Barrack, Robert L.

AimsThe aim of this study was to compare the early clinical outcomes of robotically-assisted total knee arthroplasty (RA-TKA) and manual total knee arthroplasty (M-TKA), using daily remote patient monitoring.MethodsWe prospectively enrolled and compared patients who underwent 95 RA-TKAs with those who underwent 114 M-TKAs. All patients used an activity monitor and a patient engagement platform for two weeks preoperatively and 90 days postoperatively to collect daily visual analogue scale (VAS) pain scores, opioid consumption (in morphine milligram equivalents (MMEs)), step counts, weekly Oxford Knee Scores (OKSs), and monthly Forgotten Joint Scores (FJS). There were no significant differences between groups in sex or BMI. Patients in the RA-TKA group were significantly younger (mean age 63 vs 65 years; p = 0.006). Independent-samples t-tests, chi-squared tests, and Fisher’s exact tests were used for statistical analysis.ResultsRA-TKA led to significantly decreased pain (mean VAS 3.6 vs 4.2; p = 0.011) and significantly reduced opioid consumption in the first seven days postoperatively (a mean of 10 less MMEs per day; p < 0.001) compared with M-TKA. The RA-TKA group stopped taking opioids six days sooner (mean 24 days vs 30 days; p = 0.041). There were no significant differences in the number of days before stopping the use of walking aids (mean 31 days vs 35 days; p = 0.091). Patients in the RA-TKA group had significantly increased OKSs for the first five weeks (p = 0.013). There were no significant differences in the FJSs at all times or in OKSs beyond five weeks. There were no significant differences in the operating times (p = 0.405), step counts (p = 0.642), or complications (p = 0.222) between the groups.ConclusionThe use of robotic assistance in TKA led to significant improvements in pain, opioid consumption, and OKSs compared with manual instrumentation in the early recovery after primary TKA.Cite this article: Bone Joint J 2025;107-B(10):1054–1063.

Background: We previously reported the 5-year results of the Birmingham Hip Resurfacing (BHR) implant. This study evaluates BHR survivorship as well as radiographic and clinical outcomes at long-term follow-up. Methods: A total of 224 patients with contemporary indications, including 179 patients from the original study, were included in this analysis. Survivorship was calculated. Metal ion levels and radiographs were updated. Patient-reported outcomes (PROs) were compared with those for matched patients who had undergone total hip arthroplasty (THA). The mean follow-up was 14 years. Results: Survivorship free from any revision and from aseptic revision was 96.0% and 97.4% at 15 years, respectively. Two patients had undergone revision since the original study. The median serum cobalt and chromium levels were 1.4 and 1.5 ppb, respectively. The PROs were similar to those for the THA cohort. Equal proportions of patients remained active; however, the BHR group trended toward more remaining highly active (p = 0.12). Conclusions: Although activity was similar to THA at long-term follow-up, the BHR implant remains an excellent option for the treatment of osteoarthritis in younger male patients. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

We previously reported the five to ten-year results of the Birmingham Hip Resurfacing (BHR) implant. The purpose of this study was to evaluate the survivorship, radiographic results, and clinical outcomes of the BHR at long-term follow-up.We retrospectively reviewed 250 patients from the original cohort of 324 BHRs performed from 2006 to 2013 who met contemporary BHR indications. Of these, 4 patients died and 4 withdrew. From the 242 patients, 224 patients (93%) were available for analysis. Modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) scores were collected and compared to a matched total hip arthroplasty (THA) cohort. Mean follow-up was 14 years.Survivorship free of aseptic revision was 97.4% and survivorship free of any revision was 96.0% at 15 years. Revisions included 3 periprosthetic joint infections, 2 for elevated metal ions and symptomatic pseudotumor, 2 for aseptic femoral loosening, and 1 for unexplained pain. The mean mHHS was 93 in BHR patients at final follow-up, similar to the THA cohort (p=0.44). The UCLA score was significantly higher for BHR patients (p=0.02), however there were equal proportions of patients who remained highly active (UCLA 9 or 10) in both groups, 60.5% and 52.2% (p=0.45) for BHR and THA respectively. Metal ion levels at long term follow-up were low (mean serum cobalt 1.8±1.5 ppb and mean serum chromium 2.2±2.0 ppb).BHR demonstrated excellent survivorship in males less than 60 years of age at time of surgery. Clinical outcomes and activity levels were similar to THA patients. Failures related to the metal-on-metal bearing were rare and metal levels were low at long-term follow-up.Level of evidence: IIIKeywords: survivorship; hip arthroplasty; activity; metal-on-metalSurface Replacement Arthroplasty demonstrates low revision rates and similar activity level compared to total hip arthroplasty at long-term follow-up.