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Individuals undergoing lung resections experience persistent postoperative pain and are at high risk of chronic postoperative opioid use. This study aims to identify factors associated with chronic opioid use after minimally invasive lung resections (MILR). This is a retrospective cohort study of individuals who underwent MILR from March 2019 to May 2022 at a single academic institution. The primary outcome was chronic opioid usage, defined as use at least 30 days after surgery. Postoperative pain was managed with a standardized multi-modal pain-control regimen utilizing opioids only as needed. Prescription patterns and dispensing data of opioids at 30-, 60-, and 90-days postoperatively informed usage. Univariate analysis and multivariable logistic regressions (MVLR) were performed. 376 patients were included, 38.6% male, 88.8% white, and a mean age of 64.6 years. A total of 248 (66%) underwent anatomical lung resections. 16.5% used opioids at 30 days, 10.1% at 60 days, and 8.5% at 90 days. In the multivariable model, morphine milligram equivalents (MMEs) of opioids on the day before discharge showed a statistically significant association with chronic opioid usage. Age, sex, length of stay, and surgery type were not associated. A 10-unit increase in MMEs increased odds of use at 30-days by 21% (OR 1.21, 95%CI 1.11-1.32, p < 0.001), 20% at 60-days (OR 1.20, 95%CI 1.09 1.32, p < 0.001) and 18% at 90-days (OR 1.18, 95%CI 1.06-1.30, p = 0.002). Higher pre-discharge MMEs are associated with an increased likelihood of chronic opioid usage. Future studies should focus on whether preemptive early outpatient intercostal nerve blocks or cryoablations can decrease chronic narcotic usage in high-risk patients.

Purpose Correct positioning and alignment of the prosthesis is a very important factor for durability of prosthesis and implant survival which is improved with the use of technology in total knee arthroplasty. However, the long-term functional outcomes and survivorship are unclear. For this study, it was hypothesized that mechanical axis alignment of lower limb, post-operative joint line restoration, femoral and tibial component alignment is more accurate with the new handheld semi-active robotic-assisted TKA. Method From April-2019 to March-2020, 60 patients with unilateral knee osteoarthritis who underwent total knee arthroplasties were included in this prospective randomised controlled study. Computer generated randomization was used. Study included 48 female patients and 12 male patients. Pre-operative and post-operative radiographic measurements were done and compared between the two groups. Results There was a significant difference between two groups with respect to mechanical axis deviation, joint line deviation and coronal alignment of femoral and tibial prosthesis. Mechanical axis deviation > 3° was seen in eight cases (28.5%) in C-TKA group compared to one case (3.1%) in RA-TKA ( p 0.019). Joint line deviation of 3.5 mm was noted in C-TKA group as compared to 0.9 mm in RA-TKA group ( p < 0.001) which was statistically significant. However, whether this difference of 2.6 mm of joint line elevation between C-TKA and RA-TKA leads to any difference in clinical outcome in terms of knee kinematics and knee flexion needs to be investigated with further studies. Clinically restoring normal joint line is important for improved knee function after primary TKA. No significant difference was noted in femoral component rotation on post-operative computed tomography (CT) scan. Conclusion The novel imageless, handheld semi-autonomous robotic system for TKA is highly accurate with respect to component positioning in coronal plane and mechanical alignment as compared to conventional TKA. Joint line is elevated in conventional TKA but is accurately restored using the robotic-assisted TKA which may lead to better patellofemoral kinematics. Level of evidence I.

In recent years, robotic technology is becoming more pervasive in joint arthroplasty. The role of robotics in joint replacement surgery is to bring precision and accuracy in bone preparation, implant positioning and soft tissue balancing. However, there is yet to be a study conducted to determine the accuracy of bone preparation done by a new robotic system. The purpose of this study is to evaluate and report on the accuracy of bone cuts using imageless semiautonomous freehand robotic sculpting system, Navio (Smith & Nephew) based on the data provided by the robotic system. Between August 2018 and May 2019, a total of 62 patients were prospectively enrolled in this study. All surgeries were done by the senior author using a medial para-patellar approach and using a posterior stabilised implant (Anthem, Smith & Nephew Inc.). The study included 37 female patients and 25 male patients. The parameters assessed in this study were: (1) mechanical axis, (2) femoral coronal alignment, (3) femoral rotation, (4) femoral sagittal alignment, (5) tibial slope and (6) tibial coronal alignment using paired t test and root mean squared error (RMSE). The robotic system was accurate in achieving the bone cuts as planned in mechanical axis alignment ( p  = 0.89, RMSE = 0.56), femoral coronal alignment ( p  = 0.36, RMSE = 0.36), femoral sagittal alignment ( p  = 0.10, RMSE = 0.44), femoral rotation ( p  = 0.91, RMSE = 0.11), tibial coronal alignment ( p  = 0.81, RMSE = 0.24) and tibial slope ( p  = 0.30, RMSE = 0.37) with the maximum RMSE being 0.56. This study demonstrated that semi-autonomous hand-held robotic system, Navio (Smith & Nephew) for total knee arthroplasty produced accurate component positioning as per plan in all planes. The maximum RMSE was 0.56°.