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Image-based robotic-assisted total knee arthroplasty (RA-TKA) allows three-dimensional surgical planning informed by osseous anatomy, with intraoperative adjustment based on a dynamic assessment of ligament laxity and gap balance. The aim of this study was to identify ranges of implant alignment and bone resections with RA-TKA. We retrospectively reviewed 484 primary RA-TKA cases, stratified by preoperative coronal alignment. Demographics and intraoperative data were collected and compared using Chi-square and ANOVA tests. Planned limb, femoral, and tibial alignment became increasingly varus in a progressive order from valgus to neutral to the highest in varus knees (p < 0.001). Planned external transverse rotation relative to the TEA was lowest in the valgus cohort; relative to the PCA, whereas the varus cohort was highest (p < 0.001, both). Planned resections of the lateral distal femur and of the medial posterior femur were greater in the varus group compared to neutral and valgus (p < 0.001). There were significant differences between cohorts in planned tibia resections, laterally and medially. Varus knees demonstrated higher variability, while valgus and neutral had more metrics with low variability. This study demonstrated trends in intraoperative planned alignment and resection metrics across various preoperative coronal knee alignments. These findings contribute to the understanding of RA-TKA and may inform surgical decision-making.

The Irish continental margin (ICM) encompasses many complex sedimentary basins and diverse geomorphological features displaying bedrock outcrops where a large variety of habitats can be observed. This large area of seabed extends over >400,000 km2 and cannot be mapped manually or in a standardized way. Novel bedrock suitability mapping is applied to the entire ICM to determine potential bedrock outcrop from shallow to deep settings and to improve on the regional near-surface geology of the Irish margin. With the use of ROV video transects covering all the ICM and multibeam echosounder dataset, key terrain variables diagnostic of bedrock outcrop have been derived from bathymetry. A reclassification of each terrain variable was created by identifying the suitable ranges for outcrop occurrence in the variables, corresponding to the most common values occurring where the bedrock is located. Suitable bedrock location in non-surveyed areas have been calculated using these variables with map algebra to develop the novel Bedrock Suitability Index. This high-resolution (25 m2) model indicates that the main features where outcrop could be observed are canyon heads, terraces, or failure scarps, especially noticeable on the Whittard Canyon system. The Bedrock Suitability Index model is validated by video observations of bedrock exposures and is established with 58% level of confidence with 25 m2 resolution on the overall margin over >400,000 km2. The BSI mapping suggests a structural control on bedrock outcrop occurrences, with high BSI correlating with deep structural fabrics of the margin as bedrock outcrop can be found in areas where previously mapped faults have been identified. Bedrock and hard substratum mapping are important components to improve habitat identification and mapping. This less-invasive, low-cost method can be applied with open source software in a relatively simple way of determining where bedrock could be found. It can also be used to refine areas where there will be simply too much data for use to manually classify. Potential bedrock outcrop mapping can be included in a species distribution model.

Background: The purpose of the study was to investigate the accuracy of balancing which could be achieved at total knee surgery and its relation to functional outcomes. Methods: During surgery, the forces on the medial and lateral plateaus were measured at 10-15 degrees flexion in 101 patients, using an instrumented tibial trial, with equal forces being targeted. Of the initial 101 cases, 71 cases completed all follow-up visits to 1 year. At each follow-up visit, the function was measured using the Knee Society Scoring System, and varus and valgus laxity angles were measured. Results: The mean medial/(medial + lateral) compartmental force ratio was 0.52, with a standard deviation of 0.09. The total contact force was 217 Newtons, with a standard deviation of 72 Newtons. No correlations were found between the functional scores and the compartmental force ratio or total contact force. However, the mean varus and valgus laxity angles, 2.8 and 2.3 degrees, respectively, were very close to the angles of normal intact knees. Conclusions: The likely reason for the lack of correlation of function was that the large majority of the balancing ratios were within the range 0.4-0.6 but with a wide spread of functional scores typical of total knee study groups. However, the normal varus and valgus angles achieved at follow-up indicated that equal balancing in early flexion was a reasonable surgical target. Using instrumented tibial trials enabled accurate and consistent balancing values to be achieved, as well as normal varus and valgus laxity angles, which may be important in obtaining optimal outcomes. Keywords: Total knee surgery, Surgical balancing, Soft tissue balancing, Varus-valgus laxity, Ligament pretensions

Background: There is a paucity of literature assessing whether payer type has an impact on postoperative patient-reported outcomes (PROs) after total knee arthroplasty (TKA). The aim of this study was to comparatively evaluate TKA PROs among patients with commercial and Medicare insurance. Methods: We conducted a single-center, retrospective review of patients operated between January 2017 and March 2018. Knee Disability and Osteoarthritis Outcome Score Junior (KOOS-Jr) and Veterans RAND 12 Health Survey (VR-12) Physical Component (VR-12 PCS) and Mental Component (VR-12 MCS) PRO scores were collected prospectively at baseline and 12 weeks postoperatively via an electronic patient rehabilitation application. Univariable and multivariable linear regressions were utilized to assess the effects of patient insurance type on PRO. Results: In total, 193 TKA candidates had commercial (n = 91) or Medicare (n = 102) as their primary payer type. Demographic variables including age, gender, body mass index, and race varied significantly between the cohorts (P < .05). Length of stay and discharge disposition also varied significantly (P < .05). When compared with commercial payers, Medicare beneficiaries demonstrated a 4.13 ± 2.06 increase in Knee Disability and Osteoarthritis Outcome Score JR. scores at baseline (P < .05). However, after adjusting for patient-specific demographic and perioperative variables, all PROs recorded in this study were similar between the 2 payer groups at baseline and 12 weeks postoperatively (P > .05). Furthermore, ΔPRO scores from baseline to 12 weeks were also similar (P > .05). Conclusions: After adjusting for patient-specific variables, PROs are similar at baseline and 12 weeks postoperatively between commercial and Medicare cohorts. For TKA candidates with similar baseline demographics, surgeons can expect similar perioperative PROs regardless of insurance type. Keywords: Insurance, Patient-reported outcomes, Total knee arthroplasty, Medicare

Temperature history is one of the most important factors driving subsidence and the overall tectono-stratigraphic evolution of a sedimentary basin. The McKenzie model has been widely applied for subsidence modelling and stretching factor estimation for sedimentary basins formed in an extensional tectonic environment. Subsidence modelling requires values of physical parameters (e.g., crustal thickness, lithospheric thickness, stretching factor) that may not always be available. With a given subsidence history of a basin estimated using a stratigraphic backstripping method, these parameters can be estimated by quantitatively comparing the known subsidence curve with modelled subsidence curves. In this contribution, a method to compare known and modelled subsidence curves is presented, aiming to constrain valid combinations of the stretching factor, crustal thickness, and lithospheric thickness of a basin. Furthermore, a numerical model is presented that takes into account the effect of sedimentary cover on thermal history and subsidence modelling of a basin. The parameter fitting method presented here is first applied to synthetically generated subsidence curves. Next, a case study using a known subsidence curve from the Campos Basin, offshore Brazil, is considered. The range of stretching factors estimated for the Campos basin from this study is in accordance with previous work, with an additional estimate of corresponding lithospheric thickness. This study provides insight into the dependence of thermal history and subsidence modelling methods on assumptions regarding model input parameters. This methodology also allows for the estimation of valid combinations of physical lithospheric parameters, where the subsidence history is known.

Purpose: The purpose of this study was to determine if using a sensor-equipped tibial insert would reduce medial (MED) and lateral (LAT) gapping and create more equivalent compressive forces in the MED and LAT compartments. Methods: 7 orthopedic surgeons each performed bilateral TKA on complete lower extremity cadaveric specimens. Left TKA was performed first without the use of the instrumented tibial insert. With trial components placed, the patella was reduced and joint capsule closed with towel clips. Surgeons performed varus and valgus stress tests on each knee and the mm of MED and LAT gapping were recorded. Compressive forces in the MED and LAT compartment were measured at 10°, 45°, and 90° of flexion. Sensor-assisted TKA was then performed on the right knee and compressive forces and gapping were again recorded. MED, LAT, and total mediolateral (ML) gapping and MED and LAT compressive forces were compared between conventional TKA and sensor-assisted TKA with paired t-tests. Results: Sensor-assisted TKA resulted in significantly reduced MED (1.2 vs. 1.9 mm, p