-specific instrumentation, and Enhanced Recovery After Surgery (ERAS) protocols may further improve outcomes. In India, the absence of standardized obesity-specific perioperative pathways contributes to variability in surgical decisionmaking. shift from BMI-based assessment to a phenotype-driven, individualized approach may allow better risk stratification and perioperative planning in obese patients undergoing TKA. Development of context-specific guidelines and structured optimization pathways is essential to improve outcomes in resource-constrained settings.

Early knee osteoarthritis (OA) is a common cause of pain and functional limitation, often managed conservatively with medications and physiotherapy. The EMI protocol (Exercise, Medicine, and Icing) was developed as a surgeon-led, home-based intervention aimed at improving pain, function, and muscle strength in patients with early knee OA. This prospective, parallel-group, randomised controlled trial included 150 patients aged 40–70 years with Kellgren–Lawrence Grade 1–2 knee OA. Participants were randomised to receive either the EMI protocol (exercise, icing, and a standardised 6 week medical regimen including vitamin D, calcium, and magnesium supplementation) or the same medical regimen alone. The primary outcome was change in Visual Analog Scale (VAS) pain score at 6 weeks. Secondary outcomes included Kujala score, quadriceps strength (manual muscle testing), rescue NSAID use, adherence, and adverse events over 1 year. At 1 year follow-up, 138 patients (92

Day care total knee arthroplasty (TKA) has gained global momentum as an effective strategy to reduce hospital stay while maintaining patient safety and clinical outcomes. Although widely adopted in several countries, its implementation in India remains limited. To review the current evidence on day care TKA and evaluate its feasibility, safety, cost-effectiveness, and potential applicability within the Indian healthcare setting. Methods:A narrative review of the available literature was conducted, examining international experiences, perioperative protocols, patient selection criteria, economic considerations, and reported clinical outcomes associated with day care TKA. Challenges and opportunities specific to the Indian context were also explored. Evidence suggests that day care TKA can achieve comparable safety, functional outcomes, and patient satisfaction to conventional inpatient arthroplasty in appropriately selected patients. Enhanced recovery protocols, multidisciplinary care pathways, and stringent patient selection are central to successful implementation. Potential benefits include reduced healthcare costs, improved resource utilization, and increased patient convenience. However, barriers such as clinician skepticism, medico-legal concerns, limited patient awareness, and infrastructural variability continue to impede widespread adoption in India. Day care TKA represents a safe and cost-effective model of arthroplasty care when implemented within a structured framework. With appropriate patient selection, optimized perioperative pathways, and multidisciplinary collaboration, day care TKA has the potential to transform orthopaedic care delivery in India.

Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure aimed at restoring knee stability and function following ligament injury. Although hamstring tendon (HT) autografts are widely used, concerns regarding donor-site morbidity and graft-related limitations persist. The peroneus longus tendon (PLT) has recently gained attention as an alternative autograft, offering favourable biomechanical properties and potentially reduced morbidity. However, evidence comparing clinical outcomes between PLT and HT autografts remains limited and inconsistent. Therefore, this study aimed to systematically evaluate and compare the efficacy and safety of PLT versus HT autografts in primary ACLR using high-level evidence from randomised controlled trials (RCTs). A systematic review and meta-analysis of RCTs comparing PLT and HT autografts in primary ACLR was conducted. Databases were searched up to December 2025. Outcomes included patient-reported scores, knee stability, graft characteristics, donor-site morbidity, and ankle function. Four RCTs involving 407 patients were included. Lysholm and IKDC scores were comparable between groups. The PLT group demonstrated significantly better modified Cincinnati scores (MD, 3.02; P = 0.0004) and larger graft diameter. Donor-site morbidity was significantly lower with PLT (OR 0.12; P = 0.007). Knee stability and graft failure rates were similar. AOFAS scores showed no significant postoperative decline. PLT autografts provide outcomes comparable to HT with potential advantages in donor-site morbidity and graft characteristics, supporting their use as a reliable alternative in ACLR.

Surgical site infections (SSI) following knee replacement pose significant challenges, often attributed to microorganism contamination during surgery. Robotic-assisted total knee replacement (RA-TKR) offers potential advantages but may also raise concerns regarding infection risk. This systematic review and meta-analysis aimed to evaluate infection rates following RA-TKR compared to Conventional Total knee replacement (C-TKR) within the first-year post-implantation. A systematic search of major databases was conducted from 2005 to November 2023. Eligible studies reported primary C-TKR and RA-TKR interventions, documented SSI incidence, and had a follow-up period of at least 12 months. Data on deep, superficial, and pin-site infections were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias Tool. Summary estimates were generated using a random-effects model. Eight studies were included, comprising 758,453 knees (6724 RA-TKR, 751,729 C-TKR). The overall SSI rate was 1.57

Hamstring injuries are a major cause of time-loss in athletes, often leading to prolonged recovery and high recurrence rates. This randomized controlled trial evaluated the efficacy of ultrasound-guided platelet-rich plasma (PRP) injections in accelerating return to play (RTP) and enhancing radiological healing in grade 2 hamstring injuries. Sixty athletes with MRI-confirmed grade 2 hamstring injuries were randomized into two groups: PRP plus standard therapy (n = 30) and standard therapy alone (n = 30). All followed a standardized rehabilitation protocol. Primary outcome was time to return to play (TTRTP). Secondary outcomes included MRI healing at 21 days, re-injury rates, and adverse events, with a 2-year follow-up. The PRP group showed significantly faster RTP (26.4 ± 4.5 vs. 34.2 ± 5.7 days; p < 0.001) and greater MRI healing at 21 days (70

Background Total Knee Arthroplasty (TKA) is an effective surgical intervention for end-stage osteoarthritis (OA). The decision between unilateral TKA and simultaneous bilateral TKA remains a topic of debate due to differences in functional outcomes, complication rates, and recovery trajectories. This study aims to compare the functional recovery, complications, and patient satisfaction between unilateral and simultaneous bilateral TKA in the Indian population. Methods This prospective, single-surgeon, comparative cohort study included 216 patients (112 unilateral TKA, 104 simultaneous bilateral TKA). Patients were followed for an average of 6.15 ± 1.21 years. Functional outcomes were assessed using the Oxford Knee Score (OKS) and range of motion (ROM) at 1 year and 5 years postoperatively. Pain, complication rates, hospital stay, and patient satisfaction were also evaluated. Results Both groups showed significant improvements in OKS and ROM compared to baseline. At 1 year, the OKS improved to 33.12 ± 1.66 (unilateral) and 33.56 ± 1.72 (bilateral) (P-value = 0.028), with further improvement at 5 years (38.65 ± 1.48 vs. 39.14 ± 1.54, P-value = 0.011). ROM improvements were comparable between groups (P-value = 0.787). The bilateral group had a longer hospital stay (P-value = 0.02) and higher early postoperative pain, but overall complication rates and patient satisfaction were similar (P-value = 0.74). Conclusion Simultaneous bilateral TKA provides comparable long-term functional outcomes to unilateral TKA, with efficient recovery and similar complication rates. Careful patient selection is essential to optimize outcomes.

Abstract Background: Patellar clunk syndrome (PCS) is a recognized complication following total knee replacement (TKR), particularly in posterior-stabilized (PS) knee designs. Although patellar resurfacing has been proposed to reduce PCS incidence, conflicting evidence exists regarding its protective role. This meta-analysis aimed to evaluate whether patellar resurfacing significantly reduces the incidence of PCS in primary TKR. Methods: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A comprehensive literature search was performed across PubMed (MEDLINE), Cochrane Library, and Google Scholar up to September 2024. We included randomized controlled trials, systematic reviews, and meta-analyses comparing PCS incidence between patellar resurfacing and non-resurfacing in primary TKR. Meta-analysis was conducted using a random-effects model, with pooled odds ratios (ORs) and 95% confidence intervals (CIs) calculated. Heterogeneity was assessed using the I² statistic. Results: A total of 32 studies, encompassing 13,720 knees, were included in this analysis. The pooled OR for PCS incidence between resurfaced and non-resurfaced patellae was 0.82 (95% CI: 0.59–1.15; P = 0.22), indicating no statistically significant difference. The I ² value for heterogeneity was 36%, suggesting low-to-moderate variability among studies. Contributory factors for PCS included smaller patellar components, reduced patellar height, increased patellar offset, higher tibial polyethylene thickness, and anterior tibial tray placement. PS designs showed a higher PCS incidence than cruciate-retaining designs due to femoral box impingement. Conclusion: This meta-analysis found no statistically significant reduction in PCS incidence with patellar resurfacing in TKR. Instead, prosthesis design, patellar height, tibial tray positioning, and flexion angle appear to have a greater impact on PCS development.

ImportancePartial-thickness rotator cuff tears (PTRCTs) commonly affect overhead athletes, leading to a decline in sports performance. Platelet-rich plasma (PRP) is being explored as an alternative treatment modality for individuals with PTRCTs, to reduce discomfort and enhance functional recovery. We conducted a systematic review study of randomized controlled clinical trials to determine the effectiveness of PRP in treating PTRCTs.AimTo determine the effectiveness of PRP in treating PTRCTs.Evidence ReviewWe conducted a comprehensive literature search for randomized controlled trials (RCTs) that compared the effectiveness of PRP with eccentric exercise and placebo injections as treatments for PTRCTs. We searched databases such as the Cochrane Library, Web of Science, PubMed, and EMBASE. The Visual analog scale (VAS) score, American shoulder and elbow surgeon (ASES) score, and Constant-Murley score (CMS) were utilized as outcome measures. Statistical analysis was performed using RevMan 5.3 software.FindingsOur meta-analysis included 12 studies involving 762 patients. At six weeks post-treatment, the PRP group had significantly higher VAS scores compared to the control group, indicating improvement (Standard mean difference (SMD), -2.04 [95% Confidence interval (CI), -4.00 to -0.08], I2 =97%, P-value =0.04). Patients who received PRP showed statistically significant improvements in VAS scores at 3 months and 6 months follow-up (SMD, -1.78 [95% CI, -3.03 to -0.52], I2 =96%, P-value =0.005) (SMD, -2.26 [95% CI, -3.77 to -0.76], I2 =97%, P-value =0.003). A statistically significant difference was also observed in VAS scores at the long-term 1-year follow-up (SMD, -2.27 [95% CI, -4.07 to -0.47]; I2 =98%; P-value =0.031). There were statistically significant differences in ASES scores and CMS scores in the short-term (SMD, 1.21 [95% CI, 0.19 to 2.24], I2 =96%, P-value =0.02) (SMD, 2.01 [95% CI, 0.14 to 3.88], I2 =97%, P-value =0.04). However, in the long-term ASES and CMS scores did not show any statistical significance (SMD, 2.06 [95% CI, -0.54 to 4.65], I2 =99%, P-value=0.12) (SMD, 4.36 [95% CI, -5.48 to 14.21], I2 =99%, P-value=0.39).Conclusions and RelevanceOur findings suggest that PRP treatment is effective in reducing pain for individuals with PTRCTs, providing benefits in the short term and long term. However, its impact on functional recovery appears somewhat constrained and doesn't endure over time. Additionally, significant heterogeneity exists among studies, encompassing variations in PRP composition and control group treatments. Consequently, we conclude that compelling evidence for symptom improvement in PTRCT patients following PRP treatment remains elusive.Level of EvidenceLevel I

Background: To report an unusual complication of a modern and popular treatment choice for early osteoarthritis of the knee. Case presentation: A 49-year-old female patient presented to our clinic with a history of knee pain for 6 months. She was treated conservatively with physical therapy and non-steroidal anti-inflammatory drugs, despite which her pain did not resolve. The patient, after a proper discussion about the modalities of further treatment, opted to go for an intra-articular platelet-rich plasma injection. After proper counseling, both knees were given intra-articular injections of platelet-rich plasma. Eight hours after receiving intra-articular platelet-rich plasma injection the patient was admitted to the hospital with symptoms of pain and inflammation of the left knee alone. The symptoms persisted even after conservative management. Magnetic resonance imaging was done which showed changes in synovitis with bone marrow edema in both the tibia and femoral condyles. Since her symptoms deteriorated, she was advised to undergo an arthroscopic left knee debridement with a synovectomy. Laboratory and histopathological studies did not reveal any sign of infection. Once the clinical picture was resolved, the patient was able to resume an earlier activity level. Conclusions: Although intra-articular platelet-rich plasma injections have been reported to be safe and have a few reports of minor adverse effects such as temporary increasing pain, this case proves the need for further research into published and hidden complications of this, otherwise “safe” procedure.

Total knee arthroplasty (TKA) is an efficient and common procedure used to treat advanced osteoarthritis of the knee. Geriatric patients make up the majority of TKA patients. For the surgical management of bilateral knee arthritis, there is still debate regarding whether to do a simultaneous or staged TKA. We through this study have gathered data and aimed to assess the safety of simultaneous bilateral TKA in patients. We conducted a study according to the PRISMA guidelines by searching through various databases for the following search terms: total knee arthroplasty (TKA), complications following TKA, bilateral TKA, and bilateral vs. unilateral TKA. The search included case series and clinical trials and excluded review articles, yielding 24 articles from the original search. We extracted data upon the outcomes in patients undergoing simultaneous bilateral TKA. We performed additional bias assessments to validate our search algorithm and results. One hundred and three published articles were identified, and twenty-four that included a total of 2, 18,385 patients were included in the meta-analysis. 93,074 patients underwent simultaneous bilateral TKA and 125,311 patients underwent staged bilateral TKA. Simultaneous bilateral TKA was associated with significantly increased mortality rate (P < 0.00001, Odd’s ratio [OR] 1.86, 95

Background: Computer- and robotic-assisted total knee replacement procedures have been shown to improve the accuracy of the implant size. It also allows dynamic confirmation of the implant and limb alignment during total knee arthroplasty (TKA). The major inhibition of the arthroplasty surgeon in adapting to the robotic-assisted TKA (RA-TKA) is the extra time spent during the registration process and milling of the bone with the robot. The aim of the study was to ascertain the extra time spent during these 2 steps as compared to the conventional TKA (C-TKA). Methods: It is a prospective study involving 30 patients each in the conventional TKA and RA-TKA operated by the same surgical team. The patients were given a choice between the C-TKA and RA-TKA and consecutive 30 cases in each group were studied by an independent observer. In the C-TKA group, the time for the application of appropriate zigs and execution of the bone cuts and soft -tissue release was recorded whereas in the RA-TKA group, the time taken for fixation of the tibial and femoral arrays and bone registration and bone milling with robot and required soft -tissue release was measured. Results: The preoperative patient characteristics were the same in both groups. The time taken in the C-TKA and RA-TKA groups was 24.77 +/- 1.92 minutes and 25.03 +/- 3.27 minutes, respectively, which is statistically insignificant (p = 0.709). Conclusions: The study findings show that RA-TKA does not take additional time than C-TKA.

Introduction: Plantar fasciitis (PF) is a common cause of heel pain, particularly affecting individuals involved in running sports and those with prolonged standing activities. While various nonoperative treatments are available, there is no consensus on the optimal therapy. Corticosteroid injections offer short-term relief but have associated risks and limited long-term efficacy. Platelet-rich plasma (PRP) has emerged as a potential alternative, with conflicting evidence regarding its effectiveness compared to corticosteroids. Materials and methods: This systematic review and meta-analysis adhered to Cochrane and PRISMA guidelines. We included level 1 and level 2 studies from 2015 to 2023 that compared intralesional corticosteroid and PRP injections for treating PF with at least 6 months of follow-up. Comprehensive searches were conducted in Medline, Embase, Scopus, and Google Scholar. Data extraction and quality assessment were independently performed by two reviewers, using the Cochrane risk of bias tool. Statistical analyses, including heterogeneity and subgroup analyses, were conducted using Review Manager 5.3. Results: From 826 initial studies, 13 met inclusion criteria, encompassing 941 patients (PRP 476, corticosteroids 465). Platelet-rich plasma demonstrated no significant pain relief over corticosteroids at 3 months [standard mean difference (SMD) = −0.37; 95% confidence interval (95% CI) = −1.15 to 0.41; I² = 96%; p = 0.35]. However, PRP showed statistically significant improvements in VAS scores at 6 months (SMD = −1.92; 95% CI = −3.33 to −0.51; I² = 98%; p = 0.008) and 1 year (SMD = −0.37; 95% CI = −0.70 to −0.03; I² = 0%; p = 0.03). For function, PRP resulted in significant improvements in American Orthopaedic Foot & Ankle Society (AOFAS) scores at 6 months (SMD = 0.89; 95% CI = 0.09 to 1.69; I² = 94%; p = 0.03) but not at 3 months (SMD = −0.09; 95% CI = −0.63 to 0.44; I² = 86%; p = 0.73) or 1 year (SMD = 1.68; 95% CI = −0.09 to 3.45; I² = 96%; p = 0.06). Conclusion: Platelet-rich plasma is more effective than corticosteroid injections for pain control from 6 months to 1 year. In the short term, PRP offers no significant advantage. Interpretation of these findings should consider the quality of studies, risk of bias, and variability in PRP preparation protocols, which affect the internal and external validity. Thus, compelling evidence for PRP's superiority in PF treatment remains elusive.

Adapting to robotic-assisted (RA) total knee arthroplasty (TKA) is hindered by the surgeon's fear of extra time. The main purpose of this study was to determine the robot's operative time, and the secondary goals were to assess the surgical team's anxiety, implant location and size, and limb alignment. From February to April 2022, 40 participants participated in prospective research. The study included primary Cuvis joint active RA-TKA patients for end-stage arthritis, but conversion of unicompartmental knee arthroplasty to TKA, and patients with prior knee surgery were excluded. The active RA-TKA surgical time included surgeon-dependent and surgeon-independent/active robot time. The surgeon's anxiety was measured using the state-trait anxiety inventory (STAI). The implant size/position and limb alignment were checked by post-operative weight-bearing lateral, anteroposterior, and full-length scanograms. Operative time specifically related to active RA-TKA was higher in the first 10 cases as against 10–20, 20–30 and 30–40 cases which was observed to lower from cohort 2. A similar trend was observed for the surgical team’s anxiety levels which seem to lower from cohort 2 (case 10–20). Cumulative experience of active RA-TKA showed no effect on the precision of implant alignment/ size, limb alignment and complications. The study showed progressive improvement in the surgical anxiety scores and reduction in operating time indicating the proficiency gained by the surgical team. Further no learning curve was involved in achieving the implant positioning and sizing, limb alignment with the absence of complications.

Introduction: This study addresses the current gap in the literature regarding frozen shoulder and Shoulder Injury Related to Vaccine Administration (SIRVA) following COVID-19 immunization. The primary objectives are to describe the demographic characteristics of patients who developed frozen shoulder as a result of COVID-19 vaccination and to identify commonalities with previous findings. Ultimately, this study aims to enhance healthcare providers' awareness of these conditions and provide insights for potential prevention strategies. Materials and methods: This retrospective study analysed a cohort of 80 patients (56 females and 24 males) with an average age of 53 years (±8 years). These patients sought medical care in the orthopaedic outpatient department due to shoulder stiffness and pain following COVID-19 vaccination between July 1, 2021, and July 31, 2022. Results: Radiographs of all 80 patients showed no abnormalities, and they were diagnosed with frozen shoulder. Among these patients, 20 had pre-existing medical conditions (4 with hypothyroidism, 12 with diabetes mellitus, and 4 with hypertension) at the time of presentation. Symptoms manifested immediately after vaccination in 48 patients, at 48 hours in 8 patients, and at 10 days in 24 patients. The average pain level, as assessed using the Visual Analog Scale (VAS), was 6.4 (±1.2), and both active and passive range of motion was restricted in all patients upon presentation. Conclusion: Healthcare professionals specializing in musculoskeletal issues should be mindful of the possibility of frozen shoulder occurring after COVID-19 vaccination in patients presenting with painful shoulder stiffness. Early recognition and treatment of this condition are essential for effective patient care.

IntroductionAchilles tendinopathy [AT] is a functional problem characterised by swelling and pain above the Achilles tendon insertion region. In individuals with AT, PRP or platelet-rich plasma can be used as an alternative modality of treatment with an aim to lessen the discomfort and enhance functional recovery. We assessed the available data supporting the effectiveness of PRP in treating chronic AT.Materials and methodsWe did a literature search for randomised controlled trials [RCTs] that contrasted the effectiveness of PRP with that of eccentric exercise and placebo injections as treatment for AT in databases such as the Cochrane Library, Web of Science, PubMed, and EMBASE. The Visual analogue scale [VAS] score, Victorian Institute of Sports Assessment-Achilles [VISA-A] score, and Achilles tendon thickness were used to measure the results. We used the RevMan 5.3.5 software for statistical analysis.ResultsWe included five RCTs in this meta-analysis. There was no significant difference in the VISA-A between the PRP and placebo groups at 12 weeks, 24 weeks and 1 year after treatment. However, at 6 weeks after treatment, PRP exhibited better efficacy than the placebo treatment. Two studies in our meta-analysis included VAS scores and tendon thickness. There was no significant difference in VAS scores at 6 weeks and 24 weeks after treatment. However, VAS scores at 12 weeks and tendon thickness were significantly different.ConclusionPRP injection is an effective treatment for chronic AT. It has a unique potential for increasing function and reducing discomfort in AT patients.

Background: Different techniques employed during conventional and robotic assisted Total Knee Arthroplasty may lead to variation in the immediate post-operative outcomes. Primary objective of the study was to evaluate the differences in the post-operative pain, analgesics use and length of stay between the RA-TKA and C-TKA. Secondary objective was to study the patient reported outcome measures at six months post TKA. Materials & Methods: It is a retrospective review of two cohort of patients (C -TKA and RA-TKA) who were operated between January to April 2022. Patients were given the option between C-TKA and RA- TKA. Sample size was estimated to be 28 patients in each group with α error of 0.05 and power of study being 80%. An independent observer analyzed the post-operative parameters like analgesic use, length of stay, VAS score and Oxford Knee Score at 6 months post TKA. Results: 30 patients in two cohorts were studied. There was no statistically significant difference between the two cohorts as regards the pre-operative patient characteristics. RA- TKA group had a shorter hospital stay (days) than the C-TKA group (3.24±0.50 and 4.07± 0.52, P <0.0001). Pain score (VAS score) was lower in RA -TKA than C-TKA cohort (POD1 5.23 ± 0.50 and 5.93 ± 0.52 POD2 4.40 ± 0.56 and 5.03 ± 0.49, p value <0.0001). R- TKA patients required significantly lower morphine milligram equivalent and NSAIDS than the C-TKA patients (p =0.0005 and p <0.001 respectively). The OKS at 6 months was lower in C-TKA than RA-TKA (32.5± 2.3 C-TKA vs. 33.8±1.5 RA-TKA, p value 0.0120). Conclusions: RA,-TKA cohort showed significant early advantages like decreased post-operative analgesia usage, shorter length of stay and lower pain scores on day 1 and 2 than the C TKA group. The OKS at 6 months was slightly better in RA-TKA vs. C-TKA. Keywords: Robotic-assisted total knee arthroplasty, Conventional total knee arthroplasty, Visual analog scale score, Analgesic.

Background:Use of semi-active and active robotic system for performing Total Knee Arthroplasty (TKA) is increasing. The novel fully automated active robotic system performs milling of the bone surfaces with a high speed burr. The aim of the current study was to assess the safety and efficacy of the system in robotic assisted TKA (RA-TKA).Materials and methods:A single center clinical trial was conducted following 30 knees undergoing active RA-TKA for 6 months. Inclusion criteria were patients undergoing RA-TKA for end stage arthritis. Patients undergoing conventional TKA and revision TKA were excluded from the study. Sample size was estimated to be 28 patients with α error of 0.05 and β error of 0.2 with power of study being 80. A pre-defined list of RA-TKA adverse events was employed to study the safety of the system. Efficacy was judged by comparing the planned versus achieved Implant size, alignment and limb alignment on post-operative radiographs. The post-operative clinical evaluation was done by an independent observer who was not part of the operating team. The primary safety and efficacy hypothesis was tested using a one sided Exact binomial test. The p value < 0.05 was considered significant.Results:Pre-defined adverse events did not occur in any of the 30 RA-TKA (statistically significant p value < 0.001). The implant size accuracy was 100% (30 out of 30 knees) for femoral component and 96.67% (29 out of 30 knees) for tibial component (statistically significant, Chi-squared test, p value 0.0105 and 0.0461 respectively). The implant position and limb alignment was accurate in 100% of patients (p value < 0.001).Conclusion:Early experience of the use of fully automated active robotic system in TKA shows that it is safe and also is effective in achieving accurate implant size and implant/limb alignment.

Background Nearly 20% of Total knee Arthroplasty patients remain dissatisfied. This is a major concern in twenty-first century arthroplasty practice. Accurate implant sizing is shown to improve the implant survival, knee balance and patient reported outcome. Aim of the current study is to assess the efficacy of pre-operative three-dimensional (3D) CT scan templating in a robot-assisted TKA in predicting the correct implant sizes and alignment. Materials and methods Prospectively collected data in a single center from 30 RA-TKAs was assessed. Inclusion criterion was patients with end stage arthritis (both osteoarthritis and rheumatoid arthritis) undergoing primary TKA. Patients undergoing revision TKA and patients not willing to participate in the study were excluded. Preliminary study of ten patients had indicated almost 100% accuracy in determining the implant size and position. Sample size was estimated to be 28 for 90% reduction in implant size and position error with α error of 0.05 and beta error of 0.20 with power of study being 80. Post-operative radiographs were assessed by an independent observer with respect to implant size and position. The accuracy of femoral and tibial component sizing in the study was compared with the historic control with Chi-squared test. The p value < 0.05 was considered significant. Results The pre-operative CT scan 3D templating accuracy was 100% (30 out of 30 knees) for femoral component and 96.67% (29 out of 30 knees) for tibial component. The implant position and limb alignment was accurate in 100% of patients. The accuracy of femoral component and tibial component sizing is statistically significant (Chi-squared test, p value 0.0105 and 0.0461, respectively). Conclusion The study results show the effectiveness of pre-operative 3 D CT scan planning in predicting the implant sizes and implant positioning. This may have a potential to improve the implant longevity, clinical outcomes and patient satisfaction.

Background Hip arthroscopy is a minimally invasive technology for diagnostic and therapeutic interventions in various hip disorders. Over the past decade or so, the technology and understanding related to this surgery have improved by leaps and bounds; however, in India the overall pace has been limited. The present review highlights the status of hip arthroscopy in the Indian context. Methodology A small survey with five questions related to practice of hip arthroscopy among Indian orthopaedic surgeons was conducted. Additionally a PubMed database search was conducted to recognise and assess studies pertaining to hip arthroscopy originating from India. Results Forty-two responses were received for the questionnaire, out of which 38 surgeons performed hip arthroscopy in their practice; the overall numbers were very low with only one respondent performing more than 50 surgeries in a year. For 84.2% of the respondents, the practice was limited to less than ten surgeries per year. 63.2% of the surgeons affirmed that there has been no change in their practice of hip arthroscopies over the past 5 years, signifying the slow growth and limited application of the technique. Only nine studies pertaining to the topic were available in the literature search, out of which five were case reports. The most common indication was removal of intraarticular foreign bodies, followed by joint debridement and lavage, synovial biopsies and femoroacetabular impingement (FAI). The outcomes in all the studies were satisfactory. Conclusion Hip arthroscopy is in its nascent stages in India and much is still needed to be done for better implementation of the technique on a wider scale. Adequate training and continued medical education programme, with exposure to the experts in the field, will go a long way in better utilisation of the surgery in India.