Recent Advances in Spine Surgery- Pros and Cons

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 50-53 | Arvind Janardhan Vatkar, Sumedha Shinde, Sachin Kale, Pramod Bhor

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.596

Authors: Arvind Janardhan Vatkar [1], Sumedha Shinde [2], Sachin Kale [3], Pramod Bhor [4]

[1] Consultant Orthopedic Spine Surgeon, Fortis Hiranandani Hospital, Vashi, Navi Mumbai- 400703, India,
[2] Assistant Professor, Sir JJ Blood Center, Byculla, Mumbai, Maharashtra 400008, India,
[3] Department of Orthopedics, D Y Patil Hospital and medical college, Ayyappa Temple Road, Dr D Y Patil
Vidyanagar, Sector 5, Nerul, Navi Mumbai, Maharashtra 400706, India,
[4] Director of Department of Orthopaedics, Fortis Hiranandani Hospital, Vashi, Navi Mumbai- 400703, India.

Address of Correspondence
Dr. Arvind Vatkar Janardhan,
Department of Orthopaedics, Fortis Hiranandani hospital, Juhu Nagar, Sector 10A, Vashi, Navi Mumbai,
Maharashtra 400703, India.
E-mail: vatkararvind@gmail.com

Abstract

Recent innovations in spine surgery, such as minimally invasive spine surgery, endoscopic spine surgery, robotic spine surgery, virtual reality, artificial intelligence, and biomaterials, have resulted in significant gains, although more work need to be done. Minimally invasive and endoscopic spine operations provide the advantages of minimum tissue stress and early recovery, but they have a high learning curve. Robotic spine surgery and virtual reality can improve precision and planning, although they are expensive and may be restricted in availability. Artificial intelligence and biomaterials show promise for personalised therapy, but their long-term implications are still being investigated. To make educated judgments for their patients, surgeons must consider the benefits and drawbacks of various technologies.
Keywords: Minimally invasive spine surgery, Artificial intelligence, Robotic spine surgery, Endoscopic spine surgery, Virtual reality, Biomaterials

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How to Cite this article: Vatkar AJ, Shinde S, Kale S, Bhor P. Recent Advances in Spine Surgery- Pros and Cons. Journal of Clinical Orthopaedics 2023;8(2):50-53.

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Three dimensional (3D) printing in Orthopaedics: Scope of application and future perspectives

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 41-44 | Shubhranshu S Mohanty, Tushar Kadam, Sushant Srivastava

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.592

Authors: Shubhranshu S Mohanty [1], Tushar Kadam [1], Sushant Srivastava [2]

[1] Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai-12, Hon Consultant, Jaslok, Nanavati & Shushrusha Hospitals, Mumbai, India.
[2] Department of Orthopaedics, Mata Gujri Memorial Medical College, Kishanganj, Bihar, India.

Address of Correspondence
Dr. Shubhranshu S Mohanty,
Dept of Orthopaedics, #608, 6th Floor, MS Building, Seth GS Medical College & King Edward Memorial Hospital,
Parel, Mumbai-400012, India.

Email: drssmohanty@hotmail.com

Abstract

Three dimensional (3D) printing also known as additive manufacturing has the potential to change the paradigm of Orthopaedic practice. Modern times have witnessed exponential growth in 3D-printing technology as well as its uses. A wide spectrum of printers are now available, ranging from the desktop printer to high end manufacturing units. The ability to use a plethora of materials and create almost limitless geometric shapes with varying surface topography makes this method of production highly appealing. Certain inherent advantages include easy customizability, small production runs, less wastage of material, smaller footprint. Challenges such as lack of data, absence of established government regulations and cost considerations remain, but one can expect these to be overcome as the economy of scale plays out and the medical fraternity becomes more accommodating of the new technology.
Keywords: Three dimensional printing, Recent Advances, Arthroplasty, Spine, Tumor Implants

References

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How to Cite this article: Mohanty SS, Kadam T, Srivastava S. Three dimensional (3D) printing in Orthopaedics: Scope of application and future perspectives. Journal of Clinical Orthopaedics July-December 2023;8(2):41-44.

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What’s New and Relevant in Proximal Tibia Fractures?

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 45-49 | Sachin Kale, Nrupam Mehta, Arvind Vatkar, Rahul Ghodke, Joydeep Dey

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.594

Authors: Sachin Kale [1], Nrupam Mehta [1], Arvind Vatkar [2], Rahul Ghodke [3], Joydeep Dey [1]

[1] Dr DY Patil Hospital Navi Mumbai, India,
[2] Orthopaedic Consultant at Fortis Hiranandani Hospital, Navi Mumbai, India,
[3] Assistant Professor, YMT Dental College and Hospital, Mumbai , India.

Address of Correspondence
Dr. Nrupam Mehta,
Department of Orthopaedics, Dr. DY Patil Hospital, Navi Mumbai, India.
E-mail: nrupam.m@hotmail.com

Abstract

Proximal tibia fractures include fractures of the tibia plateau and metaphyses and are relatively common injuries. The goals of treatment follow AO principles of anatomic reduction of the articular surface, restoration of limb alignment, length, and rotation. Despite notable advancements in implant design, management of proximal tibia fractures remains formidable. These fractures manifest as comminuted, intra-articular complexities, compounded by the inherent fragility of the osteoporotic bone, thereby rendering fixation a particularly intricate risk. In the realm of geriatric trauma, where comorbidities abound, therapeutic decision-making becomes a nuanced endeavor. We have aimed to bring together all the recent advances and literature in the management of proximal tibia fractures through this article.
Keywords: Proximal tibia, Plating, Nailing, Prosthesis.

References

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13. Haslhofer DJ, Kraml N, Winkler PW, Gotterbarm T, Klasan A. Risk for total knee arthroplasty after tibial plateau fractures: A systematic review. Knee Surg Sports Traumatol Arthrosc 2023;31:5145-53.
14. Pander P, Fransen BL, Hagemans FJ, Keijser LC. Functional outcome of total knee arthroplasty following tibial plateau fractures: A systematic review. Arch Orthop Trauma Surg 2023;143:1265-74.
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22. Debnath UK, Jha DK, Pujari PK. Results of ring (Ilizarov) fixator in high energy Schatzker type VI fractures of proximal tibia. J Clin Orthop Trauma 2018;9:186-91.
23. Berven H, Brix M, Izadpanah K, Kubosch EJ, Schmal H. Comparing case-control study for treatment of proximal tibia fractures with a complete metaphyseal component in two centers with different distinct strategies: fixation with Ilizarov frame or locking plates. J Orthop Surg Res 2018;13:121.

How to Cite this article: Kale S, Mehta N, Vatkar A, Ghodke R, Dey J. What’s New and Relevant in Proximal Tibia Fractures? Journal of Clinical Orthopaedics 2023;8(2):45-49.

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The Bone Screw An industrious implant

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 35-40 | Anand Thakur

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.590

Authors: Anand Thakur [1]

[1] Formerly Hon. Consultant orthopaedic surgeon R N Cooper Hospital & Hon Professor of orthopaedics Seth G S Medical college Mumbai, India.

Address of Correspondence
Dr. Anand Thakur,
D-1 Manusmruti 24-25 Relief Road, Santacruz west Mumbai 400054, India.
E-mail: thakurajt@gmail.com

Abstract

Objective: A bone screw is used for internal fixation more often any other implants. Thread of a screw is its most important part. It is akin to a long inclined plane or a wedge that gives it the power to convert an applied small torque to a large internal tensions along its axis to compress to surfaces together. Popular buttress thread has many drawbacks which are over come in a new design ‘Bone-Screw-Fastener’. It is also superior to conventional locking screw as it offers comparable stability and also generates compression at plate bone interface. Lagging is a technique that can be applied to virtually all types of screws to produce compression across the bone surfaces; exact technique and positioning of the screw in the center of the fracture fragment and at right angles to the fracture plane is mandatory for optimum results. Both bolt and screw are threaded fasteners with similar functions but different in detail.
Keywords: Bone-screw-fastner, Simple machine, Screw thread, Lag screw, Bolt, bone screw.

References

1. Tencer AF, Johnson KD. Biomechanics in Orthopaedic Trauma: Bone Fracture and Fixation. London, UK: Martin Dunitz; 1994.
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3. Stahel PF, Alfonso NA, Henderson C, Baldini T. Introducing the “Bone-Screw-Fastener” for improved screw fixation in orthopedic surgery: A revolutionary paradigm shift? Patient Saf Surg 2017;11:6.
4. SMV Scientific, Austin, TX, USA: Osteocentric Technologies.
5. Alfonso NA, Baldini T, Stahel PF. 2019 A new fastener with improved bone-to-implant interface shows superior torque stripping resistance compared with the standard buttress screw. J Orthop Trauma 2019;33:e137-42.
6. Debaun MR, Swinford ST, Chen MJ, Thio T, Behn AA, Lucas JF, et al. Biomechanical comparison of bone-screw-fasteners versus traditional locked screws in plating female geriatric bone. Injury 2020;51:193-8.
7. Pye JL, Garcia TC, Kapatkin AS, Samol MA, Stover S. Biomechanical comparison of compact versus standard flute drill bits, and interlocking versus buttress thread self-tapping cortical bone screws in cadaveric equine third metacarpal condyle. Vet Surg 2023;52:1128-39.
8. Heim U, Pfeiffer KM, Brenwald J. Internal Fixation of Small Fractures: Technique Recommended by the AO-ASIF Group. 3rd ed. Berlin: Springer-Verlag; 1988.
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How to Cite this article: Thakur A. The Bone Screw An industrious implant. Journal of Clinical Orthopaedics July-December 2023;8(2):35-40.

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Financial Literacy Rate of Orthopaedic Resident Doctors: A Cross-sectional Study

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 21-28 | Khushi A Rajani, Kashish A Rajani, Kareena Rajani, Anmol R S Mittal, Dhruv Shivdasani

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.586

Authors: Khushi A Rajani [1], Kashish A Rajani [1], Kareena Rajani [1], Anmol R S Mittal [2], Dhruv Shivdasani [3]

[1] OAKS Clinic, 707 Panchshil Plaza, N S Patkar Marg, opp. Ghanasingh Fine Jewels, next to Dharam Palace, Mumbai, Maharashtra, India.
[2] Department of  Orthopaedics, OAKS Clinic, 707 Panchshil Plaza, N S Patkar Marg, opp. Ghanasingh Fine Jewels, next to Dharam Palace, Mumbai, Maharashtra, India.
[3] Digital Initiatives and Business Intelligence, Mumbai, Maharashtra, India.

Address of Correspondence
Khushi A Rajani,
Investigator and Financial Advisor, OAKS Clinic, 707 Panchshil Plaza, N S Patkar Marg, opp. Ghanasingh Fine Jewels, next to Dharam Palace, Mumbai, Maharashtra, India.
E-mail: khushirajani04@gmail.com

Abstract

Background: Healthy financial practices directly affect the financial well-being of an individual, and subsequently the quality of life. Paucity of financial literature in young Indian professionals has been established before by studies that evaluated this topic subjectively. This study emphasizes on assessing the financial literacy of orthopedic resident doctors in a developing country and ascertaining the factors affecting it to improve the same.
Methods: Total 286 resident doctors were analyzed cross-sectionally in terms of their financial knowledge, factors affecting it, financial attitude, subjective satisfaction, and thought process regarding improving this scenario. An objective, 46-question survey-based model was used from February 2023 to April 2023. All the findings were collated and analyzed.
Results: The mean financial literacy was recorded to be 53.56±17.59%. Age, marital status, children, population of the city, education, and occupation of parent 2 had no bearing on the financial literacy of the residents (P > 0.05). The socioeconomic status, retirement savings, loan/debt, and the presence of an emergency fund significantly influenced the financial literacy (P < 0.05). Only 22.38% were satisfied with the current financial situation and 61.89% wanted an in-person meeting with a financial advisor.
Conclusion: Orthopedic resident doctors show low financial literacy and financial satisfaction. Significant steps need to be taken to improve financial knowledge and understanding of the investment options of these professionals to ensure the economic growth of the community.
Keywords: Financial literacy, financial knowledge, resident doctors, orthopedics, financial well-being, financial attitude.

References

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How to Cite this article: Rajani KA, Rajani KA, Rajani K, Mittal ARS, Shivdasani D. Financial Literacy Rate of Orthopaedic Resident Doctors: A Cross-sectional Study. Journal of Clinical Orthopaedics 2023;8(2):21-28.

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Current Concepts in Prevention of Sports Injuries

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 29-34 | Clevio Joao Baptista Desouza, Nicholas Antao

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.588

Author: Clevio Joao Baptista Desouza [1, 2], Nicholas Antao [2]

[1] Department of Orthopaedics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India

[2] Department of Orthopaedics, Holy Spirit Hospital, Andheri, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Clevio Joao Baptista Desouza, Department of Orthopaedics, Holy Spirit Hospital, Andheri, Mumbai, Maharashtra, India.

E-mail: ceviod@gmail.com

Abstract

Introduction: The contemporary surge in sports participation, from recreational to professional levels, has brought forth an undeniable enthusiasm for physical activity. However, this heightened engagement comes with an inherent risk of sports-related injuries, spanning various nature and severity. This article introduces the imperative need for a systematic and practical approach to prevent sports injuries, emphasizing the age-diverse demographic involved and the multifaceted motivations driving sports participation.

Materials and Methods: The “Rule of 10,” presented in this paper, serves as a comprehensive guideline for sports injury prevention. The methodology encompasses a range of proactive measures addressing pre-season preparation, athlete education, and holistic strategies to mitigate injury risks. Each facet of the rule, from pre-season physical check-ups to emphasizing psychological preparedness, contributes to a cohesive and multifaceted injury prevention framework.

Conclusion: We through our review article have focused on the “Rule of 10” which advocates a holistic approach to sports injury prevention, integrating pre-season assessments, diverse training, and technology. It emphasizes resilience, education, and collective responsibility for athlete well-being.

Keywords: Agility, Endurance, Prevention, Sports, Strength.

References

1. Bahr R, van Mechelen W, Kannus P. Prevention of sports injuries. In: Kjær M, Krogsgaard M, Magnusson P, Engebretsen L, Roos H, Takala T, et al., editors. Textbook of Sports Medicine. Basic Science and Clinical Aspects of Sports Injury and Physical Activity. Oxford: Blackwell Science; 2002. p. 299-314.

2. Patel DR, Yamasaki A, Brown K. Epidemiology of sports-related musculoskeletal injuries in young athletes in United States. Transl Pediatr 2017;6:160-6.

3. Drawer S, Fuller CW. Evaluating the level of injury in English professional football using a risk based assessment process. Br J Sports Med 2002;36:446-51.

4. Engebretsen L, Bahr R. Why is injury prevention in sports important? In: Sports Injury Prevention. Hoboken, NJ: Wiley-Blackwell; 2009. p. 1-6.

5. Andersen TE, Árnason A, Engebretsen L, Bahr R. Mechanisms of head injuries in elite football. Br Journal Sports Med 2004;38:690-6.

6. Griffin LY, Albohm MJ, Arendt EA, Bahr R, Beynnon BD, Demaio M, et al. Understanding and preventing noncontact anterior cruciate ligament injuries: A review of the Hunt Valley II meeting, January 2005. Am J Sports Med 2006;34:1512-32.

7. Nakase K, Shitara H, Tajika T. An analysis of pre-season risk factors for low back injury in high-school baseball pitchers: a prospective study. Sci Rep. 2021 Jun 1;11(1):11415.

8. Lauersen J.B., Bertelsen D.M., Andersen L.B. The effectiveness of exercise interventions to prevent sports injuries: A systematic review and meta-analysis of randomised controlled trials. Br. J. Sports Med. 2014;48:871–877.

9. Barengo NC, Meneses-Echávez JF, Ramírez-Vélez R, Cohen DD, Tovar G, Bautista JE. The impact of the FIFA 11+ training program on injury prevention in football players: A systematic review. Int J Environ Res Public Health 2014;11:11986-2000.

10. Árnason A, Andersen TE, Holme I, Engebretsen L, Bahr R. Prevention of hamstring strains in elite soccer: An intervention study. Scand J Med Sci Sports 2008;18:40-8.

11. Hagel BE, Pless IB, Goulet C, Platt RW, Robitaille Y. Effectiveness of helmets in skiers and snowboarders: Case-control and case crossover study. BMJ 2005;330:281.

12. Sulheim S, Holme I, Ekeland A, Bahr R. Helmet use and risk of head injuries in alpine skiers and snowboarders. JAMA 2006;295:919-24.

13. Olsen OE, Myklebust G, Engebretsen L, Holme I, Bahr R. Exercises to prevent lower limb injuries in youth sports: Cluster randomised controlled trial. BMJ 2005;330:449.

14. Quarrie KL, Gianotti SM, Hopkins WG, Hume PA. Effect of nationwide injury prevention programme on serious spinal injuries in New Zealand rugby union: Ecological study. BMJ 2007;334:1150.

15. Sadigursky, D., Braid, J.A., De Lira, D.N.L. et al. The FIFA 11+ injury prevention program for soccer players: a systematic review. BMC Sports Sci Med Rehabil 9, 18 (2017).

16. Kujala UM, Sarna S, Kaprio J, Koskenvuo M. Hospital care in later life among former world-class Finnish athletes. JAMA 1996;276:216-20.

17. Belval LN, Hosokawa Y, Casa DJ. Practical Hydration Solutions for Sports. Nutrients. 2019 Jul 9;11(7):1550.

18. Irrgang JJ, Whitney S, Cox E. Balance and proprioceptive training for rehabilitation of the lower extremity. J Sport Rehabil 1994;3:68-93.

19. Dhillon H, Dhillon S, Dhillon MS. Current concepts in sports injury rehabilitation. Indian J Orthop 2017;51:529-36.

20. Pease DG. Psychologic factors of rehabilitation. In: Andrews JR, Harrelson GL, editors. Physical Rehabilitation of the Injured Athlete. 2nd ed. Philadelphia: W. B. Saunders Co; 1996. p. 1-12.

21. Prentice W. Arnheim’s Principles of Athletic Training. 12th ed. Boston: McGraw Hill; 2005.

22. Engebretsen L, Bahr R, Cook JL, Derman W, Emery CA, Finch CF, et al. The IOC centres of excellence bring prevention to sports medicine. Br J Sports Med 2014;48:1270-5.

23. Verhagen E, Bolling C. Protecting the health of the @hlete: How online technology may aid our common goal to prevent injury and illness in sport. Br J Sports Med 2015;49:1174-8.  

How to Cite this article: Desouza C, Antao N. Current Concepts in Prevention of Sports Injuries. Journal of Clinical Orthopaedics 2023:8(2);29-34.

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Comparing the Efficiency of the Femoral Neck System and the Cannulated Compression Screw in Treating Femoral Neck Fractures in Patients Who Are Young and Middle-aged Indian Population

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 16-20 | Arvind Vatkar, Sachin Kale, Gaurav Kanade, Ashok Godke, Joydeep K. Dey, Rahul Godke, Nrupam Mehta, Sonali Das

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.584

Authors: Arvind Vatkar [1], Sachin Kale [1], Gaurav Kanade [2], Ashok Godke [3], Joydeep K. Dey [4], Rahul Godke [4], Nrupam Mehta [3], Sonali Das [4]

[1] Department of Orthopaedics, Apollo Hospital, Belapur, Navi Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, MGM Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
[3] Department of Orthopaedics, Dr. D. Y. Patil Hospital, Navi Mumbai, Maharashtra, India.
[4] Department of Orthopaedic, Matoshree Hospital, Panvel, Navi Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Arvind Vatkar,
Consultant Spine Surgeon, Department of Orthopaedics, Apollo Hospital, Belapur, Navi Mumbai, Maharashtra, India.
E-mail: vatkararvind@gmail.com

Abstract

Background: There are no long-term studies regarding the clinical effectiveness of a novel fixation technique (femoral neck system [FNS]) for femoral neck fractures. The primary aim of this study was to compare the effectiveness of two internal fixation techniques (FNS and cannulated compression screw [CCS]) for treating femoral neck fractures in individuals between the ages of 20 and 40 years.
Materials and Methods: Data of patients who underwent internal fixation surgery for femoral neck fractures in our hospital between January 2018 and January 2020 with CCS and between January 2020 and January 2022 with FNS were retrospectively evaluated. The groups of CCS and FNS were separated based on the various internal fixation techniques. Demographics about all patients, including sex, age, body mass index, and fracture type were recorded. Pre-operative and 1-year post-operative follow-up of patients was to assess femoral neck shortenings and the Harris Hip score was used to evaluate joint function. Post-operative complications such as femoral head necrosis, non-union, and femoral neck shortening were noted.
Results: 30 patients each of CCS and FNS system fixation were enrolled in the study. The male-to-female ratio was 21:9 and 18:12 for CCS and FNS, respectively. The average age of both groups was around 30 years. Compared to patients treated with CC screws, patients who had FNS treatment required less time to recuperate and resume normal activities. The HSS score improvement at 2 weeks and 12 weeks was significantly better in the FNS system than CCS fixation. There was improvement in flexion, abduction, and external rotation range of motion in FNS compared to CCS. There was no statistically significant difference between the two groups in the incidence of femoral head necrosis or fracture non-union following surgery.
Conclusion: Patients treated with FNS for femoral neck fractures in the age range of 20–40 years can achieve better hip scores than CCS fixation and also have improved range of motion in flexion, abduction, and external rotation.
Keywords: Femoral neck system, cannulated cancellous screw, femoral neck fractures, harris hip score

References

1. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am 2008;90:2254-66.
2. Thorngren KG, Hommel A, Norrman PO, Thorngren J, Wingstrand H. Epidemiology of femoral neck fractures. Injury 2002;33 Suppl 3:C1-7.
3. Protzman RR, Burkhalter WE. Femoral-neck fractures in young adults. J Bone Joint Surg Am 1976;58:689-95.
4. Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years old. A five-year follow-up study. J Bone Joint Surg Am 1981;63:1426-34.
5. Schaller F, Sidelnikov E, Theiler R, Egli A, Staehelin HB, Dick W, et al. Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture. Bone 2012;51:347-52.
6. Morri M, Chiari P, Forni C, Orlandi Magli A, Gazineo D, Franchini N, et al. What factors are associated with the recovery of autonomy after a hip fracture? A prospective, multicentric cohort study. Arch Phys Med Rehabil 2018;99:893-9.
7. Pashikanti L, Von Ah D. Impact of early mobilization protocol on the medical-surgical inpatient population: An integrated review of literature. Clin Nurse Spec 2012;26:87-94.
8. Mehraj M, Khurana S, Joshi UR, Jain A, Kumar B, Prakash BB, et al. Early results of internal fixation with femoral neck system in young patients with femoral neck fracture. Ortop Traumatol Rehabil 2022;24:305-9.
9. Khoo C, Haseeb A, Ajit Singh V. Cannulated screw fixation for femoral neck fractures: A 5-year Experience in a single institution. Malays Orthop J 2014;8:14-21.
10. Carneiro MB, Alves DP, Mercadante MT. Physical therapy in the postoperative of proximal femur fracture in elderly. Literature review. Acta Ortop Bras 2013;21:175-8.
11. Strini V, Piazzetta N, Gallo A, Schiavolin R. Barthel index: Creation and validation of two cut-offs using the BRASS Index. Acta Biomed 2020;91:19-26.
12. Zhang YZ, Lin Y, Li C, Yue XJ, Li GY, Wang B, et al. A Comparative analysis of femoral neck system and three cannulated screws fixation in the treatment of femoral neck fractures: A six-month follow-up. Orthop Surg 2022;14:686-93.
13. Yang J, Zhou X, Li L, Xu L, Zhu W, Xu W, et al. Comparison of femoral neck system and inverted triangle cannulated screws fixations in treatment of Pauwels typle femoral neck fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021;35:1111-8.
14. Yan C, Wang X, Xiang C, Jiang K, Li Y, Chen Q, et al. Comparison of effectiveness of femoral neck system and cannulate compression screw in treatment of femoral neck fracture in young and middle-aged patients. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021;35:1286-92.

How to Cite this article: Vatkar A, Kale S, Kanade G, Godke A, Dey JK, Godke R, Mehta N, Das S. Comparing the Efficiency of the Femoral Neck System and the Cannulated Compression Screw in Treating Femoral Neck Fractures in Patients Who Are Young and Middle-aged Indian Population. Journal of Clinical Orthopaedics 2023;8(2):16-20.

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Comparative Analysis of the Immediate Post-operative Outcomes between Conventional and Fully Automatic Robotic-assisted Total Knee Arthroplasty

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 12-15 | Sanjay Bhalchandra Londhe, Ravi Vinod Shah, Clevio Desouza, Vijay Shetty, Nicholas Antao, Meghana Patwardhan, Suhail Kantawala

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.582

Author: Sanjay Bhalchandra Londhe [1, 2], Ravi Vinod Shah [1], Clevio Desouza [2, 3, 4], Vijay Shetty [1, 3], Nicholas Antao [2], Meghana Patwardhan [5], Suhail Kantawala [2]

[1] Department of Orthopaedics, Criticare Asia Hospital, Andheri, Maharashtra, India,
[2] Department of Orthopaedics, Holy Spirit Hospital, Andheri, Maharashtra, India,
[3] Department of Orthopaedics, SAANVI Orthopaedics, Mumbai, Maharashtra, India,
[4] Department of Orthopaedics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai,
Maharashtra, India,
[5] Department of Anaesthesia, Criticare Asia Hospital, Andheri, Maharashtra, India.

Address of Correspondence
Dr. Sanjay Bhalchandra Londhe,
Department of Orthopaedics, Criticare Asia Hospital, Andheri, Maharashtra, India.
E-mail: sanlondhe@yahoo.com

Abstract

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.

References

1. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clin Orthop Relat Res 2010;468:57-63.
2. Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE. Patient satisfaction after total knee replacement: Asystematic review. HSS J 2018;14:192-201.
3. Mannan A, Vun J, Lodge C, Eyre-Brook A, Jones S. Increased precision of coronal plane outcomes in robotic-assisted total knee arthroplasty: A systematic review and meta-analysis. Surgeon 2018;16:237-44.
4. Jones CA, Voaklander DC, Suarez-Almazor ME. Determinants of function after total knee arthroplasty. Phys Ther
2003;83:696-706.
5. Lim HA, Song EK, Seon JK, Park KS, Shin YJ, Yang HY. Causes of aseptic persistent pain after total knee arthroplasty. Clin Orthop Surg 2016;9:50-6.
6. Jones CW, Jerabek SA. Current role of computer navigation in total knee arthroplasty. J Arthroplast 2018;33:1989-93.
7. Petursson G, Fenstad AM, Gøthesen O, Dyrhovden GS, Hallan G, Röhrl SM, et al. Computer-assisted compared with conventional total knee replacement. J Bone Joint Surg Am 2018;100:1265-74.
8. Kayani B, Konan S, Tahmassebi J, Pietrzak JR, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: A prospective cohort study. Bone Joint J 2018;100-B:930-7.
9. Marchand RC, Sodhi N, Khlopas A, Sultan AA, Harwin SF, Malkani AL, et al. Patient satisfaction outcomes after robotic arm-assisted total knee arthroplasty: Ashort-term evaluation. J Knee Surg 2017;30:849-53.
10. Naziri Q, Burekhovich SA, Mixa PJ, Pivec R, Newman JM, Shah NV, et al. The trends in robotic-assisted knee
arthroplasty: A statewide database study. J Orthop 2019;16:298-301.
11. Khlopas A, Chughtai M, Hampp EL, Scholl LY, Prieto M, Chang TC, et al. Robotic-arm assisted total knee arthroplasty demonstrated soft tissue protection. Surg Technol Int 2017;30:441-6.
12. Hampp EL, Chughtai M, Scholl LY, Sodhi N, Bhowmik-Stoker M, Jacofsky DJ, et al. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques. J Knee Surg 2018;32:239-50.
13. Kayani B, Konan S, Pietrzak JR, Haddad FS. Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: Aprospective cohort study and validation of a new classification system. J Arthroplast 2018;33:2496-501.
14. Nicoll D, Rowley DI. Internal rotational error of the tibial component is a major cause of pain after total knee
replacement. J Bone Joint Surg Br 2010;92:1238-44.
15. Kayani B, Konan S, Pietrzak JR, Huq SS, Tahmassebi J, Haddad FS. The learning curve associated with robotic-arm assisted unicompartmental knee arthroplasty. Bone Joint J 2018;100-B:1033-42.
16. Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS. Robotic technology in total knee arthroplasty: A systematic review. EFORTOpen Rev 2019;4:611-7.
17. Clark G, Steer R, Tippett B, Wood D. Short-term benefits of robotic assisted total knee arthroplasty over computer navigated total knee arthroplasty are not sustained with no difference in postoperative patient-reported outcome measures. Arthroplast Today 2022;14:210-5.e0.

How to Cite this article: Londhe SB, Shah RV, Desouza C, Shetty V, Antao N, Patwardhan M, Kantawala S. Comparative Analysis of the Immediate Post-operative Outcomes between Conventional and Fully Automatic Robotic-assisted Total Knee Arthroplasty. Journal of Clinical Orthopaedics 2023;8(2):12-15.

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What is Associated with the Greatest Effect on Lengths of Stay after Total Knee Arthroplasty: The Hospital, the Surgeon, or the Patient

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 07-11 | Max Willinger, Peter Gold, Luke Garbarino, Hiba Anis, Nipun Sodhi, Jonathan R Danoff

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.580

Author: Max Willinger [1], Peter Gold [1], Luke Garbarino [1], Hiba Anis [2], Nipun Sodhi [1], Jonathan R Danoff [3]

[1] Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA,
[2] Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA,
[3] Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, New York, USA.

Address of Correspondence
Dr. Max Willinger,
Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
E-mail: max.willinger1@gmail.com

Abstract

Introduction: Patient-, hospital-, and surgeon-related factors are each associated with the variable nature of length of stay (LOS) after total knee arthroplasty (TKA). However, there is a paucity of literature regarding these intertwined relationships. This study aimed to determine if the hospital, the surgeon, or the patient has the greatest association with LOS after TKA.
Materials and Methods: A total of 11,402 patients were identified from a multicenter prospectively collected institutional database between January 01, 2017, and April 01, 2019. Surgeons and hospitals were subdivided into three groups: (1) low volume (<10 and <100 cases, respectively), (2) intermediate volume (10–150 and 100–400 cases, respectively), and (3) high volume (>150 and >400 cases, respectively). Patient demographics, comorbidities, hospital academic status, and LOS were identified. Univariate and multivariate analyses were performed to compare hospital-, surgeon-, and patient-related factors.
Results: Neither hospital (P = 0.173) volume nor surgeon (P = 0.413) volume were significantly associated with LOS in multivariate analyses while controlling for patient-, surgeon-, and hospital-related factors. Patient medical factors including diabetes (P < 0.001), congestive heart failure (P < 0.001), peripheral vascular disease (P < 0.001), chronic kidney disease (P < 0.001), chronic obstructive pulmonary disease (P < 0.001), and anemia (P < 0.033), as well as academic teaching hospitals (P < 0.001) were associated with a significant increase in hospital LOS.
Conclusion: Patient’s chronic medical conditions and hospital status as an academic teaching hospital were found to be the most important associated risk factors on post-operative hospital LOS after TKA. This study directs the focus onto pre-operative optimization and patient selection and helps demonstrate where to best allocate resources to successfully decrease LOS.
Keywords: Lengths of stay, Total knee arthroplasty, Pre-operative optimization, Complications, High volume surgeon.

References

1. Hoffmann JD, Kusnezov NA, Dunn JC, Zarkadis NJ, Goodman GP, Berger RA. The shift to same-day outpatient joint arthroplasty: A systematic review. J Arthroplasty 2018;33:1265-74.
2. Burn E, Edwards CJ, Murray DW, Silman A, Cooper C, Arden NK, et al. Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: Evidence from linked primary care and NHS hospital records from 1997 to 2014. BMJ Open 2018;8:e019146.
3. Kreder HJ, Grosso P, Williams JI, Jaglal S, Axcell T, Wal EK, et al. Provider volume and other predictors of outcome after total knee arthroplasty: A population study in Ontario. Can J Surg 2003;46:15-22.
4. Styron JF, Koroukian SM, Klika AK, Barsoum WK. Patient vs provider characteristics impacting hospital lengths of stay after total knee or hip arthroplasty. J Arthroplasty 2011;26:1418- 26.e1.
5. Yasunaga H, Tsuchiya K, Matsuyama Y, Ohe K. Analysis of factors affecting operating time, postoperative complications, and length of stay for total knee arthroplasty: Nationwide web-based survey. J Orthop Sci 2009;14:10-6.
6. Piuzzi NS, Strnad GJ, Sakr Esa WA, Barsoum WK, Bloomfield MR, Brooks PJ, et al. The main predictors of length of stay after total knee arthroplasty: Patient-related or procedure-related risk factors. J Bone Joint Surg Am 2019;101:1093.
7. Bozic KJ, Maselli J, Pekow PS, Lindenauer PK, Vail TP, Auerbach AD. The influence of procedure volumes and standardization of care on quality and efficiency in total joint replacement surgery. J Bone Joint Surg Am 2010;92:2643-52.
8. Prohaska MG, Keeney BJ, Beg HA, Swarup I, Moschetti WE, Kantor SR, et al. Preoperative body mass index and physical function are associated with length of stay and facility discharge after total knee arthroplasty. Knee 2017;24:634-40.
9. Winemaker M, Petruccelli D, Kabali C, de Beer J. Not all total joint replacement patients are created equal: Preoperative factors and length of stay in hospital. Can J Surg 2015;58:160-6.
10. Martino J, Peterson B, Thompson S, Cook JL, Aggarwal A. Day of week and surgery location effects on stay length and cost for total joint arthroplasty: Academic versus orthopaedic-specific hospital. J Knee Surg 2018;31:815-21.
11. Pamilo KJ, Peltola M, Paloneva J, Makela K, Hakkinen U, Remes V. Hospital volume affects outcome after total knee arthroplasty. Acta Orthop 2015;86:41-7.
12. Lavernia CJ, Guzman JF. Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty 1995;10:133-40.
13. Hervey SL, Purves HR, Guller U, Toth AP, Vail TP, Pietrobon R. Provider volume of total knee arthroplasties and patient outcomes in the HCUP-nationwide inpatient sample. J Bone Joint Surg Am 2003;85:1775-83.

How to Cite this article: Willinger M, Gold P, Garbarino L, Anis H, Sodhi N, Danoff JR. What is associated with the Greatest Effect on Lengths of Stay after Total Knee Arthroplasty: The Hospital, the Surgeon, or the patient. Journal of Clinical Orthopaedics 2023:8(2);07-11.

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ORTHO AI: The Dawn of a New Era: Artificial Intelligence in Orthopaedics

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 05-06 | Parag Sancheti, Neeraj Bijlani, Ashok Shyam, Amit Yerudkar, Rohan Lunawat

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.578

Authors: Parag Sancheti [1], Neeraj Bijlani [2], Ashok Shyam [1, 3], Amit Yerudkar [4], Rohan Lunawat [4]

[1] Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra India.

[2] Orthotech Clinic, Chembur, Mumbai, India.

[3] ndian Orthopaedic Research group, Thane, India.

[4] Scriptlanes Pvt Ltd, Pune, India.

Address of Correspondence
Dr. Ashok Shyam, Indian Orthopaedic Research group, Thane, India.

E-mail: drashokshyam@gmail.com

Editorial

OrthoAI is the new buzz word in Orthopaedics. It was launched on 11th Dec 2023 at the hands of Dr Raghunath Mashelkar. It was an amazing event structured around the World’s First AI Focussed on Orthopaedics. Artificial Intelligence revolution began in Nov 2022 with advent of Chat GPT 3.5 on the AI landscape. Since then the advancements in Artificial Intelligence (AI) have started to change the landscape of various industries, and orthopaedics is no exception. Based on our observations and research, we firmly believe AI will redefine the landscape of orthopaedics in the near future specially in fields mentioned below but not restricted to it. With OrthoAI as first step we have created the foundation on which we can build on. We would be working in this field and follow it as it unfolds and present our insights from time to time.

OrthoAI: A Generative AI Revolution in Orthopaedics
As said OrthoAI is the foundation of the AI Revolution in Orthopaedics, and we would like to share some more insights about it. OrthoAI primary is a Generative AI like chat GPT. You can even call it OrthoGPT (Ortho Generative Pre-trained Transformer), a type of artificial intelligence model designed for understanding and generating human-like text. OrthoAI, akin to a specialized version of Chat GPT, or ‘OrthoGPT’, stands on three foundational pillars:
1. The OrthoAI Database: The essence of OrthoAI lies in its meticulously curated vector database, developed over nine months by a team of expert orthopaedic surgeons. This database is the cornerstone of OrthoAI’s reliability and validation.
2. PubMed Access: OrthoAI’s integration with PubMed enriches its evidence base, ensuring that its responses are grounded in the latest orthopaedic literature.
3. OrthoTV Access: With over eleven thousand orthopaedic videos, OrthoTV provides a wealth of expert knowledge and experiences. OrthoAI’s access to this repository allows it to offer comprehensive answers, supplemented with relevant article links and video content
Before we explore the far-reaching applications of OrthoAI, it’s crucial to gain an understanding of what AI is and its main types. At its core, AI involves creating computer systems that mimic human intelligence, enabling them to perform tasks that usually require human intellect.
Before delving into OrthoAI’s applications, it’s vital to understand AI’s core components:

• Machine Learning (ML) is a subset of AI that allows computers to learn and improve from experience without being explicitly programmed. In simpler terms, it’s like teaching a child to identify objects. Over time, the child learns to recognize and distinguish objects on their own, much like ML algorithms learn from data and improve over time. OrthoAI is primed with Machine Learning
• Deep Learning (DL) is a more complex subset of ML that mimics the neural networks of our brain. DL involves feeding a computer system a vast amount of data, which it uses to make decisions. For example, DL can help computers identify diseases by analyzing thousands of radiographs or MRI Scans. This ability to process and analyse a significant amount of data makes DL particularly valuable for OrthoAI.
• Natural Language Processing (NLP) is another critical aspect of AI that focuses on the interaction between computers and humans using natural language. NLP can read and understand human language, enabling it to extract essential information from clinical notes or respond to patient queries in real-time. OrthoAI has NLP built in and will continue to learn from all its interactions.
The rise of NLP and Large language models in last few months has infused new life in the AI arena and has piked the interest in these models.

We believe AI will primarily impact in following Five areas of Orthopaedics
OrthoAI & Clinical Decision Making

OrthoAI as discussed above is built on a validated database, along with PubMed and OrthoTV access. This makes the answers most relevant and trustworthy. With a synthesised answer from all sources, it will be source of having a huge thinking knowledge bank at your fingertips. It will act as CO-PILOT or as EBM Assistant to Orthopaedic Surgeons, helping them in tricky situations. The queries can vary from clinical, academic, case based, surgical steps, drug interactions, rehabilitation, complications, and surgical planning too. This is the version 1, and more things would be added in coming versions

AI and Orthopaedic Imaging
One of the most promising applications of AI in orthopaedics is in imaging. We rely heavily on imaging for diagnosis and treatment planning. AI can help streamline this process. ML algorithms, with their ability to identify patterns, can analyse and interpret imaging data from radiographs, MRIs, CT scans, etc. These algorithms can diagnose conditions like fractures, disc herniations and osteoarthritis with a level of accuracy comparable to experienced radiologists, saving significant diagnostic time. We believe radiologist are already using such algorithms and DL models, but it will soon extrapolate into a more common use by orthopaedic surgeons too

AI in Surgical Planning and Execution
The influence of AI will also transform surgical planning and execution. Patient specific planning and preoperative templating can be easily done by AI. AI’s influence isn’t confined to diagnostics—it’s also transforming surgical planning and execution. Additionally, AI can help surgeons place implants accurately during orthopaedic procedures, thus reducing complications and improving patient outcomes. With large data available from the rise of robotic surgeries in last decade, will help in training these models and soon a combination of robotic AI will be available to help us. OrthoAI is currently being worked as a platform for surgical planning too

AI in Prosthetics and Rehabilitation
Customised prosthetic development and suggesting innovative strategies in prosthetics that mimic natural movements will be achieve through advanced machine learning algorithms. Furthermore, AI-based rehabilitation programs will offer personalized therapy plans and monitor patient progress in real-time, ensuring a more efficient recovery process. Customisation & utilisation of smart devices in this area will increase.

AI in Predictive Analytics
Predictive analytics is another area where AI is showing tremendous potential. AI algorithms can analyse vast amounts of patient data to identify risk factors and predict disease progression. This information allows orthopaedic professionals to intervene early, potentially preventing the development of severe conditions and improving patient care. The algorithmic nature of these analysis make it most suitable to be plugged in into OrthoAI. A separate team in working on adding this unique feature to OrthoAI and we are sure that this will come as an update soon.

Ethical Considerations and Challenges
Like any technology even AI has its limitations. The issues of hallucinations of AI and providing wrong information are not uncommonly reported. This is the reason why we started with creating a validated database for OrthoAI and also limit its access to all unnecessary information. The integration of AI into orthopaedics will not be without challenges but we have created a foundation for it. AI will also raise critical ethical considerations concerning data privacy, informed consent, and accountability in the event of AI errors. Additionally, we need to develop a standardized set of regulations for using AI in healthcare to ensure its ethical and safe application.

Conclusion
OrthoAI is launched at the threshold of a new era in orthopaedics, bringing significant improvements in diagnosis, treatment planning, surgical execution, prosthetics, rehabilitation, and predictive analytics. As we start to incorporate AI more comprehensively into our practice, we need to conscientiously navigate the ethical and legal challenges it presents. Our enthusiasm as technologically inclined orthopaedic surgeons drives us to harness OrthoAI’s full potential, ushering in an era of precision, efficiency, and patient-centric care in orthopaedics.

 

How to Cite this article: Sancheti P, Bijlani N, Shyam A, Yerudkar A, Lunawat R. ORTHO AI: The Dawn of a New Era: Artificial Intelligence in Orthopaedics. Journal of Clinical Orthopaedics 2023;8(2):05-06.

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