Dr. Adarsh Annapareddy

The purpose of this study was to develop a ‘modified macroscopic soft tissue injury (MASTI) classification’ for cruciate retaining (CR) total knee arthroplasty (TKA), and compare the iatrogenic injury of robotic-arm assisted (RA) TKA and conventional jig-based (CJ) TKA using it. 100 symptomatic knee osteoarthritis patients were chosen of which fifty received RA TKA, whereas fifty received CJ TKA. Posterior cruciate ligament (PCL), soft tissue envelope and bone resection surfaces were assessed during operation and scores allotted for each. The overall score was then graded to form the classification. The classification had a high inter-observer reliability. RA TKA patients had significantly better PCL scores, soft tissue injury scores, bony injury scores, and modified MASTI grades, and had decreased chances and extent of soft tissue release for coronal balancing. Lesser degree of constitutional varus and sagittal plane deformity, and lower BMI have been found to be associated with better soft tissue preservation and better-modified MASTI grades. The ‘modified MASTI classification’ is a validated and reliable system to serve as a universal tool and platform for recording and grading iatrogenic bone and soft tissue injury during CR TKA. Using this classification, RA TKA is found to be less invasive and inflicts lesser extent of iatrogenic injuries when compared to CJ TKA. This classification can also be used as a parameter for evaluating the outcome of bone and soft tissue injuries and soft tissue releases to short- and long-term functional outcomes of patients, complications and longevity of implants.

Robotic-assisted technology in total joint arthroplasty (TJA) offers improved precision in component placement and alignment, addressing challenges, such as ligament imbalance, malalignment, and patient dissatisfaction. In India, where diverse healthcare settings exist, trends in robotic adoption remain underexplored. This study examines the adoption patterns and geographic distribution of robotic systems for TJA in India, highlighting market dynamics over the past 5 years. A cross-sectional observational study was conducted using data from manufacturers of robotic arthroplasty systems. Annual installations, tier-wise city classifications, and geographic distributions were analyzed. Statistical methods included descriptive analysis for installation trends, time-series visualization for adoption trajectories, and linear regression to forecast 2025 installations. As of September 2024, 290 robotic systems were installed across India. Among these, the CUVIS system (Meril) accounted for 89 installations (30.7%), followed by CORI (Smith and Nephew) with 66 installations (22.8%), and VELYS (DePuy) with 52 installations (17.9%). The MAKO system (Stryker) contributed 38 installations (13.1%), while MISSO (Meril) and ROSA (Zimmer) had 25 (8.6%) and 20 (6.9%) installations, respectively. Tier I hospitals dominated with 50% of installations, while Tier III and IV facilities accounted for only 10%. Linear regression predicts steady growth, with over 80 new robotic installations in 2025. Robotic technology adoption in Indian TJA has surged, with a strong preference for systems offering precision and versatility. However, barriers such as high costs and limited training impede penetration in lower tier facilities. Addressing these challenges could enhance equitable access and support the integration of robotics into diverse healthcare settings.

Introduction: Total hip arthroplasty (THA) is recognized as one of the most effective surgical procedures for the treatment of end-stage hip arthritis. However, the increasing number of primary THA cases has led to a corresponding rise in the frequency of revision surgeries, which are often more complex and challenging due to severe acetabular bone loss. In such cases, managing Paprosky type 3A and 3B defects requires precise implant design and advanced surgical techniques. Standard acetabular augments and anti-protrusio cages are commonly used, but they often fail to provide the necessary stability, leading to re-revision rates as high as 36% within 10 years. This case series explores the efficacy of custom-made 3D-printed acetabular augments and cages in managing severe acetabular bone loss during revision THA. Materials and Methods: This retrospective case series includes seven patients who underwent revision THA for Paprosky grade 3 acetabular bone loss between January 2023 and April 2024 at two high-volume tertiary care centers. The mean age of the patients was 45 years, with three males and four females included in the study. Pre-operative planning involved advanced imaging techniques, including 3D-computed tomography scans and custom virtual modeling, to design the acetabular components tailored to each patient’s specific anatomical requirements. During the surgeries, custom-made 3D-printed titanium augments and cages were used. These implants were fabricated using in-house software, and the turnaround time from the decision to surgery was approximately 10 days. Post-operatively, the planned 3D model was superimposed on post-operative radiographs to assess implant placement accuracy. The Harris hip score at the final follow-up averaged 69.16, with no signs of implant loosening observed. Conclusion: Custom-made 3D-printed acetabular augments and cages offer a reliable and cost-effective solution for managing severe acetabular bone loss in revision THA. Despite the small sample size and short follow-up period, the results demonstrate the potential of these custom implants to improve outcomes in complex acetabular reconstructions. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings and establish long-term efficacy.