Background and objectives: The introduction of novel techniques in total knee arthroplasty (TKA) aiming to enhance outcomes and satisfaction of the procedure is constantly ongoing. In order to evidence a priority of one, we have conducted a randomized controlled trial with the aim of comparing patient-reported functional outcomes, radiographic outcomes and intraoperative measures between imageless (NAVIO and CORI), robotic-assisted (ra)- TKA (ra-TKA) and manual TKA (mTKA) for primary knee osteoarthritis (KOA). Materials and Methods: A total of 215 patients with the diagnosis of KOA of the knee were randomly assigned to one of the three groups: NAVIO (76 patients) or CORI (71 patients) robotic-assisted TKA, or manual technique (68 patients) TKA. The primary outcome (Knee Injury and Osteoarthritis Outcome Study [KOOS]), Visual Analogue Scale (VAS), Range of motion (ROM), femoral component rotational alignment and the secondary outcomes (surgery time, blood loss, complications, and revision at 12 months after surgery) were compared between three groups. KOOS and VAS were collected at particular follow up visits from each patient individually and ROM in flexion and extension was assessed during the physical examination. Femoral component rotational alignment was measured on the CT scan performed postoperatively utilizing the Berger’s method. Statistical significance was set at p < 0.05. Results: Both the ra-TKA groups and mTKA group displayed significant improvements in the majority of the functional outcome scores at 12 months. Despite having more prominent surgery time (NAVIO: mean +44.5 min in comparison to mTKA and CORI: mean +38.5 min in comparison to mTKA), both NAVIO and CORI tend to achieve highly accurate femoral component rotational alignment with mean radiographic scores in NAVIO vs. CORI vs. mTKA of 1.48° vs. 1.33° vs. 3.15° and lower blood loss (NAVIO: 1.74; CORI: 1.51; mTKA: 2.32. Furthermore, the investigation revealed the significant difference in femoral component rotational alignment between mTKA—NAVIO and mTKA—CORI and significantly different KOOS scores in NAVIO vs. CORI vs. mTKA of 87.05 vs. 85.59 vs. 81.76. Furthermore, the KOOS analysis showed between group significant statistical differences, but did not reach minimal clinically significant difference. There were no differences in postoperative ROM and VAS. There were no differences in complications between groups. Conclusions: To achieve a successful TKA, the precise tool and individualised objective is of great importance. The results suggest satisfactory results after both ra-TKA methods and mTKA. Ra-TKA and mTKA stand for a safe and reliable treatment method for OA. Patients reported excellent alleviation in functional outcomes and the radiological results revealed that the better precision does not necessarily lead to a better outcome. Therefore, ra-TKA does not imply strong enough advantages in comparison to the manual method, especially in terms of cost-efficiency and surgical time.

Total hip arthroplasty (THA) is currently considered the most effective treatment for end-stage hip osteoarthritis (OA). The surgery can be performed via a number of different approaches, including direct anterior (DAA; Smith–Petersen; Hueter), anterolateral (ALA; Watson–Jones), direct lateral (LA; Bauer), posterior (PA; Kocher–Langenbeck), and posterolateral (PLA). There is still a dispute over the optimal technique. The aim of this systematic review was to assess how different surgical approaches toward a THA influence the prosthesis elements’ positioning. We conducted a literature search of Scopus, ScienceDirect, PubMed, Embase, and The Cochrane Library. We evaluated studies in terms of the first author’s name, country, publication year, type of surgical approach being compared to the direct anterior approach, any significant differences at baseline, sample size, and radiographic analysis. A subanalysis of each approach in comparison to the DAA revealed differences in terms of all analyzed implant positioning radiographic parameters. There is still an insufficient number of randomized controlled studies that include radiological analyses comparing THRs (total hip replacements) performed using DAA with other approaches. Implant placement is a crucial step during a THR and surgeons must be aware that the approach they use might impact their judgment on angles and spaces inside the joint and thus alter the implant positioning.

Worldwide tendencies to perform large numbers of total hip arthroplasties in the treatment of osteoarthritis are observable over a long period of time. Every year, there is an observable increase in the number of these procedures performed. The outcomes are good but not ideal, especially in groups of patients with spine problems. In recent years, a growing interest in this field may be observed, since spinopelvic alignment seems to have a significant impact on total hip replacement (THR) results. The aim of this study is to describe relations between spine and pelvic alignment and provide practical information about its impact on total hip replacement. The authors performed a literature review based on PubMed, Embase, and Medline and provide practical guidelines based on them and their own experience.

Background Total hip arthroplasty (THR) is considered as the most effective available method of treatment of end-stage hip osteoarthritis (OA). This surgery can be performed via many different approaches. One of the newly developed technique is called direct anterior approach (DAA). It gains popularity and recognition as the least traumatic to the soft tissues, thus quickening rehabilitation and improving joint stability in the early postoperative period. There are no systematic reviews covering this subject in terms of potential differences in radiological prosthesis placement, and while there is still unsatisfactory evidence concerning long-term outcomes of DAA, such review may prove useful in the debate. The objective of our study was to systematically collect and review available data from randomized-controlled trials (RCTs) regarding radiographic assessment of prosthesis placement after total hip arthroplasty using direct anterior approach compared to other common approaches.Methods A systematic review of randomized controlled trials (RCTs) will be conducted. SciFinder, Scopus, ScienceDirect, PubMed, Embase, Clinical Key and The Cochrane Library databases will be searched without restriction to date up to June 2020. Primary outcomes will include measurements related with the radiological analysis of trials comparing use of DAA to other approaches used for THR, containing at least two of the following: femoral stem alignment, mean radiographic cup inclination, mean radiographic cup anteversion, mean radiographic cup abduction, position in Lewinnek's safe zone. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for RCTs. Discussion This systematic review will provide missing information regarding influence of differences between DAA and other surgical approaches in total hip replacement on prosthesis implants placement in case of femoral stem and cup. This may result in improving knowledge and awareness of surgeons, improving patients satisfaction and functional outcome and lowering the risk of hip dislocations and other complications. Trial registration International Registration of Systematic reviews (PROSPERO) number CRD42019122675

BackgroundTotal hip arthroplasty (THR) is considered as the most effective available method of treatment of end-stage hip osteoarthritis (OA). This surgery can be performed via many different approaches. One of the newly developed technique is called direct anterior approach (DAA). It gains popularity and recognition as the least traumatic to the soft tissues, thus quickening rehabilitation and improving joint stability in the early postoperative period. There are no systematic reviews covering this subject in terms of potential differences in radiological prosthesis placement, and while there is still unsatisfactory evidence concerning long-term outcomes of DAA, such review may prove useful in the debate. The objective of our study was to systematically collect and review available data from randomized-controlled trials (RCTs) regarding radiographic assessment of prosthesis placement after total hip arthroplasty using direct anterior approach compared to other common approaches.MethodsA systematic review of randomized controlled trials (RCTs) will be conducted. SciFinder, Scopus, ScienceDirect, PubMed, Embase, Clinical Key and The Cochrane Library databases will be searched without restriction to date up to June 2020. Primary outcomes will include measurements related with the radiological analysis of trials comparing use of DAA to other approaches used for THR, containing at least two of the following: femoral stem alignment, mean radiographic cup inclination, mean radiographic cup anteversion, mean radiographic cup abduction, position in Lewinnek's safe zone. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for RCTs. DiscussionThis systematic review will provide missing information regarding influence of differences between DAA and other surgical approaches in total hip replacement on prosthesis implants placement in case of femoral stem and cup. This may result in improving knowledge and awareness of surgeons, improving patients satisfaction and functional outcome and lowering the risk of hip dislocations and other complications. Trial registrationInternational Registration of Systematic reviews (PROSPERO) numberCRD42019122675

In every surgical subspecialty surgical site infection (SSI) or implant infections, although occur seldom, pose a threat to patients’ health. Risk factors of such states is diabetes mellitus (DM), considered one of the most widespread health-related problems of the 21st century. Orthopedists perform big joint replacements that usually concern older adults and therefore often deal with patients suffering from comorbidities. DM is frequently one of them and can furthermore often remain underdiagnosed. The other risk for complication is a rapid beginning of the rehabilitation which starts on the day following the surgery. To eliminate the debilitating impact of DM and hypoglycemia on surgical patients, we aim to investigate the relationship between the glycemia values and the postoperative outcomes in certain periods of time in patients undergoing orthopedic surgeries. Participants meeting inclusion criteria will have inserted a glycemia measuring device (Dexcom G5, Inc., San Diego, CA) in the periods of time. First time it will take place 14 days prior to the surgery and right after the surgery for the second time for the period of another 14 days. All patients will undergo standard total knee arthroplasty or total hip arthroplasty procedures. Patients will be assessed preoperatively and 14 days, 1, 3, 6, 12, and 24 months postoperatively. The assessment of the joint condition will consist of: patient-reported outcomes (The Knee injury and Osteoarthritis Outcome Score, Harris Hip Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]); assessment of potential SSI and cardiovascular complications (the Finnish Diabetes Risk Score [FINDRISC], the Systematic Coronary Risk Evaluation [SCORE]) and the clinical examination. To investigate the influence of orthopedic surgery (anesthesia) on glycemia and the significance and safety of early patients mobilization after the big joints surgeries. To investigate changes of glycemia in patients with normal glycemia metabolism, potentially protecting them from hypoglycemia during hospital stay and increasing their awareness of potential development of DM in the future. Additionally, this study will correlate perioperative glycemic levels with risk of cardiovascular events in one year follow-up, and its influence on SSI and implant complications.