Background and objectives: Our study aimed to assess the learning curve for robot-assisted (RA) total knee arthroplasty (TKA) in our hospital, compare operative times between RA-TKAs and manual TKAs, and assess the early complications rate between the two approaches. Methods: We included 39 patients who underwent RA-TKA and 45 control patients subjected to manual TKA in the same period and operated on by the same surgical staff. We collected demographic and patient-related data to assess potential differences between the two groups. Results: No statistical differences were recorded in regard to age, BMI, sex, Kellgren–Lawrence classification, or limb alignment between patients undergoing RA-TKA and manual TKA, respectively. Three surgeons transitioned from the learning to the proficiency phase in our study after a number of 6, 4, and 3 cases, respectively. The overall operative time for the learning phase was 111.54 ± 20.45 min, significantly longer compared to the average of 86.43 ± 19.09 min in the proficiency phase (p = 0.0154) and 80.56 ± 17.03 min for manual TKAs (p < 0.0001). No statistically significant difference was recorded between the global operative time for the proficiency phase TKAs versus the controls. No major complications were recorded in either RA-TKA or manual TKA groups. Conclusions: Our results suggest that experienced surgeons may adopt RA-TKA using this platform and quickly adapt without significant complications.

Background: The Coronal Plane Alignment of the Knee (CPAK) classification system has been developed as a comprehensive framework delineating nine coronal plane phenotypes, based on arithmetic hip–knee angle (aHKA) and joint line obliquity (JLO). Our study aimed to assess the prevalence of knee phenotypes in the Romanian population using the CPAK classification, encompassing both osteoarthritic and healthy cohorts. Methods: We conducted an observational cross-sectional study, analyzing data from 500 knees with osteoarthritis and 500 healthy knees that met the inclusion criteria. Demographic data were collected, and radiological parameters including lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), aHKA, and JLO were measured. Knee phenotypes were categorized using the CPAK classification. Results: In the osteoarthritic cohort, the most prevalent CPAK phenotype was type I (42.4%), characterized by varus alignment and an apex distal joint. Conversely, in the healthy population, CPAK type II, indicating neutral alignment and an apex distal joint, was the most prevalent phenotype (39.0%). CPAK types VII, VIII, and IX were rare. Conclusions: Our findings demonstrate similarities in knee phenotypes compared to other populations, with some minor differences and particularities. The CPAK classification proves to be a valuable tool in assessing knee tyalignment.

Total hip arthroplasty (THA) is commonly performed for conditions like osteoarthritis, avascular necrosis, hip fractures, and hip dysplasia. Complications following THA can result in major proximal femoral defects (MPFD), which are challenging to manage. Megaprostheses provide a solution, offering stability and early weight-bearing, though they present their own challenges. However, maintaining hip symmetry with megaprostheses is challenging in accurately restoring femoral offset, acetabular orientation, and soft tissue tension. These factors can contribute to instability, altered biomechanics, and functional impairment. Therefore, achieving hip symmetry through femoral and acetabular offset, limb length discrepancy (LLD), and center of rotation (COR) is an important consideration. Achieving proper symmetry may improve gait, quality of life, and overall outcomes. This case series includes 10 patients with non-tumoral pathology treated with megaprostheses for complications after THA between 2014 and 2024. Megaprosthesis conversion was performed for sepsis (n = 2), aseptic loosening (n = 4), and periprosthetic fracture (n = 4). Dislocation occurred in 20%, with one case showing restored hip symmetry but dislocating due to trauma and noncompliance. Another case had an LLD of 3 cm, contributing to dislocation. Periprosthetic infection was observed in 20%, managed with a two-stage approach. Although hip symmetry was not fully restored in all patients, strict follow-up and rehabilitation were essential for improving functionality and quality of life. Megaprosthesis is an effective solution for MPFD in non-oncological patients when performed correctly. Restoring hip symmetry is challenging and depends on patient care and compliance, though it is an important factor influencing outcomes.

Enhanced Recovery After Surgery (ERAS) protocols are used in elective colorectal surgeries and have shown improved recovery for many patients. However,

Introduction: Chronic osteomyelitis is a persistent infection of the bone that poses significant challenges, particularly when associated with pathological fractures and extensive bone defects. This case report highlights the application of Masquelet’s induced membrane technique (MIMT) in managing a complex distal femur defect in a 50-year-old male with a long-standing history of chronic osteomyelitis. The patient presented with a non-union fracture, severe osseous destruction, and infection, requiring a multidisciplinary approach. Case report: The first stage involved radical debridement of necrotic tissue and stabilization with a titanium plate and an antibiotic-impregnated polymethylmethacrylate spacer to induce a bioactive membrane. The second stage, performed 30 days later, after infection resolution, entailed removing the spacer, harvesting an autologous iliac crest bone graft, and filling the defect within the preserved membrane. Postoperative care included a tailored antibiotic regimen and gradual weight-bearing, leading to favorable clinical and radiological outcomes. Conclusions: This case demonstrates the utility of MIMT in reconstructing extensive bone defects while addressing infection. The technique provides a reliable and effective alternative to amputation, offering high success rates and functional restoration in complex cases.

Background and Objectives: Robotic-assisted total knee arthroplasty (rTKA) is being increasingly used to improve surgical precision, soft-tissue balancing, and functional recovery. However, evidence comparing rTKA with conventional manual TKA (mTKA) across functional, patient-reported, neuromotor, and safety outcomes remains heterogeneous. Materials and Methods: This narrative (non-systematic) review synthesises studies evaluating functional outcomes, patient-reported outcome measures (PROMs), joint awareness, range of motion (ROM), neuromotor recovery, and complications following rTKA versus mTKA. Study inclusion was based on author judgement and data accessibility. The reviewed evidence included five randomised controlled trials, 9 retrospective studies, six prospective non-randomised studies, two meta-analyses, one cross-sectional study, and one umbrella review, covering CT-based and imageless robotic platforms, including semi-active and active systems such as MAKO, NAVIO, CORI, ROSA, ROBODOC, CUVIS Joint, SkyWalker, TSolution One, AKEC, JIANJIA, and YUANHUA. Results: rTKA consistently demonstrated outcomes comparable to mTKA in PROMs (OKS, KOOS, WOMAC, KSS), with some studies reporting modest early improvements in pain and function. Joint awareness and patient satisfaction showed the most consistent early advantages for rTKA. Early postoperative ROM and neuromotor recovery, including balance and gait symmetry, were improved with rTKA, likely due to enhanced alignment and soft-tissue balancing; however, mid- and long-term outcomes were similar. Complication rates were low and comparable, with robotic-specific issues being rare and self-limited. Conclusions: rTKA provides small but reproducible early benefits in joint awareness, neuromotor function, and patient satisfaction, without clear long-term superiority. These early advantages may translate into meaningful population-level benefits, including faster recovery and potential healthcare cost reduction. Further high-quality studies are needed to assess long-term clinical and economic outcomes.