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Total Knee Arthroplasty Outcomes

Works Count: 69253

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Description

This cluster of papers focuses on the projections, outcomes, and epidemiology of arthroplasty surgeries, particularly total knee and hip replacements, in the United States. It covers topics such as patient satisfaction, revision surgery, alignment, complications, and health-related quality of life following arthroplasty procedures.

Keywords

Arthroplasty; Total Knee Replacement; Total Hip Replacement; Patient Satisfaction; Revision Surgery; Epidemiology; Outcomes; Alignment; Complications; Health-Related Quality of Life

Predicting dissatisfaction following total knee replacement

2010-08-26

Chloe E. H. Scott , C. R. Howie , Deborah J. MacDonald +1 more

Up to 20% of patients are not satisfied with the outcome following total knee replacement (TKR). This study investigated the pre- and post-operative predictors of dissatisfaction in a large cohort … Up to 20% of patients are not satisfied with the outcome following total knee replacement (TKR). This study investigated the pre- and post-operative predictors of dissatisfaction in a large cohort of patients undergoing TKR. We assessed 1217 consecutive patients between 2006 and 2008 both before operation and six months after, using the Short-form (SF)-12 health questionnaire and the Oxford Knee Score. Detailed information concerning comorbidity was also gathered. Satisfaction was measured at one year when 18.6% (226 of 1217) of patients were unsure or dissatisfied with their replacement and 81.4% (911 of 1217) were satisfied or very satisfied. Multivariate regression analysis was performed to identify independent predictors of dissatisfaction. Significant (p < 0.001) predictors at one year included the pre-operative SF-12 mental component score, depression and pain in other joints, the six-month SF-12 score and poorer improvement in the pain element of the Oxford Knee Score. Patient expectations were highly correlated with satisfaction. Satisfaction following TKR is multifactorial. Managing the expectations and mental health of the patients may reduce dissatisfaction. However, the most significant predictor of dissatisfaction is a painful total knee replacement.

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Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS‐PS), Knee Outcome Survey Activities of Daily Living Scale (KOS‐ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS)

2011-11-01

Natalie J. Collins , Devyani Misra , David T. Felson +2 more

Patient-reported measures of knee function are important for the comprehensive assessment of rheumatology conditions in both clinical and research contexts. To merit inclusion in this review, measures of knee function … Patient-reported measures of knee function are important for the comprehensive assessment of rheumatology conditions in both clinical and research contexts. To merit inclusion in this review, measures of knee function were required to be patient reported and assess aspects considered important by adult patients with knee problems such as injury or osteoarthritis (OA). Therefore, measures used in rheumatology, orthopedics, and sports medicine were considered. Dimensions deemed to be important to patients included pain, function, quality of life, and activity level. To identify instruments fulfilling these criteria, we utilized published reviews of knee instruments (1), knee OA instruments (2), and measures for use in patellofemoral arthroplasty (3). Based on these reviews, as well as extensive searches of more recent literature, we included the following 9 patient-reported outcomes: Activity Rating Scale, International Knee Documentation Committee Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form, Knee Outcome Survey Activities of Daily Living Scale, Lysholm Knee Scoring Scale, Tegner Activity Scale, Oxford Knee Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Although the WOMAC can be applied to the hip and knee, this study contains data only applicable to the knee. Measures assessing activity level are listed separately. Psychometric data pertaining to the reliability and responsiveness of each patient-reported outcome are shown in Tables 1 and and2.2. The number of psychometric reports concerning each instrument ranges from 2–27. A higher number of reports indicates a higher degree of certainty in interpretation of the psychometric properties. Table 1 Summary of reliability data* Table 2 Summary of responsiveness data* Psychometric properties were based on data provided in Tables 1 and 2, and interpreted using standardized guidelines. Internal consistency was considered adequate if Cronbach’s alpha was at least 0.7 (4), and test–retest (intra-rater) reliability was adequate if the intraclass correlation coefficient was at least 0.8 for groups and 0.9 for individuals (5). Floor and ceiling effects were considered to be absent if no participants scored the bottom or top score, respectively, and acceptable if 0.8 were considered large (9). In this context, the minimum clinically important difference is the amount of change of a patient-reported outcome that represents a meaningful change to the patient, while the patient-acceptable symptom state is the least abnormal function score at which patients would consider themselves having acceptable function (10).

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Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study

1987-03-01

Philippe Hernigou , D. Medevielle , J Debeyre +1 more

JBJS Journal Case Connector Reviews JBJS.org Surgical Techniques Open Access JOPA JBJS.org JBJS Journal Case Connector Reviews Surgical Techniques Open Access JOPA JBJS Journal Case Connector Reviews JBJS.org Surgical Techniques Open Access JOPA JBJS.org JBJS Journal Case Connector Reviews Surgical Techniques Open Access JOPA

A comparison of four models of total knee-replacement prostheses

1976-09-01

JN Insall , Ranawat Cs , Paolo Aglietti +1 more

Twenty-nine knees with unicondylar, sixty-four with duocondylar, fifty with Guepar, and fifty with geometric prostheses were studied. The follow-up ranged from two to three and one-half years. The unicondylar prosthesis … Twenty-nine knees with unicondylar, sixty-four with duocondylar, fifty with Guepar, and fifty with geometric prostheses were studied. The follow-up ranged from two to three and one-half years. The unicondylar prosthesis was used in the mildest cases and gave the least complications, but the quality of results was not superior to that achieved with the other prostheses. The duocondylar model was best suited for knees with rheumatoid arthritis and mild deformity. The geometric prosthesis was the best condylar prosthesis for osteoarthritis with moderate to severe deformity, but gave the worst results in knees with rheumatoid arthritis. The Guepar prosthesis was used in the worst knees and gave the best results, but it had the highest infection rate and was the most difficult to salvage. A radiolucency was observed in about 60 per cent of the condylar replacements around the tibial component and in 45 per cent of the Geupar replacements around the femoral component. The significance of this cannot yet be determined but it suggest that the fixation may not be ideal. In all types, residual pain was most frequently attributed to the patellar compartment. Patellectomy was not a solution.

Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015

2010-06-17

Judd S. Day , Edmund Lau , Kevin Ong +3 more

Loading of the knee joint during activities of daily living measured in vivo in five subjects

2010-06-08

Ines Kutzner , Bernd Heinlein , F. Graichen +5 more

Bone Marrow Edema and Its Relation to Progression of Knee Osteoarthritis

2003-09-02

David T. Felson , Sara McLaughlin , Joyce Goggins +6 more

Background: While factors affecting the course of knee osteoarthritis are mostly unknown, lesions on bone scan and mechanical malalignment increase risk for radiographic deterioration. Bone marrow edema lesions on magnetic … Background: While factors affecting the course of knee osteoarthritis are mostly unknown, lesions on bone scan and mechanical malalignment increase risk for radiographic deterioration. Bone marrow edema lesions on magnetic resonance imaging correspond to bone scan lesions. Objective: To determine whether edema lesions in the subarticular bone in patients with knee osteoarthritis identify knees at high risk for radiographic progression and whether these lesions are associated with limb malalignment. Design: Natural history study. Setting: A Veterans Administration hospital in Boston, Massachusetts. Patients: Persons 45 years of age and older with symptomatic knee osteoarthritis. Measurements: Baseline assessments included magnetic resonance imaging of the knee and fluoroscopically positioned radiography. During follow-up at 15 and 30 months, patients underwent repeated radiography; at 15 months, long-limb films were obtained to assess mechanical alignment. Progression was defined as an increase over follow-up in medial or lateral joint space narrowing, based on a semi-quantitative grading. Generalized estimating equations were used to evaluate the relation of medial bone marrow edema lesions to medial progression and lateral lesions to lateral progression, before and after adjustment for limb alignment. Results: Of 256 patients, 223 (87.1%) participated in at least one follow-up examination. Medial bone marrow lesions were seen mostly in patients with varus limbs, and lateral lesions were seen mostly in those with valgus limbs. Twenty-seven of 75 knees with medial lesions (36.0%) showed medial progression versus 12 of 148 knees without lesions (8.1%) (odds ratio for progression, 6.5 [95% CI, 3.0 to 14.0]). Approximately 69% of knees that progressed medially had medial lesions, and lateral lesions conferred a marked risk for lateral progression. These increased risks were attenuated by 37% to 53% after adjustment for limb alignment. Conclusion: Bone marrow edema is a potent risk factor for structural deterioration in knee osteoarthritis, and its relation to progression is explained in part by its association with limb alignment.

Patient Satisfaction after Total Knee Arthroplasty: Who is Satisfied and Who is Not?

2009-10-21

Robert B. Bourne , Bert M. Chesworth , Aileen M. Davis +2 more

Despite substantial advances in primary TKA, numerous studies using historic TKA implants suggest only 82% to 89% of primary TKA patients are satisfied. We reexamined this issue to determine if … Despite substantial advances in primary TKA, numerous studies using historic TKA implants suggest only 82% to 89% of primary TKA patients are satisfied. We reexamined this issue to determine if contemporary TKA implants might be associated with improved patient satisfaction. We performed a cross-sectional study of patient satisfaction after 1703 primary TKAs performed in the province of Ontario. Our data confirmed that approximately one in five (19%) primary TKA patients were not satisfied with the outcome. Satisfaction with pain relief varied from 72-86% and with function from 70-84% for specific activities of daily living. The strongest predictors of patient dissatisfaction after primary TKA were expectations not met (10.7x greater risk), a low 1-year WOMAC (2.5x greater risk), preoperative pain at rest (2.4x greater risk) and a postoperative complication requiring hospital readmission (1.9x greater risk).

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Outcomes of total hip and knee replacement: Preoperative functional status predicts outcomes at six months after surgery

1999-08-01

Paul R. Fortin , Ann E. Clarke , Lawrence Joseph +7 more

Objective To determine whether patients with knee or hip osteoarthritis (OA) who have worse physical function preoperatively achieve a postoperative status that is similar to that of patients with better … Objective To determine whether patients with knee or hip osteoarthritis (OA) who have worse physical function preoperatively achieve a postoperative status that is similar to that of patients with better preoperative function. Methods This study surveyed an observational cohort of 379 consecutive patients with definite OA who were without other inflammatory joint diseases and were undergoing either total hip or knee replacement in a US (Boston) and a Canadian (Montreal) referral center. Questionnaires on health status (the Short Form 36 and Western Ontario and McMaster Universities Osteoarthritis Index) were administered preoperatively and at 3 and 6 months postoperatively. Physical function and pain due to OA were deemed the most significant outcomes to study. Results Two hundred twenty-two patients returned their questionnaires. Patients in the 2 centers were comparable in age, sex, time to surgery, and proportion of hip/knee surgery. The Boston group had more education, lower comorbidity, and more cemented knee prostheses. Patients undergoing hip or knee replacement in Montreal had lower preoperative physical function and more pain than their Boston counterparts. In patients with lower preoperative physical function, function and pain were not improved postoperatively to the level achieved by those with higher preoperative function. This was most striking in patients undergoing total knee replacement. Conclusion Surgery performed later in the natural history of functional decline due to OA of the knee, and possibly of the hip, results in worse postoperative functional status.

What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients

2012-01-01

Andrew D Beswick , Vikki Wylde , Rachael Gooberman‐Hill +2 more

Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes. However, some people experience long-term pain.To review published studies in representative populations with total hip or knee … Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes. However, some people experience long-term pain.To review published studies in representative populations with total hip or knee replacement for the treatment of osteoarthritis reporting proportions of people by pain intensity.MEDLINE and EMBASE databases searched to January 2011 with no language restrictions. Citations of key articles in ISI Web of Science and reference lists were checked.Prospective studies of consecutive, unselected osteoarthritis patients representative of the primary total hip or knee replacement population, with intensities of patient-centred pain measured after 3 months to 5-year follow-up.Two authors screened titles and abstracts. Data extracted by one author were checked independently against original articles by a second. For each study, the authors summarised the proportions of people with different severities of pain in the operated joint.Searches identified 1308 articles of which 115 reported patient-centred pain outcomes. Fourteen articles describing 17 cohorts (6 with hip and 11 with knee replacement) presented appropriate data on pain intensity. The proportion of people with an unfavourable long-term pain outcome in studies ranged from about 7% to 23% after hip and 10% to 34% after knee replacement. In the best quality studies, an unfavourable pain outcome was reported in 9% or more of patients after hip and about 20% of patients after knee replacement.Other studies reported mean values of pain outcomes. These and routine clinical studies are potential sources of relevant data.After hip and knee replacement, a significant proportion of people have painful joints. There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes.

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Increased knee joint loads during walking are present in subjects with knee osteoarthritis

2002-07-01

Algis J. Baliunas , Debra E. Hurwitz , A. B. Ryals +4 more

Normal Axial Alignment of the Lower Extremity and Load-Bearing Distribution at the Knee

1990-06-01

Robert Wen‐Wei Hsu , SHLNKICHL HIMENO , Mark B. Coventry +1 more

Based on a series of 120 normal subjects of different gender and age, the geometry of the knee joint was analyzed using a full-length weight-bearing roentgenogram of the lower extremity. … Based on a series of 120 normal subjects of different gender and age, the geometry of the knee joint was analyzed using a full-length weight-bearing roentgenogram of the lower extremity. A special computer program based on the theory of a rigid body spring model was applied to calculate the important anatomic and biomechanical factors of the knee joint. The tibiofemoral mechanical angle was 1.2° varus. Hence, it is difficult to rationalize the 3° varus placement of the tibial component in total knee arthroplasty suggested by some authors. The distal femoral anatomic valgus (measured from the lower one-half of the femur) was 4.2° in reference to its mechanical axis. This angle became 4.9° when the full-length femoral anatomic axis was used. When simulating a one-legged weight-bearing stance by shifting the upper-body gravity closer to the knee joint, 75% of the knee joint load passed through the medial tibial plateau. The knee joint-line obliquity was more varus in male subjects. The female subjects had a higher peak joint pressure and a greater patello-tibial Q angle. Age had little effect on the factors relating to axial alignment of the lower extremity and load transmission through the knee joint.

Determining the Rotational Alignment of the Femoral Component in Total Knee Arthroplasty Using the Epicondylar Axis

1993-01-01

Richard A. Berger , Harry E. Rubash , Michael J. Seel +2 more

The posterior condylar surfaces of the femur are routinely used as the reference for the rotational orientation of the femoral component during most primary total knee arthroplasties. The purpose of … The posterior condylar surfaces of the femur are routinely used as the reference for the rotational orientation of the femoral component during most primary total knee arthroplasties. The purpose of this investigation was to identify a clearly discernible, reproducible secondary anatomic axis useful for determining the rotational orientation of the femoral component when the posterior condylar surfaces cannot be used. Seventy-five embalmed anatomic specimen femurs were studied. A surgical epicondylar axis was defined as the line connecting the lateral epicondylar prominence and the medial sulcus of the medial epicondyle. The posterior condylar angle was measured as the angle between the posterior condylar surfaces and the surgical epicondylar axis. Measurement of the posterior condylar angle referenced from the surgical epicondylar axis yielded a mean posterior condylar angle of 3.5 degrees (+/- 1.2 degrees) of internal rotation for males and a mean posterior condylar angle of 0.3 degree (+/- 1.2 degrees) of internal rotation for females. Thus, rotational alignment of the femoral component can be accurately estimated using the posterior condylar angle. The posterior condylar angle, referenced from the surgical epicondylar axis, provides a visual rotational alignment check during primary arthroplasty and may improve alignment of the femoral component at revision.

Interaction between active and passive knee stabilizers during level walking

1991-01-01

O.D. Schipplein , Thomas P. Andriacchi

Abstract The gait of normal subjects and patients with varus deformities at the knee was studied by analyzing the interaction between the dynamic (muscular) and passive (ligamentous) restraints affecting lateral … Abstract The gait of normal subjects and patients with varus deformities at the knee was studied by analyzing the interaction between the dynamic (muscular) and passive (ligamentous) restraints affecting lateral stability of the knee. A statically determinant model predicted that the midstance‐phase adducting moment during normal gait would cause lateral knee joint opening if either antagonistic muscle force and/or pretension in the lateral soft tissues were not present at the knee. The patient group tended to compensate for a high midstance‐phase adducting moment by walking with a style of gait that demanded more muscle force (greater flexion‐extension moments). This walking style reduced the chance of lateral joint opening. It can be speculated that this style of gait would help to maintain equilibrium at the knee. The higher muscle force would aid in resisting the adducting moment, keeping the joint closed laterally and thus increasing the stability of the knee.

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Effect of Postoperative Mechanical Axis Alignment on the Fifteen-Year Survival of Modern, Cemented Total Knee Replacements

2010-09-01

Sébastien Parratte , Mark W. Pagnano , Robert T. Trousdale +1 more

One long-held tenet of total knee arthroplasty is that implant durability is maximized when postoperative limb alignment is corrected to 0° ± 3° relative to the mechanical axis. Recently, substantial … One long-held tenet of total knee arthroplasty is that implant durability is maximized when postoperative limb alignment is corrected to 0° ± 3° relative to the mechanical axis. Recently, substantial health-care resources have been devoted to computer navigation systems that allow surgeons to more often achieve that alignment. We hypothesized that a postoperative mechanical axis of 0° ± 3° would result in better long-term survival of total knee arthroplasty implants as compared with that in a group of outliers.Clinical and radiographic data were reviewed retrospectively to determine the fifteen-year Kaplan-Meier survival rate following 398 primary total knee arthroplasties performed with cement in 280 patients from 1985 to 1990. Preoperatively, most knees were in varus mechanical alignment (mean and standard deviation, 6° ± 8.8° of varus [range, 30° of varus to 22° of valgus]), whereas postoperatively most knees were corrected to neutral (mean and standard deviation, 0° ± 2.8° [range, 8° of varus to 9° of valgus]). Postoperatively, we defined a mechanically aligned group of 292 knees (with a mechanical axis of 0° ± 3°) and an outlier group of 106 knees (with a mechanical axis of beyond 0° ± 3°).At the time of the latest follow-up, forty-five (15.4%) of the 292 implants in the mechanically aligned group had been revised for any reason, compared with fourteen (13%) of the 106 implants in the outlier group (p = 0.88); twenty-seven (9.2%) of the 292 implants in the mechanically aligned group had been revised because of aseptic loosening, mechanical failure, wear, or patellar problems, compared with eight (7.5%) of the 106 implants in the outlier group (p = 0.88); and seventeen (5.8%) of the 292 implants in the mechanically aligned group had been revised because of aseptic loosening, mechanical failure, or wear, compared with four (3.8%) of the 106 implants in the outlier group (p = 0.49).A postoperative mechanical axis of 0° ± 3° did not improve the fifteen-year implant survival rate following these 398 modern total knee arthroplasties. We believe that describing alignment as a dichotomous variable (aligned versus malaligned) on the basis of a mechanical axis goal of 0° ± 3° is of little practical value for predicting the durability of modern total knee arthroplasty implants.

Comparisons of Five Health Status Instruments for Orthopedic Evaluation

1990-07-01

Matthew H. Liang , Anne H. Fossel , Martin G. Larson

This study represents a long-term effort to find optimal techniques for evaluating outcome in patients who have undergone total joint arthroplasty. Sensitivity of five health status questionnaires was studied in … This study represents a long-term effort to find optimal techniques for evaluating outcome in patients who have undergone total joint arthroplasty. Sensitivity of five health status questionnaires was studied in a longitudinal evaluation of orthopedic surgery. The questionnaires (Arthritis Impact Measurement Scales [AIMS], Functional Status Index [FSI], Health Assessment Questionnaire [HAQ], Index of Well Being [IWB], and Sickness Impact Profile [SIP]) were administered to 38 patients with end-stage arthritis at three points in time: two weeks before hip or knee arthroplasty, and at three-month and 12- to 15-month follow-up. Response values (i.e., changes within patients) were calculated on four scales: global health, pain, mobility, and social function. By the three-month follow-up, most instruments detected large mean responses in global health, pain scores, and mobility. Smaller changes on these scales were found between three and 12 to 15 months. Social function showed small to modest gains at successive follow-ups. Standardized response means were calculated to assess sensitivity to detect change. Confidence intervals for these indices were constructed using a jackknife procedure, and significance tests were performed by pairing selected indices. Finally, the study projected sample sizes required to assess a new therapy, using each response. These statistical tools facilitated comparisons among instruments and may prove useful in other settings.

The Chitranjan Ranawat Award: Is Neutral Mechanical Alignment Normal for All Patients?: The Concept of Constitutional Varus

2011-06-08

Johan Bellemans , William Colyn , Hilde Vandenneucker +1 more

Most knee surgeons have believed during TKA neutral mechanical alignment should be restored. A number of patients may exist, however, for whom neutral mechanical alignment is abnormal. Patients with so-called … Most knee surgeons have believed during TKA neutral mechanical alignment should be restored. A number of patients may exist, however, for whom neutral mechanical alignment is abnormal. Patients with so-called "constitutional varus" knees have had varus alignment since they reached skeletal maturity. Restoring neutral alignment in these cases may in fact be abnormal and undesirable and would likely require some degree of medial soft tissue release to achieve neutral alignment.We investigated what percentage of the normal population has constitutional varus knees and what are the contributing factors.We recruited a cohort of 250 asymptomatic adult volunteers between 20 and 27 years old for this cross-sectional study. All volunteers had full-leg standing digital radiographs on which 19 alignment parameters were analyzed. The incidence of constitutional varus alignment was determined and contributing factors were analyzed using multivariate prediction models.Thirty-two percent of men and 17% of women had constitutional varus knees with a natural mechanical alignment of 3° varus or more. Constitutional varus was associated with increased sports activity during growth, increased femoral varus bowing, an increased varus femoral neck-shaft angle, and an increased femoral anatomic mechanical angle.An important fraction of the normal population has a natural alignment at the end of growth of 3° varus or more. This might be a consequence of Hueter-Volkmann's law. Restoration of mechanical alignment to neutral in these cases may not be desirable and would be unnatural for them.

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Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030

2007-04-01

Steven M. Kurtz , Kevin Ong , Edmund Lau +2 more

Over the past decade, there has been an increase in the number of revision total hip and knee arthroplasties performed in the United States. The purpose of this study was … Over the past decade, there has been an increase in the number of revision total hip and knee arthroplasties performed in the United States. The purpose of this study was to formulate projections for the number of primary and revision total hip and knee arthroplasties that will be performed in the United States through 2030.The Nationwide Inpatient Sample (1990 to 2003) was used in conjunction with United States Census Bureau data to quantify primary and revision arthroplasty rates as a function of age, gender, race and/or ethnicity, and census region. Projections were performed with use of Poisson regression on historical procedure rates in combination with population projections from 2005 to 2030.By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures. The demand for hip revision procedures is projected to double by the year 2026, while the demand for knee revisions is expected to double by 2015. Although hip revisions are currently more frequently performed than knee revisions, the demand for knee revisions is expected to surpass the demand for hip revisions after 2007. Overall, total hip and total knee revisions are projected to grow by 137% and 601%, respectively, between 2005 and 2030.These large projected increases in demand for total hip and knee arthroplasties provide a quantitative basis for future policy decisions related to the numbers of orthopaedic surgeons needed to perform these procedures and the deployment of appropriate resources to serve this need.

The Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System

1989-11-01

F C Ewald

A roentgenographic knee evaluation system endorsed by The Knee Society is included in this year's proceedings to encourage uniform reporting of the results of total knee arthroplasty. No rating system … A roentgenographic knee evaluation system endorsed by The Knee Society is included in this year's proceedings to encourage uniform reporting of the results of total knee arthroplasty. No rating system is ideal, but if many surgeons and centers use the same reporting system, then relative comparisons will at least become possible. Agreement on a new system by many experienced surgeons and institutions with a large clinical volume represents a sacrifice because old rating system data will have to be discarded.

Why Are Total Knee Arthroplasties Failing Today?

2002-11-01

Peter F. Sharkey , William J. Hozack , Richard H. Rothman +2 more

The incidence of failure after knee replacement is low, yet it has been reported that more than 22,000 knee replacements are revised yearly. The purpose of the current study was … The incidence of failure after knee replacement is low, yet it has been reported that more than 22,000 knee replacements are revised yearly. The purpose of the current study was to determine current mechanisms of failure of total knee arthroplasties. A retrospective review was done on all patients who had revision total knee arthroplasty during a 3-year period (September 1997-October 2000) at one institution. The preoperative evaluation in conjunction with radiographs, laboratory data, and intraoperative findings were used to determine causes of failure. Two hundred twelve surgeries were done on 203 patients (nine patients had bilateral surgeries). The reasons for failure listed in order of prevalence among the patients in this study include polyethylene wear, aseptic loosening, instability, infection, arthrofibrosis, malalignment or malposition, deficient extensor mechanism, avascular necrosis in the patella, periprosthetic fracture, and isolated patellar resurfacing. The cases reviewed included patients who had revision surgery within 9 days to 28 years (average, 3.7 years) after the previous surgery. More than half of the revisions in this group of patients were done less than 2 years after the index operation. Fifty percent of early revision total knee arthroplasties in this series were related to instability, malalignment or malposition, and failure of fixation.

Alignment in total knee arthroplasty

2004-07-01

H. Bäthis , L. Perlick , Markus Tingart +3 more

Restoration of neutral alignment of the leg is an important factor affecting the long-term results of total knee arthroplasty (TKA). Recent developments in computer-assisted surgery have focused on systems for … Restoration of neutral alignment of the leg is an important factor affecting the long-term results of total knee arthroplasty (TKA). Recent developments in computer-assisted surgery have focused on systems for improving TKA. In a prospective study two groups of 80 patients undergoing TKA had operations using either a computer-assisted navigation system or a conventional technique. Alignment of the leg and the orientation of components were determined on post-operative long-leg coronal and lateral films. The mechanical axis of the leg was significantly better in the computer-assisted group (96%, within ±3° varus/valgus) compared with the conventional group (78%, within ±3° varus/valgus). The coronal alignment of the femoral component was also more accurate in the computer-assisted group. Computer-assisted TKA gives a better correction of alignment of the leg and orientation of the components compared with the conventional technique. Potential benefits in the long-term outcome and functional improvement require further investigation.

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The Epidemiology of Revision Total Knee Arthroplasty in the United States

2009-07-29

Kevin J. Bozic , Steven M. Kurtz , Edmund Lau +5 more

Understanding the cause of failure and type of revision total knee arthroplasty (TKA) procedures performed in the United States is essential in guiding research, implant design, and clinical decision making … Understanding the cause of failure and type of revision total knee arthroplasty (TKA) procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in TKA. We assessed the causes of failure and specific types of revision TKA procedures performed in the United States using newly implemented ICD-9-CM diagnosis and procedure codes related to revision TKA data from the Nationwide Inpatient Sample (NIS) database. Clinical, demographic, and economic data were reviewed and analyzed from 60,355 revision TKA procedures performed in the United States between October 1, 2005 and December 31, 2006. The most common causes of revision TKA were infection (25.2%) and implant loosening (16.1%), and the most common type of revision TKA procedure reported was all component revision (35.2%). Revision TKA procedures were most commonly performed in large, urban, nonteaching hospitals in Medicare patients ages 65 to 74. The average length of hospital stay (LOS) for all revision TKA procedures was 5.1 days, and the average total charges were $49,360. However, average LOS, average charges, and procedure frequencies varied considerably by census region, hospital type, and procedure performed.Level II, economic and decision analysis. See Guidelines for Authors for a complete description of levels of evidence.

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Postoperative Alignment of Total Knee Replacement Its Effect on Survival

1994-02-01

Merrill A. Ritter , Philip M. Faris , E. Michael Keating +1 more

Four hundred twenty-one posterior cruciate condylar total knee arthroplasties were performed between 1975 and 1983. Anatomic alignment of the knee was recorded on follow-up evaluations from two months to 13 … Four hundred twenty-one posterior cruciate condylar total knee arthroplasties were performed between 1975 and 1983. Anatomic alignment of the knee was recorded on follow-up evaluations from two months to 13 years postoperatively. Patients were stratified into a normal group that was 5° to 8° anatomic valgus, a varus group that was from 4° anatomic valgus to any degree of varus, and a valgus group that was more than 9° anatomic valgus. There were eight failures, five in the varus group and three in the normal group. There were no failures in the valgus group. Kaplan-Meier survival curves showed no significant difference between normal and valgus groups; however, there was a statistical difference between the valgus and varus and the normal and varus groups. A surgeon should align a total knee prosthesis in neutral or a slight amount of anatomic valgus to give the patient the best chance for long-term survival.

Total Knee Arthroplasty

1985-01-01

John N. Insall , Roberto Binazzi , Michael Soudry +1 more

The standard prosthesis for most arthritic conditions is a tricompartmental type. Patellar resurfacing should be done in most cases. The question of cruciate preservation or substitution is unresolved, and both … The standard prosthesis for most arthritic conditions is a tricompartmental type. Patellar resurfacing should be done in most cases. The question of cruciate preservation or substitution is unresolved, and both types give equivalent clinical results. No advantage has been shown for left or right components. Correction of deformity occurs by soft-tissue release and ligament balancing, rather than by bone resection. Most primary replacements can be performed in this manner, but alignment is critical to the function and survival of a functioning arthroplasty. Most failures can be attributed to incorrect ligament balance or incorrect alignment. Cement fixation of the components has proved effective, and there is no immediate need for alternative methods such as bone ingrowth; new methods will have to prove themselves against the standard already established for cemented prostheses. Patellar complications such as fatigue fracture of the patellar bone now constitute the majority of problems following total knee arthroplasty.

Proximal tibial osteotomy. A critical long-term study of eighty-seven cases.

1993-02-01

M B Coventry , D M Ilstrup , Steven L. Wallrichs

Eighty-seven valgus osteotomies of the tibia were performed in seventy-three patients for osteoarthrosis of the medial compartment of the knee; the median follow-up was ten years (range, three to fourteen … Eighty-seven valgus osteotomies of the tibia were performed in seventy-three patients for osteoarthrosis of the medial compartment of the knee; the median follow-up was ten years (range, three to fourteen years). The data were subjected to univariate and multivariate statistical analysis and to survivorship analysis. For these calculations, the end-point of failure was defined as an arthroplasty of the knee, and additional calculations were performed with the end-point defined as the performance of an arthroplasty or moderate or severe pain in patients who had declined an arthroplasty. None of the many risk factors that were evaluated could be found to be associated with the duration of survival, except for relative weight and angular correction. The median loss of correction after the osteotomy was 1 degree. If, at one year after the operation, the valgus angulation was 8 degrees or more, or if the patient's weight was 1.32 times the ideal weight or less, the probability of survival five years thereafter was at least 90 per cent and the probability ten years thereafter was at least 65 per cent. However, when valgus angulation at one year was less than 8 degrees in a patient whose weight was more than 1.32 times the ideal weight, the rate of survival decreased to 38 per cent five years thereafter and to 19 per cent ten years thereafter. There is a considerable risk of failure of a proximal tibial osteotomy if the alignment is not overcorrected to at least 8 degrees of valgus angulation and if the patient is substantially overweight.

Total Knee Arthroplasty Volume, Utilization, and Outcomes Among Medicare Beneficiaries, 1991-2010

2012-09-26

Peter Cram , Xin Lü , Stephen L. Kates +3 more

<h3>Context</h3>Total knee arthroplasty (TKA) is one of the most common and costly surgical procedures performed in the United States.<h3>Objective</h3>To examine longitudinal trends in volume, utilization, and outcomes for primary and … <h3>Context</h3>Total knee arthroplasty (TKA) is one of the most common and costly surgical procedures performed in the United States.<h3>Objective</h3>To examine longitudinal trends in volume, utilization, and outcomes for primary and revision TKA between 1991 and 2010 in the US Medicare population.<h3>Design, Setting, and Participants</h3>Observational cohort of 3 271 851 patients (aged ≥65 years) who underwent primary TKA and 318 563 who underwent revision TKA identified in Medicare Part A data files.<h3>Main Outcome Measures</h3>We examined changes in primary and revision TKA volume, per capita utilization, hospital length of stay (LOS), readmission rates, and adverse outcomes.<h3>Results</h3>Between 1991 and 2010 annual primary TKA volume increased 161.5% from 93 230 to 243 802 while per capita utilization increased 99.2% (from 31.2 procedures per 10 000 Medicare enrollees in 1991 to 62.1 procedures per 10 000 in 2010). Revision TKA volume increased 105.9% from 9650 to 19 871 while per capita utilization increased 59.4% (from 3.2 procedures per 10 000 Medicare enrollees in 1991 to 5.1 procedures per 10 000 in 2010). For primary TKA, LOS decreased from 7.9 days (95% CI, 7.8-7.9) in 1991-1994 to 3.5 days (95% CI, 3.5-3.5) in 2007-2010 (P < .001). For primary TKA, rates of adverse outcomes resulting in readmission remained stable between 1991-2010, but rates of all-cause 30-day readmission increased from 4.2% (95% CI, 4.1%-4.2%) to 5.0% (95% CI, 4.9%-5.0%) (P < .001). For revision TKA, the decrease in hospital LOS was accompanied by an increase in all-cause 30-day readmission from 6.1% (95% CI, 5.9%-6.4%) to 8.9% (95% CI, 8.7%-9.2%) (P < .001) and an increase in readmission for wound infection from 1.4% (95% CI, 1.3%-1.5%) to 3.0% (95% CI, 2.9%-3.1%) (P < .001).<h3>Conclusions</h3>Increases in TKA volume have been driven by both increases in the number of Medicare enrollees and in per capita utilization. We also observed decreases in hospital LOS that were accompanied by increases in hospital readmission rates.

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Impact of the Economic Downturn on Total Joint Replacement Demand in the United States

2014-04-16

Steven M. Kurtz , Kevin Ong , Edmund Lau +1 more

Few studies have explored the role of the National Health Expenditure and macroeconomics on the utilization of total joint replacement. The economic downturn has raised questions about the sustainability of … Few studies have explored the role of the National Health Expenditure and macroeconomics on the utilization of total joint replacement. The economic downturn has raised questions about the sustainability of growth for total joint replacement in the future. Previous projections of total joint replacement demand in the United States were based on data up to 2003 using a statistical methodology that neglected macroeconomic factors, such as the National Health Expenditure.Data from the Nationwide Inpatient Sample (1993 to 2010) were used with United States Census and National Health Expenditure data to quantify historical trends in total joint replacement rates, including the two economic downturns in the 2000s. Primary and revision hip and knee arthroplasty were identified using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Projections in total joint replacement were estimated using a regression model incorporating the growth in population and rate of arthroplasties from 1993 to 2010 as a function of age, sex, race, and census region using the National Health Expenditure as the independent variable. The regression model was used in conjunction with government projections of National Health Expenditure from 2011 to 2021 to estimate future arthroplasty rates in subpopulations of the United States and to derive national estimates.The growth trend for the incidence of joint arthroplasty, for the overall United States population as well as for the United States workforce, was insensitive to economic downturns. From 2009 to 2010, the total number of procedures increased by 6.0% for primary total hip arthroplasty, 6.1% for primary total knee arthroplasty, 10.8% for revision total hip arthroplasty, and 13.5% for revision total knee arthroplasty. The National Health Expenditure model projections for primary hip replacement in 2020 were higher than a previously projected model, whereas the current model estimates for total knee arthroplasty were lower.Economic downturns in the 2000s did not substantially influence the national growth trends for hip and knee arthroplasty in the United States. These latest updated projections provide a basis for surgeons, hospitals, payers, and policy makers to plan for the future demand for total joint replacement surgery.

The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network.

1999-04-01

Jill Binkley , Paul W. Stratford , Stacy Lott +1 more

The purpose of this study was to assess the reliability, construct validity, and sensitivity to change of the Lower Extremity Functional Scale (LEFS).The LEFS was administered to 107 patients with … The purpose of this study was to assess the reliability, construct validity, and sensitivity to change of the Lower Extremity Functional Scale (LEFS).The LEFS was administered to 107 patients with lower-extremity musculoskeletal dysfunction referred to 12 outpatient physical therapy clinics.The LEFS was administered during the initial assessment, 24 to 48 hours following the initial assessment, and then at weekly intervals for 4 weeks. The SF-36 (acute version) was administered during the initial assessment and at weekly intervals. A type 2,1 intraclass correlation coefficient was used to estimate test-retest reliability. Pearson correlations and one-way analyses of variance were used to examine construct validity. Spearman rank-order correlation coefficients were used to examine the relationship between an independent prognostic rating of change for each patient and change in the LEFS and SF-36 scores.Test-retest reliability of the LEFS scores was excellent (R = .94 [95% lower limit confidence interval (CI) = .89]). Correlations between the LEFS and the SF-36 physical function subscale and physical component score were r=.80 (95% lower limit CI = .73) and r = .64 (95% lower limit CI = .54), respectively. There was a higher correlation between the prognostic rating of change and the LEFS than between the prognostic rating of change and the SF-36 physical function score. The potential error associated with a score on the LEFS at a given point in time is +/-5.3 scale points (90% CI), the minimal detectable change is 9 scale points (90% CI), and the minimal clinically important difference is 9 scale points (90% CI).The LEFS is reliable, and construct validity was supported by comparison with the SF-36. The sensitivity to change of the LEFS was superior to that of the SF-36 in this population. The LEFS is efficient to administer and score and is applicable for research purposes and clinical decision making for individual patients.

Unicondylar knee arthroplasty.

1989-01-01

Stuart C. Kozinn , Richard D. Scott

Etude des indications cliniques et fonctionnelles, ainsi que des techniques et resultats operatoires de l'arthroplastie unicondylienne pour arthrose unicompartimentale du genou Etude des indications cliniques et fonctionnelles, ainsi que des techniques et resultats operatoires de l'arthroplastie unicondylienne pour arthrose unicompartimentale du genou

Hip disability and osteoarthritis outcome score (HOOS) – validity and responsiveness in total hip replacement

2003-05-30

Anna Nilsdotter , Stefan Lohmander , Maria Klässbo +1 more

The aim of the study was to evaluate if physical functions usually associated with a younger population were of importance for an older population, and to construct an outcome measure … The aim of the study was to evaluate if physical functions usually associated with a younger population were of importance for an older population, and to construct an outcome measure for hip osteoarthritis with improved responsiveness compared to the Western Ontario McMaster osteoarthritis score (WOMAC LK 3.0). A 40 item questionnaire (hip disability and osteoarthritis outcome score, HOOS) was constructed to assess patient-relevant outcomes in five separate subscales (pain, symptoms, activity of daily living, sport and recreation function and hip related quality of life). The HOOS contains all WOMAC LK 3.0 questions in unchanged form. The HOOS was distributed to 90 patients with primary hip osteoarthritis (mean age 71.5, range 49–85, 41 females) assigned for total hip replacement for osteoarthritis preoperatively and at six months follow-up. The HOOS met set criteria of validity and responsiveness. It was more responsive than WOMAC regarding the subscales pain (SRM 2.11 vs. 1.83) and other symptoms (SRM 1.83 vs. 1.28). The responsiveness (SRM) for the two added subscales sport and recreation and quality of life were 1.29 and 1.65, respectively. Patients ≤ 66 years of age (range 49–66) reported higher responsiveness in all five subscales than patients >66 years of age (range 67–85) (Pain SRM 2.60 vs. 1.97, other symptoms SRM 3.0 vs. 1.60, activity of daily living SRM 2.51 vs. 1.52, sport and recreation function SRM 1.53 vs. 1.21 and hip related quality of life SRM 1.95 vs. 1.57). The HOOS 2.0 appears to be useful for the evaluation of patient-relevant outcome after THR and is more responsive than the WOMAC LK 3.0. The added subscales sport and recreation function and hip related quality of life were highly responsive for this group of patients, with the responsiveness being highest for those younger than 66.

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The use of the Oxford hip and knee scores

2007-08-01

David W. Murray , Ray Fitzpatrick , Katherine Rogers +4 more

The Oxford hip and knee scores have been extensively used since they were first described in 1996 and 1998. During this time, they have been modified and used for many … The Oxford hip and knee scores have been extensively used since they were first described in 1996 and 1998. During this time, they have been modified and used for many different purposes. This paper describes how they should be used and seeks to clarify areas of confusion.

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Influence of positioning of prosthesis in total knee replacement

1977-01-01

Lotke Pa , ML Ecker

The early clinical results of geometric total knee arthroplasty were compared with the position of the prosthetic device by a roentgenographic score system. It was noted that there is a … The early clinical results of geometric total knee arthroplasty were compared with the position of the prosthetic device by a roentgenographic score system. It was noted that there is a statistically significant positive correlation between a good clinical result and a well positioned prosthesis. In addition, it was appreciated that perfect positioning of the device was difficult to obtain. We believe that the long-term clinical results, wear resistance, and resistance to prosthetic failure depend on correct positioning of the devices.

The “Forgotten Joint” as the Ultimate Goal in Joint Arthroplasty

2011-10-17

Henrik Behrend , Karlmeinrad Giesinger , Johannes M. Giesinger +1 more

The John Insall Award: Patient Expectations Affect Satisfaction with Total Knee Arthroplasty

2006-09-08

Philip C. Noble , Michael A. Conditt , Karon F. Cook +1 more

Satisfaction with the outcome of total knee arthroplasty is highly variable, with a small but significant percentage of patients reporting dissatisfaction with the procedure. The purpose of this study was … Satisfaction with the outcome of total knee arthroplasty is highly variable, with a small but significant percentage of patients reporting dissatisfaction with the procedure. The purpose of this study was to determine which factors contribute to patient satisfaction with total knee replacement (TKR), and their relative importance. At a minimum of 1 year post unilateral primary TKR, 253 patients completed a self-administered, validated "Knee Function Questionnaire," which examined each patient's participation in a broad range of activities involving the knee, their level of satisfaction, and the extent to which TKR had fulfilled their expectations. The association between function, expectation and satisfaction was examined using univariate and multivariate logistic regression. Seventy-five percent of patients were either "satisfied" or "very satisfied" with their knee replacement, while 14% were "dissatisfied" or "very dissatisfied." Satisfaction correlated significantly (p < 0.001) with age less than 60, absence of residual symptoms, fulfillment of expectations, and absence of functional impairment. Satisfaction with TKR is primarily determined by patients' expectations, and not their absolute level of function. Real improvements in the outcome of TKA must address prevention of residual pain, stiffness and swelling, and each patient's preoperative concept of the likely outcome of these procedures.

Questionnaire on the perceptions of patients about total knee replacement

1998-01-01

Jill Dawson , Ray Fitzpatrick , David G. Murray +1 more

We have developed a 12-item questionnaire for patients having a total knee replacement (TKR). We made a prospective study of 117 patients before operation and at follow-up six months later, … We have developed a 12-item questionnaire for patients having a total knee replacement (TKR). We made a prospective study of 117 patients before operation and at follow-up six months later, asking them to complete the new questionnaire and the form SF36. Some also filled in the Stanford Health Assessment Questionnaire (HAQ). An orthopaedic surgeon completed the American Knee Society (AKS) clinical score. The single score derived from the new questionnaire had high internal consistency, and its reproducibility, examined by test-retest reliability, was found to be satisfactory. Its validity was established by obtaining significant correlations in the expected direction with the AKS scores and the relevant parts of the SF36 and HAQ. Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up. We also compared change in scores with the patients' retrospective judgement of change in their condition. The effect size for the new questionnaire compared favourably with those for the relevant parts of the SF36. The change scores for the new knee questionnaire were significantly greater (p < 0.0001) for patients who reported the most improvement in their condition. The new questionnaire provides a measure of outcome for TKR that is short, practical, reliable, valid and sensitive to clinically important changes over time.

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A Randomized, Controlled Trial of Total Knee Replacement

2015-10-22

Søren Thorgaard Skou , Ewa M. Roos , Mogens Berg Laursen +4 more

More than 670,000 total knee replacements are performed annually in the United States; however, high-quality evidence to support the effectiveness of the procedure, as compared with nonsurgical interventions, is lacking. More than 670,000 total knee replacements are performed annually in the United States; however, high-quality evidence to support the effectiveness of the procedure, as compared with nonsurgical interventions, is lacking.

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Why Are Total Knee Arthroplasties Failing Today—Has Anything Changed After 10 Years?

2014-07-05

Peter F. Sharkey , Paul M. Lichstein , Chao Shen +2 more

Principles of Deformity Correction

2009-01-01

Dror Paley

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The role of pain and function in determining patient satisfaction after total knee replacement

2007-07-01

Philip N. Baker , Jan van der Meulen , Jim Lewsey +1 more

A postal questionnaire was sent to 10 000 patients more than one year after their total knee replacement (TKR). They were assessed using the Oxford knee score and were asked … A postal questionnaire was sent to 10 000 patients more than one year after their total knee replacement (TKR). They were assessed using the Oxford knee score and were asked whether they were satisfied, unsure or unsatisfied with their TKR. The response rate was 87.4% (8231 of 9417 eligible questionnaires) and a total of 81.8% (6625 of 8095) of patients were satisfied. Multivariable regression modelling showed that patients with higher scores relating to the pain and function elements of the Oxford knee score had a lower level of satisfaction (p < 0.001), and that ongoing pain was a stronger predictor of this. Female gender and a primary diagnosis of osteoarthritis were found to be predictors of lower levels of patient satisfaction. Differences in the rate of satisfaction were also observed in relation to age, the American Society of Anesthesiologists grade and the type of prosthesis. This study has provided data on the Oxford knee score and the expected levels of satisfaction at one year after TKR. The results should act as a benchmark of practice in the United Kingdom and provide a baseline for peer comparison between institutions.

Health-Related Quality of Life after Knee Replacement

1998-02-01

Gillian Hawker , James G. Wright , Peter C. Coyte +7 more

A cross-sectional, community-based survey of a random sample of 1750 of 242,311 Medicare recipients was performed. The patients were at least sixty-five years old and had had a primary or … A cross-sectional, community-based survey of a random sample of 1750 of 242,311 Medicare recipients was performed. The patients were at least sixty-five years old and had had a primary or revision knee replacement (either unilaterally or bilaterally) between 1985 and 1989. Three samples were surveyed separately: a national sample (to reflect the United States as a whole) and samples from Indiana and the western part of Pennsylvania (sites chosen for convenience to assess the validity of the findings for the national sample on a regional level). Each sample was stratified by race, age, residence (urban or rural), and the year of the procedure. Valid and reliable questionnaires were used to elicit the participants' assessments of pain, physical function, and satisfaction two to seven years after the knee replacement.Of the 1486 patients who were eligible for inclusion in the survey, 1193 (80.3 per cent) responded. The mean age of the respondents was 72.6 years. Eight hundred and forty-nine respondents (71.2 per cent) were white, and 849 (71.2 per cent) were women.The participants reported that they had little or no pain in the knee at the time of the survey, regardless of the age at the time of the knee replacement, the body-mass index, or the length of time since the knee replacement. After adjustment for potential confounding variables, predictors of better physical function after the replacement were an absence of problems with the contralateral knee, primary knee replacement (rather than revision) (Indiana sample only), and a lower body-mass index (Indiana and western Pennsylvania samples). Four hundred and fifteen (85.2 per cent) of the 487 patients in the national sample were satisfied with the result of the knee replacement.In what we believe to be the first community-based study of the outcome of knee replacement, patients reported having significant (p = 0.0001) and persistent relief of pain, improved physical function, and satisfaction with the result two to seven years postoperatively. The findings of the present study suggest that age and obesity do not have a negative impact on patient-relevant outcomes (pain and physical function). Dissemination of these findings has the potential to increase appropriate referrals for knee replacement and thereby reduce the pain and functional disability due to osteoarthrosis of the knee.

Prevalence of Total Hip and Knee Replacement in the United States

2015-09-01

Hilal Maradit Kremers , Dirk R. Larson , Cynthia S. Crowson +5 more

Descriptive epidemiology of total joint replacement procedures is limited to annual procedure volumes (incidence). The prevalence of the growing number of individuals living with a total hip or total knee … Descriptive epidemiology of total joint replacement procedures is limited to annual procedure volumes (incidence). The prevalence of the growing number of individuals living with a total hip or total knee replacement is currently unknown. Our objective was to estimate the prevalence of total hip and total knee replacement in the United States.Prevalence was estimated using the counting method by combining historical incidence data from the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 1969 to 2010 with general population census and mortality counts. We accounted for relative differences in mortality rates between those who have had total hip or knee replacement and the general population.The 2010 prevalence of total hip and total knee replacement in the total U.S. population was 0.83% and 1.52%, respectively. Prevalence was higher among women than among men and increased with age, reaching 5.26% for total hip replacement and 10.38% for total knee replacement at eighty years. These estimates corresponded to 2.5 million individuals (1.4 million women and 1.1 million men) with total hip replacement and 4.7 million individuals (3.0 million women and 1.7 million men) with total knee replacement in 2010. Secular trends indicated a substantial rise in prevalence over time and a shift to younger ages.Around 7 million Americans are living with a hip or knee replacement, and consequently, in most cases, are mobile, despite advanced arthritis. These numbers underscore the substantial public health impact of total hip and knee arthroplasties.

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Health-Related Quality of Life in Total Hip and Total Knee Arthroplasty

2004-05-01

Olivier Ethgen , Olivier Bruyère , Florent Richy +2 more

Background: Total hip and total knee arthroplasties are well accepted as reliable and suitable surgical procedures to return patients to function. Health-related quality-of-life instruments have been used to document outcomes … Background: Total hip and total knee arthroplasties are well accepted as reliable and suitable surgical procedures to return patients to function. Health-related quality-of-life instruments have been used to document outcomes in order to optimize the allocation of resources. The objective of this study was to review the literature regarding the outcomes of total hip and knee arthroplasties as evaluated by health-related quality-of-life instruments. Methods: The Medline and EMBASE medical literature databases were searched, from January 1980 to June 2003, to identify relevant studies. Studies were eligible for review if they met the following criteria: (1) the language was English or French, (2) at least one well-validated and self-reported health-related quality of life instrument was used, and (3) a prospective cohort study design was used. Results: Of the seventy-four studies selected for the review, thirty-two investigated both total hip and total knee arthroplasties, twenty-six focused on total hip arthroplasty, and sixteen focused on total knee arthroplasty exclusively. The most common diagnosis was osteoarthritis. The duration of follow-up ranged from seven days to seven years, with the majority of studies describing results at six to twelve months. The Short Form-36 and the Western Ontario and McMaster University Osteoarthritis Index, the most frequently used instruments, were employed in forty and twenty-eight studies, respectively. Seventeen studies used a utility index. Overall, total hip and total knee arthroplasties were found to be quite effective in terms of improvement in health-related quality-of-life dimensions, with the occasional exception of the social dimension. Age was not found to be an obstacle to effective surgery, and men seemed to benefit more from the intervention than did women. When improvement was found to be modest, the role of comorbidities was highlighted. Total hip arthroplasty appears to return patients to function to a greater extent than do knee procedures, and primary surgery offers greater improvement than does revision. Patients who had poorer preoperative health-related quality of life were more likely to experience greater improvement. Conclusions: Health-related quality-of-life data are valuable, can provide relevant health-status information to health professionals, and should be used as a rationale for the implementation of the most adequate standard of care. Additional knowledge and scientific dissemination of surgery outcomes should help to ensure better management of patients undergoing total hip or total knee arthroplasty and to optimize the use of these procedures. Level of Evidence: Therapeutic study, Level III-3 (systematic review of Level-III studies). See Instructions to Authors for a complete description of levels of evidence.

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Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030

2018-09-05

Matthew Sloan , Ajay Premkumar , Neil P. Sheth

The volume of primary total joint arthroplasty (TJA) procedures has risen in recent decades. However, recent procedure growth has not been at previously projected exponential rates. To anticipate the future … The volume of primary total joint arthroplasty (TJA) procedures has risen in recent decades. However, recent procedure growth has not been at previously projected exponential rates. To anticipate the future expense of TJA, updated models are necessary to predict TJA volume in the U.S.Retrospective review using the National Inpatient Sample, a representative sample of all hospital discharges within the U.S., was employed to determine the volume of primary TJA procedures performed from 2000 to 2014. Over 116 million discharge records were reviewed and weighted to determine the simulated annual TJA volume. The annual incidence rate of each procedure was determined by combining procedure volume with annual census data among the overall population and in subpopulations defined by sex and age. Linear and Poisson regression analyses were performed to determine the projected future volume of TJA procedures. Subanalysis with linear regression estimates based on 2000 to 2008 and 2008 to 2014 growth rates was performed.On the basis of 2000-to-2014 data, primary total hip arthroplasty (THA) is projected to grow 71%, to 635,000 procedures, by 2030 and primary total knee arthroplasty (TKA) is projected to grow 85%, to 1.26 million procedures, by 2030. However, TKA procedure growth rate has been slowing over recent years, and models based on 2008-to-2014 data projected growth to only approximately 935,000 procedures by 2030.Previously anticipated exponential TJA growth is inconsistent with the most recent trends. An updated projection based on 2000-to-2014 data is provided to project the growth of primary TJA procedures to the year 2030. These data will help guide health-care economic policy and allocation of future resources in order to optimize the delivery of patient care.

How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up

2019-02-01

Jonathan Evans , R. Walker , Jonathan P Evans +3 more

BackgroundKnee replacements are the mainstay of treatment for end-stage osteoarthritis and are effective. Given time, all knee replacements will fail and knowing when this failure might happen is important. We … BackgroundKnee replacements are the mainstay of treatment for end-stage osteoarthritis and are effective. Given time, all knee replacements will fail and knowing when this failure might happen is important. We aimed to establish how long a knee replacement lasts.MethodsIn this systematic review and meta-analysis, we searched MEDLINE and Embase for case series and cohort studies published from database inception until July 21, 2018. Articles reporting 15 year or greater survival of primary total knee replacement (TKR), unicondylar knee replacement (UKR), and patellofemoral replacements in patients with osteoarthritis were included. Articles that reviewed specifically complex primary surgeries or revisions were excluded. Survival and implant data were extracted, with all-cause survival of the knee replacement construct being the primary outcome. We also reviewed national joint replacement registry reports and extracted the data to be analysed separately. In the meta-analysis, we weighted each series and calculated a pooled survival estimate for each data source at 15 years, 20 years, and 25 years, using a fixed-effects model. This study is registered with PROSPERO, number CRD42018105188.FindingsFrom 4363 references found by our initial search, we identified 33 case series in 30 eligible articles, which reported all-cause survival for 6490 TKRs (26 case series) and 742 UKRs (seven case series). No case series reporting on patellofemoral replacements met our inclusion criteria, and no case series reported 25 year survival for TKR. The estimated 25 year survival for UKR (based on one case series) was 72·0% (95% CI 58·0–95·0). Registries contributed 299 291 TKRs (47 series) and 7714 UKRs (five series). The pooled registry 25 year survival of TKRs (14 registries) was 82·3% (95% CI 81·3–83·2) and of UKRs (four registries) was 69·8% (67·6–72·1).InterpretationOur pooled registry data, which we believe to be more accurate than the case series data, shows that approximately 82% of TKRs last 25 years and 70% of UKRs last 25 years. These findings will be of use to patients and health-care providers; further information is required to predict exactly how long specific knee replacements will last.FundingThe National Institute for Health Research, the National Joint Registry for England, Wales, Northern Ireland, and Isle of Man, and the Royal College of Surgeons of England.

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Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample

2019-04-15

Jasvinder A. Singh , Shaohua Yu , Lang Chen +1 more

Objective. To project future total hip and knee joint arthroplasty (THA, TKA) use in the United States to 2040. Methods. We used the 2000–2014 US National Inpatient Sample (NIS) combined … Objective. To project future total hip and knee joint arthroplasty (THA, TKA) use in the United States to 2040. Methods. We used the 2000–2014 US National Inpatient Sample (NIS) combined with Census Bureau data to develop projections for primary THA and TKA from 2020 to 2040 using polynomial regression to account for the nonlinearity and interactions between the variables, assuming the underlying distribution of the number of THA/TKA to be Poisson distributed. We performed sensitivity analyses using a negative binomial regression to account for overdispersion. Results. Predicted total annual counts (95% prediction intervals) for THA in the United States by 2020, 2025, 2030, and 2040 are (in thousands): 498 (475, 523), 652 (610, 696), 850 (781, 925), and 1429 (1265, 1615), respectively. For primary TKA, predicted total annual counts for 2020, 2025, 2030, and 2040 are (in thousands): 1065 (937, 1211), 1272 (1200, 1710), 1921 (1530, 2410), and 3416 (2459, 4745), respectively. Compared to the available 2014 NIS numbers, the percent increases in projected total annual US use for primary THA and TKA in 2020, 2025, 2030, and 2040 are as follows: primary THA, by 34%, 75%, 129%, and 284%; and primary TKA, 56%, 110%, 182%, and 401%, respectively. Primary THA and TKA use is projected to increase for both females and males, in all age groups. Conclusion. Significant increases in use of THA and TKA are expected in the United States in the future, if the current trend continues. The increased use is evident across age groups in both females and males. A policy change may be needed to meet increased demand.

The Oxford medial unicompartmental arthroplasty

1998-11-01

David W. Murray , John Goodfellow , John O’Connor

Retrieval studies have shown that the use of fully congruent meniscal bearings reduces wear in knee replacements. We report the outcome of 143 knees with anteromedial osteoarthritis and normal anterior … Retrieval studies have shown that the use of fully congruent meniscal bearings reduces wear in knee replacements. We report the outcome of 143 knees with anteromedial osteoarthritis and normal anterior cruciate ligaments treated by unicompartmental arthroplasty using fully congruous mobile polyethylene bearings. At review, 34 knees were in patients who had died and 109 were in those who were still living. The mean elapsed time since operation was 7.6 years (maximum 13.8). We established the status of all but one knee. There had been five revision operations giving a cumulative prosthetic survival rate at ten years (33 knees at risk) of 98% (95% CI 93% to 100%). Considering the knee lost to follow-up as a failure, the 'worst-case' survival rate was 97%. No failures were due to polyethylene wear or aseptic loosening of the tibial component. One bearing which dislocated at four years was reduced by closed manipulation. The ten-year survival rate is the best of those reported for unicompartmental arthroplasty and not significantly different from the best rates for total knee replacement.

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Knee replacement

2012-03-06

Andrew Carr , Otto Robertsson , Stephen E. Graves +4 more

Questionnaire on the perceptions of patients about total knee replacement

1998-01-01

Jill Dawson , Ray Fitzpatrick , David W. Murray +1 more

We have developed a 12-item questionnaire for patients having a total knee replacement (TKR). We made a prospective study of 117 patients before operation and at follow-up six months later, … We have developed a 12-item questionnaire for patients having a total knee replacement (TKR). We made a prospective study of 117 patients before operation and at follow-up six months later, asking them to complete the new questionnaire and the form SF36. Some also filled in the Stanford Health Assessment Questionnaire (HAQ). An orthopaedic surgeon completed the American Knee Society (AKS) clinical score. The single score derived from the new questionnaire had high internal consistency, and its reproducibility, examined by test-retest reliability, was found to be satisfactory. Its validity was established by obtaining significant correlations in the expected direction with the AKS scores and the relevant parts of the SF36 and HAQ. Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up. We also compared change in scores with the patients’ retrospective judgement of change in their condition. The effect size for the new questionnaire compared favourably with those for the relevant parts of the SF36. The change scores for the new knee questionnaire were significantly greater (p < 0.0001) for patients who reported the most improvement in their condition. The new questionnaire provides a measure of outcome for TKR that is short, practical, reliable, valid and sensitive to clinically important changes over time.

The Effect of High Tibial Osteotomy on Osteoarthritis of the Knee

1979-07-01

Yoshiyuki Fujisawa , Kenji Masuhara , Shunji Shiomi

Rationale, of The Knee Society Clinical Rating System

1989-11-01

John N. Insall , Lawrence D. Dorr , Richard D. Scott +1 more

A new total knee rating system has been developed by The Knee Society to provide an up-to-date more stringent evaluation form. The system is subdivided into a knee score that … A new total knee rating system has been developed by The Knee Society to provide an up-to-date more stringent evaluation form. The system is subdivided into a knee score that rates only the knee joint itself and a functional score that rates the patient's ability to walk and climb stairs. The dual rating system eliminates the problem of declining knee scores associated with patient infirmity.

Performance and Validity of Knee Function Assessment Tools After Total Knee Arthroplasty: A Systematic Review

2025-06-25

Andrei Machado Viegas da Trindade , Helder Rocha da Silva Araújo , Mário Soares Ferreira Júnior +5 more | Trends journal of sciences research

Corrigendum to ‘Influence of Femoral Component Flexion on Outcomes After Primary Total Knee Arthroplasty’ [Arthroplasty Today 33 (2025) 101, 718]

2025-06-24

Praharsha Mulpur , Tarun Jayakumar , Mudidana Prudhvi +3 more | Arthroplasty Today

Total Temporomandibular Joint Replacement: A Case Report Highlighting Complexities in Management

2025-06-24

H. Dhamu , Gurushankar Govindarajan , P. Siroraj +1 more | International Journal of Oral and Maxillofacial Surgery

Total Temporomandibular Joint Replacement: 7-Year-Experience at Royal Free London Hospital

2025-06-24

Deepak Komath , A. Koraitim | International Journal of Oral and Maxillofacial Surgery

“Neutral Satisfied” Patients Should Not Be Dichotomized to “Satisfied” or “Dissatisfied” in Patient-Reported Outcomes After Total Knee Arthroplasty

2025-06-24

Jason M. Cholewa , Mike B. Anderson , Krishna R. Tripuraneni +2 more | Journal of Clinical Medicine

Background: The purpose of this study was to clinically characterize neutrally satisfied patients and compare outcomes between satisfied, dissatisfied, and neutral patients. Methods: This was a secondary analysis from data … Background: The purpose of this study was to clinically characterize neutrally satisfied patients and compare outcomes between satisfied, dissatisfied, and neutral patients. Methods: This was a secondary analysis from data collected in a multicenter longitudinal cohort study comprising total knee arthroplasty (TKA) patients using a digital care management platform. The Knee Society Score (KSS) satisfaction survey was administered at post-operative 90 days, and dissatisfaction was defined as a composite score of less than 20, satisfied as a score equal to or greater than 30, and neutral as a score of 20 up to 29. Patient-reported outcome measures (PROMs) were assessed pre-operatively and at post-operative one, three, six, and twelve months. Results: Approximately 58% of patients were satisfied (n = 1486), 29.4% neutral (n = 747), and 12.2% dissatisfied (n = 311). Neutral and dissatisfied patients were younger and more likely to be female and had lower pre-operative KSS scores compared to satisfied patients, though statistical differences were found between all groups. Pre-operative pain was significantly less in satisfied compared to neutral or dissatisfied patients. Changes in the pre-operative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) displayed significant differences between all groups at all time points, with greater improvements in satisfied versus neutral patients and neutral versus dissatisfied patients. Similarly, satisfied patients experienced significantly greater improvements in pain and KSS scores at post-operative three months, and neutral patients improved more than dissatisfied patients. Conclusions: Neutral patients present with distinctively different clinical outcomes compared to satisfied or dissatisfied patients and should be classified separately as neutral.

The relationship between fibular head height and lower limb alignment deviation and severity after TKA for varus deformity knee osteoarthritis

2025-06-24

Xiaochun Qin , Hengzhi Liu , Yinghao Liu +1 more | PLoS ONE

Purpose To investigate the correlation between fibular head height and the deviation and severity of lower limb alignment after TKA in patients with varus deformity and knee osteoarthritis. Methods Based … Purpose To investigate the correlation between fibular head height and the deviation and severity of lower limb alignment after TKA in patients with varus deformity and knee osteoarthritis. Methods Based on the varus angle (γ = 10°), the sample was divided into two groups: < 10° and ≥10°, The differences in fibular head height between the two groups of patients were analyzed using an independent samples t-test; The Mann-Whitney test was used to analyze the differences in fibular head height between genders. An unordered multinomial logistic regression analysis was conducted to evaluate the effects of age, gender, height, weight, body mass index, and fibular head height on postoperative lower limb alignment; Pearson correlation analysis was used to assess the correlation between fibular head height and varus angle, preoperative HKA angle, and postoperative HKA angle; A Multiple linear regression was performed to evaluate the effects of gender, age, height, weight, body mass index, fibular head height, preoperative HKA angle, and varus angle on the postoperative HKA angle. Results The sample was divided into two groups based on the varus angle: ≥ 10° and <10°. The fibular head height was 8.1825 ± 2.72505 mm in one group and 9.2234 ± 2.68225 mm in the other group (p = 0.028 < 0.05), which was statistically significant; The median fibular head height in females was 8.050 mm, compared to 10.645 mm in males (p < 0.05), which was statistically significant. In the unordered multinomial logistic regression, with postoperative lower limb alignment (varus, valgus, neutral) as the dependent variable, In the unordered multinomial logistic regression with postoperative lower limb alignment as the dependent variable, Height, weight, and body mass index are influencing factors for postoperative lower limb alignment in patients with varus deformity knee osteoarthritis, affecting both varus and valgus alignment, while fibular head height is a significant factor for postoperative varus alignment. In the Pearson correlation analysis, fibular head height was positively correlated with postoperative HKA angle (r = 0.212, p < 0.05). In the multiple linear regression with postoperative HKA angle as the dependent variable, fibular head height and preoperative HKA angle were identified as significant factors influencing the postoperative HKA angle (p < 0.05). Conclusions This study found that in patients with varus deformity knee osteoarthritis, a greater degree of varus was associated with a lower fibular head height. Additionally, the fibular head in female patients was positioned closer to the lateral tibial plateau compared to male patients. In varus deformity knee osteoarthritis, fibular head height is a risk factor for postoperative lower limb varus alignment following total knee arthroplasty (TKA). Patients with a higher-positioned fibular head (lower fibular head height) are more likely to develop postoperative varus malalignment after TKA. Therefore, routine measurement of fibular head height is warranted in clinical practice for patients with varus deformity knee osteoarthritis.

Parallel tunnel ligamentopexy-a novel technique for medial collateral ligament deficiency in primary total knee arthroplasty: a case study

2025-06-24

Natesh Kolusu , Sudheer Kumar Pothu , Vinay K. Singh | International Journal of Research in Orthopaedics

Managing medial collateral ligament (MCL) deficiency in primary total knee arthroplasty (TKA) remains a challenge, often necessitating constrained implants or revision prostheses. We present an innovative technique, Parallel Tunnel Ligamentopexy, … Managing medial collateral ligament (MCL) deficiency in primary total knee arthroplasty (TKA) remains a challenge, often necessitating constrained implants or revision prostheses. We present an innovative technique, Parallel Tunnel Ligamentopexy, which stabilizes the MCL without requiring revision implants, thus preserving native structures and reducing bone loss. A 68-year-old male with severe varus deformity and grade 4 osteoarthritis of the left knee presented with progressive difficulty in ambulation and performing daily activities. Radiographic evaluation confirmed knee subluxation. The patient underwent left-sided TKA. Intraoperatively, a femoral attachment deficiency of the MCL was observed. Parallel tunnel ligamentopexy was performed by whip-stitching the residual MCL, creating two parallel 2-mm tunnels in the lateral distal femur, and securing the MCL using these tunnels. This approach was preferred over semitendinosus augmentation, given its reduced risk of supracondylar femoral fractures and improved suitability for osteoporotic bones. The patient was mobilized on postoperative day 1. The varus deformity was corrected, and knee stability was maintained. At six months follow-up, clinical and radiological evaluations demonstrated no signs of MCL laxity. The patient resumed daily activities independently, highlighting the efficacy of Parallel Tunnel Ligamentopexy in preserving knee stability without requiring a constrained implant. Parallel Tunnel Ligamentopexy is a cost-effective, biologically favorable solution for MCL deficiency in primary TKA. This technique avoids constrained implants, minimizes bone loss, and optimizes functional outcomes, particularly in osteoporotic patients.

Comparison of the patients undergoing total knee arthroplasty with and without drain in terms of functional outcome, hemoglobin drop and infection rate

2025-06-24

K. V. Shamseer , Pradeep Kumar T , G. M. Shameem +1 more | International Journal of Research in Orthopaedics

Background: There is still no consensus about use of post-op drain in TKA. We compared postoperative outcomes of TKA with drain and without drain in terms of hemoglobin drop, functional … Background: There is still no consensus about use of post-op drain in TKA. We compared postoperative outcomes of TKA with drain and without drain in terms of hemoglobin drop, functional outcome and infection. Methods: An observational cohort study was conducted at a tertiary hospital between March 2023, and March 2024. Men and women with primary OA knee and age more than 40 years were included. Patients on antiplatelets, with acute and active infection, revision TKA, malignancy were excluded. Results: 90 patients were included age range 50-80 years. Males to female ratio was 74.4:25.6. Of 90 patients, 45 (50%) received a drain. The drain group had greater hemoglobin drops. There was no statistically significant difference in functional outcome by KOOS score and WOMAC score in both groups. There was no significant difference in occurrence of infection in both groups. Conclusions: This comparative study aimed to assess the outcomes of total knee arthroplasty (TKA) with and without drain insertion, focusing on hemoglobin drop, functional outcomes measured by (KOOS) and (WOMAC) scores, and infection rates. In conclusion, my study supports reconsidering routine drain use in TKA procedures, as omitting drains was associated with a notable reduction in hemoglobin drop without compromising functional outcomes or increasing infection risks. Surgeons should carefully weigh the potential benefits of reduced blood loss against the need for drainage and associated risks, considering individual patient factors and surgical circumstances.

Assessment of the role of manipulation under anaesthesia in knee stiffness following total knee arthroplasty

2025-06-24

Rakesh Rajput , Kunal Kanti Pal , Debangshu Kumar | International Journal of Research in Orthopaedics

About 3-4% of all total knee arthroplasty (TKA) patients develop unfortunately develop stiff knee. There is inadequate understanding of risk factors and a lack of consensus regarding its management protocol. … About 3-4% of all total knee arthroplasty (TKA) patients develop unfortunately develop stiff knee. There is inadequate understanding of risk factors and a lack of consensus regarding its management protocol. This study aims to assess the risk factors and outcome of manipulation under anaesthesia to treat stiff knee following TKA. 18 knees with stiffness following primary TKA were enrolled in this study who underwent manipulation under anesthesia (MUA) between January 2023 and April 2024. Patient demographics, type of surgery (conventional or robotic), contributing factors and knee motion before and after manipulation were assessed from hospital records. Final FFD and arc of motion was recorded in a follow-up clinic. Female patients were significantly more affected than male. Delayed physiotherapy due to comorbidities was associated with stiffness. 72.22% stiff knee patients had conventional surgery while rest had robotic assisted surgery. Manipulation under anaesthesia led to mean 31.11degree improvement in arc of motion immediate post manipulation and 26.39 degree in final follow-up. There was no complication during MUA. MUA is safe, effective and noninvasive and can be considered as a first line treatment for stiff knee following TKA.

Does Achieving the Minimal Clinically Important Difference in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement at 1 Year Postoperative Predict Satisfaction Following Total Knee Arthroplasty?

2025-06-24

George N. Guild , Anita Alex Bradham , Natalie L Gresham +3 more | Arthroplasty Today

Risk of Early Periprosthetic Tibial Fracture After Medial Unicompartmental Knee Arthroplasty with Cemented Versus Cementless Fixation

2025-06-24

S K Risager , Anders Troelsen , Bjarke Viberg +2 more | Journal of Bone and Joint Surgery

The usage of medial unicompartmental knee arthroplasty (mUKA) is increasing, but concerns remain regarding the risk of early periprosthetic tibial fracture (PPTF), particularly following cementless mUKA. The aims of this … The usage of medial unicompartmental knee arthroplasty (mUKA) is increasing, but concerns remain regarding the risk of early periprosthetic tibial fracture (PPTF), particularly following cementless mUKA. The aims of this study were to compare the risk of PPTF between cemented and cementless mUKAs and to analyze risk factors for early PPTF. Using data from the Danish Knee Arthroplasty Register and the Danish National Patient Registry, all mUKAs from 1997 to 2022 were identified and stratified as cemented or cementless mUKAs. Subsequent fractures were identified through the reason for revision, diagnosis codes, and fracture-specific procedure codes. This study included 9,700 cemented mUKAs (mean follow-up of 9 years) and 12,380 cementless mUKAs (mean follow-up of 3 years). The 4-month cumulative proportions of PPTF were 0.2% (95% confidence interval [CI], 0.2% to 0.4%) after cemented mUKA and 0.7% (95% CI, 0.6% to 0.9%) after cementless mUKA. Risk factors for early PPTF (≤4 months) were cementless mUKA (hazard ratio [HR], 2.9; 95% CI, 1.6 to 5.5), female sex (HR, 2.6; 95% CI, 1.6 to 4.2), an age of ≥70 years (HR, 4.0; 2.5 to 6.4), body mass index (BMI) of ≥40 kg/m2 (HR, 2.4; 95% CI, 1.0 to 5.8), and a height of <160 cm (HR, 2.2; 95% CI, 1.3 to 3.6). Female patients ≥70 years of age with a BMI of ≥40 kg/m2 and/or a height of <160 cm represented 3% of all mUKAs. In this group, patients with cementless mUKA had a 4-month cumulative proportion of PPTF of 4.5% (95% CI, 2.9% to 6.9%). The risk of early, surgery-related PPTF was higher after cementless mUKA compared with cemented mUKA. Risk factors for early PPTF include cementless mUKA, female sex, an age of ≥70 years, a BMI of ≥40 kg/m2, and a height of <160 cm. Our data highlight the need for careful, bone-conserving tibial preparation and consideration of cemented tibial fixation for female patients ≥70 years of age with a height of <160 cm and/or a BMI of ≥40 kg/m2. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Clinical efficacy of unicompartmental knee arthroplasty on limb swelling, pain, and functional rehabilitation in knee osteoarthritis patients

2025-06-24

Xiaoliu Zhang , Yongbin Han , Qing-bing Bai +2 more | Journal of Orthopaedic Surgery and Research

Knee osteoarthritis (KOA) is common in middle-aged and elderly individuals, leading to progressive cartilage degeneration, pain, and impaired mobility. To investigate the effect of unicompartmental knee arthroplasty (UKA) on swelling … Knee osteoarthritis (KOA) is common in middle-aged and elderly individuals, leading to progressive cartilage degeneration, pain, and impaired mobility. To investigate the effect of unicompartmental knee arthroplasty (UKA) on swelling and pain of affected limbs and functional rehabilitation in patients with KOA. One hundred KOA patients treated in our hospital from August 2022 to December 2024 were selected and divided into a test group (n = 48) receiving UKA and a matched group (n = 52) receiving total knee arthroplasty (TKA). The ROM, HKA, circumferences 10 cm below and above the midpoint of the patella, HSS score, VAS score, and the European Cancer Treatment Research Organization Quality of Life Scale (EORTC QLQ-C30) score were compared before and after operation. At 6 months postoperatively, the HSS score and ROM were significantly higher in the test group (92.21 ± 7.10 points and 103.30 ± 5.50°) than in the matched group (P < 0.05), while HKA (2.33 ± 0.82°) was significantly lower (P < 0.05). On the 7th postoperative day, circumferences 10 cm below and above the patella were significantly reduced in the test group compared to the matched group (P < 0.05). The VAS score in the test group was lower (1.02 ± 0.34 vs. 3.20 ± 0.92, P < 0.05). The EORTC QLQ-C30 score was significantly higher in the test group (92.10 ± 7.82 vs. 81.18 ± 8.40, P < 0.05), indicating better quality of life. Complication rates did not differ significantly between groups (P > 0.05). Compared with total knee arthroplasty, UKA demonstrates better short-term outcomes in relieving pain, reducing swelling, and promoting functional recovery in patients with knee osteoarthritis. These findings support UKA as an effective option for appropriately selected patients. However, the study is limited by its single-center design and short-term follow-up.

Implantierbare Federsysteme und Kniegelenksdistraktion – Indikation, Technik und Ergebnisse

2025-06-24

Ahmed Ellafi , Romed P. Vieider , Johannes Holz +1 more | Knie Journal

Mini Facelift Approach for Total Joint Replacement surgery- How I do it

2025-06-24

M. Halsnad | International Journal of Oral and Maxillofacial Surgery

Predictors of Knee Osteoarthritis Progression Following Low-Dose Radiation Therapy: a 10-Year Randomized Controlled Trial

2025-06-23

М. В. Макарова , М. Yu. Valkov , Alexander V. Kudryavtsev +1 more | Bulletin of the Russian Military Medical Academy

BACKGROUND: Osteoarthritis is the most prevalent joint disease, characterized by its progressive nature. Risk factors for radiographic progression remain poorly understood and inconsistently reported in the literature. The influence of … BACKGROUND: Osteoarthritis is the most prevalent joint disease, characterized by its progressive nature. Risk factors for radiographic progression remain poorly understood and inconsistently reported in the literature. The influence of low-dose radiation therapy on the baseline predictors of osteoarthritis progression has not been previously investigated. AIM: This study aimed to identify predictors of knee osteoarthritis progression over a 10-year follow-up period following low-dose radiation therapy. METHODS: Predictors of knee osteoarthritis progression over a 10-year follow-up period were identified based on baseline clinical, demographic, and magnetic resonance imaging (MRI) parameters in patients treated with symptom-modifying slow-acting drugs (glucosamine and chondroitin sulfate) in combination with low-dose radiation therapy (experimental group) and in those who received only symptom-modifying slow-acting drugs (control group). This randomized controlled trial initially enrolled 292 patients with clinically confirmed knee osteoarthritis (according to the Altman criteria) and radiographically verified Kellgren–Lawrence stage 0–2. At the time of analysis, 274 patients remained: 139 in the experimental group and 135 in the control group (18 were excluded for various reasons). Radiographic imaging of the knee joint was done in two projections prior to therapy, and a follow-up imaging was done ten years later. An analytical approach for magnetic resonance imaging evaluation was used to analyze baseline MRI data. Progression was classified into two types: any progression (an increase of ≥ 1 radiographic grade) and marked progression (an increase of ≥ 2 grades). Multivariate logistic regression was used in three stages to analyze the determinants of osteoarthritis progression. RESULTS: After 10 years, osteoarthritis progression was noted in 209 patients (76.2%): 86 (31.3%) in the experimental group and 123 (44.9%) in the control group. Marked progression was observed in 3 patients (3%) in the experimental group and in 39 patients (36.1%) in the control group. Overall, the most significant predictors of marked knee osteoarthritis progression were age over 60 years, body mass index over 30 kg/m2, presence of pain (as assessed by the Western Ontario and McMaster Universities Osteoarthritis Index), subchondral plate thinning, treatment type, and initial radiographic stage. CONCLUSION: The presence of synovitis increased the risk of osteoarthritis progression 2.6 times in patients with grade 0–2 disease. Low-dose radiation therapy exhibited a protective effect on disease progression.

Modified Judet quadricepsplasty leads to enhanced knee function in patients with post-traumatic stiffness: a case series of 19 consecutive patients at 10 years mean follow-up

2025-06-23

Alberto Fogacci , Vito Gaetano Rinaldi , Iacopo Sassoli +5 more | The Knee

Impact of Alignment Strategies on Trochlear Morphology Following Robotic-Assisted Total Knee Arthroplasty

2025-06-23

Abinash Ghadei , Aurobinda Das | International Journal of Science and Research (IJSR)

Patient perspectives of using a single home-based exercise when eligible for knee replacement due to severe osteoarthritis: A qualitative interview study

2025-06-23

Birk Mygind Grønfeldt , Rasmus Skov Husted , Michael Skovdal Rathleff +3 more | F1000Research

<ns3:p>Background Exercise therapy is recommended for patients with severe osteoarthritis (OA) who are candidates for total knee arthroplasty (TKA). How this patient group perceives and experiences a simplified approach to … <ns3:p>Background Exercise therapy is recommended for patients with severe osteoarthritis (OA) who are candidates for total knee arthroplasty (TKA). How this patient group perceives and experiences a simplified approach to pre-surgical exercise (non-surgical care) with a systematic re-assessment of the need for surgery (surgical care) after exercise has not been well explored. The aim of this study was to explore perceived (before) and experienced (after) facilitators and barriers (determinants) towards 12 weeks of home-based exercise therapy using a simple 1-exercise program in patients with severe knee OA who were eligible for TKA. Methods A qualitative design was employed from 2018 to 2019, involving 10 patients recruited through purposive sampling for semi-structured interviews conducted before and after a 12-week exercise therapy program. The collected data were categorized through inductive content analysis. Results Through abstraction, the data material was condensed into three interrelated categories: 1) Less-is-more unless it is too “less”, 2) Feedback-loops to motivation and adherence, and 3) Comprehensive re-assessment and universal healthcare-support empowers patient-centered care; and six sub-categories. These three categories reflect the complex interplay of barriers and facilitators that impacts the success of home-based exercise programs, highlighting the importance of personalized patient-centered care in this context. Conclusion The determinants of exercise adherence differed among participants, with some determinants serving as facilitators for some but barriers to others. These differences in perceptions and experiences suggest that adherence to the 1-exercise program could be enhanced by accommodating individual preferences. The participants had positive perceptions and experiences of the coordination of non-surgical and surgical care. Knowing that their need for surgery was systematically re-assessed after non-surgical care provided a sense of security and safety. QUADX-1 trial registration identifier: NCT02931058.</ns3:p>

What is the Association Between Nontobacco Nicotine Dependence and Postoperative Complications in Total Hip Arthroplasty? A Large Propensity-Matched Cohort Study

2025-06-23

Logan Good , Collin W. Blackburn , Jeremy M. Adelstein +4 more | Arthroplasty Today

Proximal tibia bone mineral density correlates more closely with hip density in men with knee osteoarthritis

2025-06-22

Junya Itou , Ayano Kuwasawa , Kotaro Nihei +1 more | Journal of Joint Surgery and Research

Investigating the Influence of Oxford Unicompartmental Knee Arthroplasty Keel on Sagittal Plane Stresses: A Finite Element Analysis

2025-06-21

Takaaki Imada , Mitsuru Hanada , Kohei MURASE +1 more | Cureus

Knee biomechanics in the deep squatting state after unicompartmental knee arthroplasty versus high tibial osteotomy: A 3-dimensional finite element study

2025-06-20

Ziheng Zhang , Baogang Wei , Yongxiang Wang +5 more | Research Square (Research Square)

<title>Abstract</title> <bold>Objective: </bold>Knee osteoarthritis (KOA) often necessitates surgical interventions like unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO), but their biomechanical responses during deep squatting. This three-dimensional finite element … <title>Abstract</title> <bold>Objective: </bold>Knee osteoarthritis (KOA) often necessitates surgical interventions like unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO), but their biomechanical responses during deep squatting. This three-dimensional finite element analysis (FEA) aimed to compare the mechanical behaviors of knees treated with UKA and open-wedge HTO (OW-HTO) during 120° squatting, providing insights for postoperative mechanical evaluations and patient management. <bold>Methods: </bold>Laser 3D scanning/MRI/CT data were used to construct 3D finite element models of the healthy knee, KOA knee, UKA knee and OW-HTO knee in 120° flexion conditions, and mechanical loads in the deep squat condition were applied to assess the stresses on the meniscus, cartilage, bone, ligaments, and implants under deep squat conditions. <bold>Results: </bold>The results showed that in the normal knee during deep squatting, the menisci had a symmetrical stress distribution. In KOA knees, there were significant stress increases and concentrations in the menisci, cartilage, and subchondral bone. UKA effectively reduced lateral meniscus stress, lateral femoral cartilage stress, and ligament stresses, restoring a more normal mechanical environment. In contrast, OW-HTO knees still had high meniscal, cartilage, and bone stresses, similar to the KOA state. The maximum stresses in the implants of both UKA and OW-HTO approached the fatigue limits of their materials, and high stresses at the bone-implant interfaces might lead to complications such as aseptic loosening. <bold>Conclusion: </bold>This study tentatively suggests that UKA is suitable for patients with high-frequency flexion demands, but there is a risk of aseptic loosening and fragmentation of the prosthesis, whereas HTO is suitable for young, well-boned patients with predominantly extra-articular deformities. Regardless of the procedure, prolonged knee flexion at large angles should be avoided to improve the prognosis.

Pain Mechanisms and Psychosocial Variables in Patients With Chronic Pain After Total Knee Arthroplasty: Secondary Analysis From a Randomised Controlled Trial

2025-06-20

Jesper Bie Larsen , Søren Thorgaard Skou , Mogens Berg Laursen +3 more | European Journal of Pain

ABSTRACT Introduction Chronic pain after total knee arthroplasty (TKA) affects approx. 15%–20% of patients undergoing surgery. It is largely unexplained why some patients develop chronic pain after TKA, but several … ABSTRACT Introduction Chronic pain after total knee arthroplasty (TKA) affects approx. 15%–20% of patients undergoing surgery. It is largely unexplained why some patients develop chronic pain after TKA, but several factors, e.g., central pain mechanisms and psychosocial factors, have been suggested. This study assessed central pain mechanisms and psychosocial factors in patients with chronic pain after TKA, receiving neuromuscular exercise and pain neuroscience education (PNE) as treatment. Methods This is the secondary analysis of a randomised controlled trial. Sixty‐nine patients with chronic pain at least one‐year post‐TKA, experiencing an average daily pain intensity of ≥ 4 on a numerical rating scale, were recruited. Participants were randomised to receive either 12 weeks of group‐based neuromuscular exercise and two sessions of group‐based PNE or two sessions of group‐based PNE alone. Outcomes measured included temporal summation of pain (TSP) and pressure pain thresholds at the index knee and forearm, conditioned pain modulation, PainDETECT scores, fear‐avoidance beliefs and pain catastrophizing. Results The study found a significant between‐group difference in change from baseline to 12 months for TSP at the index knee, favouring the neuromuscular exercise and PNE group (−1.45, 95% CI −2.48 to −0.42, p = 0.006). This indicates less facilitated TSP in the neuromuscular exercise and PNE group after intervention. No significant between‐group differences were observed for the remaining outcomes. Conclusion The results indicated that neuromuscular exercise combined with PNE significantly reduced TSP at the index knee, suggesting a reduction in central pain amplification. The clinical importance of this exploratory finding should be further investigated. Significance Statement This trial showed that neuromuscular exercises in combination with pain neuroscience education resulted on decreased pain sensitization, measured as temporal summation of pain, in patients with chronic pain after total knee arthroplasty. The clinical relevance of central amplification of pain remains unclear but point at improved pain processing, i.e., reduced pain amplification.

From Injury to Full Recovery: Monitoring Patient Progress Through Advanced Sensor and Motion Capture Technology

2025-06-20

Annchristin Andres , Michael Roland , Marcel Orth +1 more | Sensors

Background: Advanced sensor insoles and motion capture technology can significantly enhance the monitoring of rehabilitation progress for patients with distal tibial fractures. This study leverages the potential of these innovative … Background: Advanced sensor insoles and motion capture technology can significantly enhance the monitoring of rehabilitation progress for patients with distal tibial fractures. This study leverages the potential of these innovative tools to provide a more comprehensive assessment of a patient’s gait and weight-bearing capacity following surgical intervention, thereby offering the possibility of improved patient outcomes. Methods: A patient who underwent distal medial tibial plating surgery in August 2023 and subsequently required revision surgery due to implant failure, involving plate removal and the insertion of an intramedullary nail in December 2023, was meticulously monitored over a 12-week period. Initial assessments in November 2023 revealed pain upon full weight-bearing without crutches. Following the revision, precise weekly measurements were taken, starting two days after surgery, which instilled confidence in accurately tracking the patient’s progress from initial crutch-assisted walking to full recovery. The monitoring tools included insoles, hand pads for force absorption of the crutches, and a motion capture system. The patient was accompanied throughout all steps of his daily life. Objectives: The study aimed to evaluate the hypothesis that the approximation and formation of a healthy gait curve are decisive tools for monitoring healing. Specifically, it investigated whether cadence, imbalance factors, and ground reaction forces could be significant indicators of healing status and potential disorders. Results: The gait parameters, cadence, factor of imbalance ground reaction forces, and the temporal progression of kinematic parameters significantly correlate with the patient’s recovery trajectory. These metrics enable the early identification of deviations from expected healing patterns, facilitating timely interventions and underscoring the transformative potential of these technologies in patient care. Conclusions: Integrating sensor insoles and motion capture technology offers a promising approach for monitoring the recovery process in patients with distal tibial fractures. This method provides valuable insights into the patient’s healing status, potentially predicting and addressing healing disorders more effectively. Future studies are recommended to validate these findings in a larger cohort and explore the potential integration of these technologies into clinical practice.

A Low-Cost, Reusable, Three-Dimensional Printed Ultrasound Phantom for Simulation of Knee Arthrocentesis

2025-06-19

Susan D. Meierhans Ruf , Sara Baker | Western Journal of Emergency Medicine

Measurement of Value in Uncomplicated Total Knee Arthroplasty

2025-06-19

Rebekah M. Kleinsmith , Haley D. Puckett , Nicholas F. Banfield +5 more | Journal of Bone and Joint Surgery

Background: Patient-level value analysis (PLVA) has been applied to several orthopaedic procedures but has not yet been utilized to assess the value of total knee arthroplasty (TKA). The purpose of … Background: Patient-level value analysis (PLVA) has been applied to several orthopaedic procedures but has not yet been utilized to assess the value of total knee arthroplasty (TKA). The purpose of this study was to evaluate the 1-year episode of care for TKA with use of PLVA to identify characteristics that influence value at both the patient and surgeon level. Methods: The institutional patient-reported outcome (PRO) database was queried for all patients who underwent TKA from 2020 to 2022. Patients were excluded on the basis of an index revision procedure, a pathology other than primary osteoarthritis, unicompartmental knee arthroplasty, robotic-assisted TKA, incomplete baseline or 1-year PROs, concomitant procedures (i.e., bilateral TKA or hardware removal), complications requiring readmission or reoperation, TKA without patellar resurfacing, the use of constrained implants, incomplete cost information, or other hip or knee arthroplasty procedure during the 1-year episode of care. PROs of interest included preoperative and 1-year postoperative Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) scores. Episode-of-care costs were calculated using time-driven activity-based costing. The 1-year value quotient (V KOOS ) was calculated for each patient as the ratio of the 1-year change in KOOS-JR score to the total episode-of-care cost. Results: A total of 684 patients (62% female; mean age, 68 ± 8 years) met the inclusion criteria. The mean KOOS-JR score significantly increased from baseline (53 ± 11) to 1 year (79 ± 14; p < 0.001), with a mean improvement of 26 ± 16. The mean total episode-of-care cost was $9,563 ± $2,370. There was no significant correlation between episode-of-care costs and the change in KOOS-JR score (r = 0.02; p = 0.581). Surgery performed at an ambulatory surgery center (p < 0.001) and as an outpatient procedure (p = 0.036) were predictive of lower costs. Patient-specific instrumentation (p < 0.001) and a tibial stem extension (p < 0.001) were predictive of higher costs. Older age (p = 0.023) and male sex (p = 0.007) were predictive of less improvement in KOOS-JR scores from baseline to 1 year. Conclusions: Our study identified patient and surgical characteristics that drive costs and PROs in TKA. PLVA can be used to identify “bright spots” in orthopaedic procedures to optimize care delivery. Level of Evidence: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Risk of Revision and Patient-Reported Outcomes Following Primary UKR Performed Using Computer Navigation or Patient-Specific Instrumentation

2025-06-19

Muhamed M Farhan-Alanie , Daniel Gallacher , Patrick Craig +7 more | Journal of Bone and Joint Surgery

Background: Computer navigation and patient-specific instrumentation in unicompartmental knee replacement (UKR) improve the precision of implant positioning, but there is limited information regarding their impact on implant survival and patient-reported … Background: Computer navigation and patient-specific instrumentation in unicompartmental knee replacement (UKR) improve the precision of implant positioning, but there is limited information regarding their impact on implant survival and patient-reported outcomes. We aimed to compare postoperative implant survival, Oxford Knee Score (OKS) values, health-related quality of life (measured using the EuroQol-5 Dimension 3-level version [EQ-5D-3L]), and intraoperative complications between UKRs performed using computer navigation or patient-specific instrumentation versus conventional instrumentation. Methods: Using National Joint Registry data, an observational study of patients who underwent primary UKR for osteoarthritis between 2003 and 2020 was performed. The primary analyses focused on all-cause revision, and the secondary analyses focused on differences in the OKS and EQ-5D-3L at 6 to 12 months postoperatively. To account for several covariates, weights based on propensity scores were generated. Cox proportional hazards models and generalized linear models were used to assess for differences in revision risk, and OKS and EQ-5D-3L change scores, respectively, between patient groups. Sensitivity analyses accounting for body mass index were performed. Effective sample sizes (ESSs) were computed, representing the statistical power comparable with that of an unweighted sample. Results: Compared with conventional instrumentation, the hazard ratio (HR) for all-cause revision was 1.126 (95% confidence interval [CI], 0.909 to 1.395; p = 0.277; ESS, 4,273) with computer navigation and 0.805 (95% CI, 0.442 to 1.467; p = 0.478; ESS, 1,199) with patient-specific instrumentation. No difference was found in the change in OKS between the groups (−1.287; 95% CI, −2.851 to 0.278; p = 0.107; ESS, 470), although improvement in the EQ-5D-3L scores was relatively lower for computer-navigated UKR compared with conventional instrumentation (−0.049, 95% CI, −0.093 to −0.005; p = 0.028; ESS, 455). However, sensitivity analyses demonstrated that computer navigation was associated with an increased risk of all-cause revision (HR, 1.446; 95% CI, 1.102 to 1.898; p = 0.008; ESS, 3,011) and relatively smaller improvements in the OKS (−2.845; 95% CI, −5.006 to −0.684; p = 0.010; ESS, 272) and EQ-5D-3L scores (−0.087; 95% CI, −0.145 to −0.030; p = 0.003; ESS, 286). There were no differences in intraoperative complications (p = 0.073). Conclusions: This study found no clinically meaningful differences in patient-reported outcomes following computer-navigated UKR. Although likely underpowered, the primary analyses showed no difference in implant survival. While a sensitivity analysis suggested that computer navigation could worsen implant survival, this analysis had a smaller sample size. These findings highlight potential signals that warrant further investigation. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Augmented reality in total knee arthroplasty: Balancing precision, promise, and challenges in surgical innovation

2025-06-18

Miao He , Antonia RuJia Sun , Xiaoxin Wu +2 more | World Journal of Orthopedics

Augmented reality (AR) is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information. With the rapid development … Augmented reality (AR) is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information. With the rapid development of digital technology, AR has been increasingly adopted in orthopedic surgeries across the globe, especially in total knee arthroplasty procedures which demand high precision. By overlaying digital information onto the surgeon's field of view, AR systems enhance precision, improve alignment accuracy, and reduce the risk of complications associated with malalignment. Some concerns have been raised despite accuracy, including the learning curve, long-term outcomes, and technical limitations. Furthermore, it is essential for health practitioners to gain trust in the utilisation of AR.

The Novel Osteopore® Wedge in Medial Opening Wedge High Tibial Osteotomy: A Technical Note

2025-06-18

Walter-Soon-Yaw Wong , Hun Yi Koh , KH Lee +1 more | Cureus

A network meta-analysis evaluating valgization high tibial osteotomy cutting guides: improving surgical precision through navigation and PSI

2025-06-18

Fanny Delaigue , Hassan M. Wardani , Jules Descamps +3 more | Knee Surgery and Related Research

Abstract Background A total of three techniques are used to guide tibial cuts in high tibial osteotomy (HTO): the conventional method, navigation systems, and patient-specific instrumentation (PSI). This network meta-analysis … Abstract Background A total of three techniques are used to guide tibial cuts in high tibial osteotomy (HTO): the conventional method, navigation systems, and patient-specific instrumentation (PSI). This network meta-analysis sought to assess whether any of these methods achieve better radiological outcomes, greater functional gains, or a reduced rate of complications. Design We included all controlled and noncontrolled trials comparing at least two of the surgical techniques. Primary outcomes were rates of medial proximal tibial angle (MPTA) and posterior tibial slope (PTS) outliers. Secondary outcomes included the rate of hip-knee-ankle (HKA) angle outliers, joint range of motion, postoperative clinical scores, and complication rates. Results The analysis included 24 studies with 1817 patients and 1951 operated knees. PSI did not reduce the rate of MPTA outliers compared with conventional techniques (95% credible intervals, CI [0.09–56.84]) or navigation (95% CI [0.03–25.62]), and navigation did not reduce the rate compared with conventional methods (95% CI [0.84–9.17]). Navigation reduced the rate of PTS outliers compared with conventional techniques (95% CI [1.93–1.56.10 4 ]). No study investigating PTS outliers with PSI was identified or included. Both navigation and PSI reduced the rate of HKA angle outliers (95% CI [1.33–3.16] and [1.15–42.61], respectively). Aside from the rate of HKA angle outliers and the Lysholm score between 1 and 2 years postoperatively, no differences were observed for other outcomes. Conclusions Navigation and PSI allow for more precise achievement of the PTS and HKA angle values set by the surgeons but do not affect long-term knee function or complication rates. However, the cost and limited availability of these techniques should be considered, especially in the absence of additional functional benefits.

An Exercise Therapists’ Guide to Neuromuscular Exercise for People With Knee or Hip Osteoarthritis

2025-06-18

Ewa M. Roos , Sarah Kroman , Eva Ageberg | Journal of Orthopaedic and Sports Physical Therapy

BACKGROUND: Neuromuscular exercise is commonly used in knee injury prevention programs and in rehabilitation following knee injury but can also be used to address functional impairments is middle-aged and older … BACKGROUND: Neuromuscular exercise is commonly used in knee injury prevention programs and in rehabilitation following knee injury but can also be used to address functional impairments is middle-aged and older individuals with knee and hip osteoarthritis (OA). CLINICAL QUESTION: What is neuromuscular exercise for OA? Why should clinicians use it? And how? Nine themes of common questions from exercise therapists new to neuromuscular exercise are addressed. KEY RESULTS: Neuromuscular exercise aims to improve sensorimotor control and obtain functional joint stabilization. Exercises are mainly performed in weightbearing positions, involving multiple joints and muscle groups, to resemble activities of daily life using commonly available and inexpensive equipment. Neuromuscular exercise should be adapted to the individual and is preferably delivered under the supervision of a trained and experienced exercise therapist. Neuromuscular exercise is safe in terms of serious adverse events and pain flares, and associated with a positive change in pain, function and quality of life like other types of exercise for OA. CLINICAL APPLICATION: Neuromuscular exercise can be used as an alternative to, or in addition to, aerobic exercise and strength training in individuals with hip and knee OA.

Patients with Prior Colectomy Who Undergo Primary Total Knee Arthroplasty May Have Higher Risks of Reoperation

2025-06-18

David Mai , Bruce B Zhang , Md. Ashraf Uddin +3 more | The Journal of Knee Surgery

Background: There is a lack of consensus on the effects of prior colectomy on health outcomes, particularly those that involve orthopaedic procedures. We sought to characterize the association between prior … Background: There is a lack of consensus on the effects of prior colectomy on health outcomes, particularly those that involve orthopaedic procedures. We sought to characterize the association between prior colectomy and outcomes following primary total knee arthroplasty (TKA). We hypothesized that compared to patients without, those with prior colectomy who undergo primary TKA have higher odds of same-admission postoperative complication and reoperation. Methods: We performed a retrospective cohort study using the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample (NIS) database to identify patients who underwent primary TKA. Patients with prior colectomy were propensity-score matched to patients without prior colectomy at a ratio of 1:50 by age, gender, race/ethnicity, Charlson-Deyo Comorbidity index, history of osteoporosis, history of smoking, insurance status, hospital size, hospital location and teaching status, and hospital ownership. Adjusted logistic regression analyses were used to determine the relationship between colectomy and the same-admission outcomes, postoperative complication, and reoperation. Results: Overall, 894,911 patients underwent primary TKA during the study period. After PSM, 2,625 (1.96%) patients were assigned to the cohort with prior colectomy, while 131,250 (98.04%) patients were assigned to the cohort without prior colectomy. Compared to patients without prior colectomy, those with prior colectomy who underwent primary TKA had no significantly higher odds of same-admission postoperative complication; however, they had 2.12 times higher odds (95% confidence interval 1.04 to 4.31; p=0.038) of same-admission reoperation. Conclusions: Compared to patients with no prior colectomy, those with prior colectomy who underwent primary TKA had no higher odds of postoperative complication but had over twice the odds of reoperation during the same admission for surgery. Further studies examining the role of the colon and microbiota may help to better understand outcomes associated with history of prior colectomy in the setting of primary TKA.

Revision of unicompartmental knee arthroplasty results in outcomes similar to those of primary total knee arthroplasty and superior to those of revision total knee arthroplasty

2025-06-18

Chiara Ursino , Nicola Ursino , Amit Meena +2 more | The Journal of Knee Surgery

Purpose: The main aim of this study was to analyse whether revision of medial unicompartmental knee arthroplasty (rUKA) has better clinical outcomes than revision of primary total knee arthroplasty (TKA) … Purpose: The main aim of this study was to analyse whether revision of medial unicompartmental knee arthroplasty (rUKA) has better clinical outcomes than revision of primary total knee arthroplasty (TKA) or revision of total knee arthroplasty (rTKA). Methods: The study reference group (rUKA) was identified and matched with two control groups: primary TKA and revision rTKA. Patients were matched according to five preoperative factors: follow-up (minimum of 60 months), age, sex, body mass index (BMI), and operation side at a ratio of 1:1:1. The Knee Society score (KSS) and the forgotten joint score (FJS) were used for the clinical assessment. Pain was measured via the visual analogue scale (VAS) for pain. The following complications were also recorded: postoperative anaemia, infection and revision surgeries. Results: Forty-five patients were included in each group. The three groups did not differ in terms of age, sex, operation side, BMI, or follow-up (p > 0.05). At the final follow-up, the rTKA group had lower values than did the rUKA and TKA groups in terms of the KSS (rUKA=95; TKA=100; rTKA=87.5) and FJS (rUKA=95; TKA=100; rTKA=90) (p<0.05). For the KSS, no difference was found between the rUKA and TKA groups (p>0.05). Regarding pain, the rTKA group had a lower value than the TKA group did (p=0.001; rUKA=3; TKA=2; rTKA=3), whereas in terms of FJS, there was also a difference between the rUKA and TKA groups (p=0.038). The rates of complications in terms of postoperative anaemia and aseptic loosening were similar among the three groups (p > 0.05). Conclusions: Revised UKA has comparable clinical and patient-reported outcomes to those of primary TKA and better outcomes than those of revised TKA, whereas medical complications of revised UKA are similar to those of primary TKA. These findings serve to inform discussions with patients requiring revision of a UKA regarding clinical outcomes and complications following this procedure.

AI-assisted Preoperative Planning Combined with Robotic-assisted Total Knee Arthroplasty vs. Conventional Surgery: A Retrospective Controlled Study

2025-06-18

Yingdong Hu , Yuyu Fan , Zejia Sun +1 more | Research Square (Research Square)

<title>Abstract</title> <bold>Objective:</bold> To compare perioperative outcomes and early functional recovery between AI-robotic and conventional total knee arthroplasty (TKA). <bold>Methods: </bold>We retrospectively analyzed data from 88 patients who underwent primary unilateral … <title>Abstract</title> <bold>Objective:</bold> To compare perioperative outcomes and early functional recovery between AI-robotic and conventional total knee arthroplasty (TKA). <bold>Methods: </bold>We retrospectively analyzed data from 88 patients who underwent primary unilateral TKA for knee osteoarthritis between April 2024 and December 2024. The AI-robotic group (n=44) received AI-assisted preoperative planning and robot-assisted TKA, while the traditional group (n=44) underwent conventional 2D templating and manual TKA. Key metrics included preoperative prosthesis prediction accuracy, intraoperative and postoperative blood loss, osteotomy time, postoperative radiographic alignment, and functional scores. <bold>Results: </bold>The AI-robotic group showed significantly higher prosthesis prediction accuracy (femoral: 79.5% vs. 52.3%, <italic>P</italic>=0.023; tibial: 84.1% vs. 61.4%, <italic>P</italic>=0.042), shorter osteotomy time (15.24±4.71 vs. 18.43±4.76 minutes, <italic>P</italic>=0.002), reduced intraoperative blood loss (197.41±78.41 vs. 234.35±74.53 mL, <italic>P</italic>=0.026), and lower 72-hour total blood loss (1022.96±226.14 vs. 1118.71±193.30 mL, <italic>P</italic>=0.036). Postoperative lateral femoral component (LFC) angles were superior in the AI-robotic group (5.87±2.18° vs. 6.91±2.10°, <italic>P</italic>=0.025). At 6 weeks, the AI-robotic group had better VAS pain scores (2.27±1.12 vs. 2.84±1.22, <italic>P</italic>=0.029) and HSS scores (61.57±4.40 vs. 59.59±3.80, <italic>P</italic>=0.027). <bold>Conclusion: </bold>AI-assisted preoperative planning with robotic TKA improves prosthesis sizing accuracy, reduces perioperative blood loss and 72h total blood loss, and enhances early functional outcomes compared to conventional methods. These findings support AI-robotic integration as a precision solution for TKA, particularly in complex cases.

Robotic-Assisted Conversion of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty: A Surgical Technique Review

2025-06-17

Harold I. Salmons , Andrew D. Pumford , Nicholas A. Bedard +2 more | Arthroplasty Today

The effect of lateral hinge fracture with hinge hole and protective K-wire for medial opening-wedge high tibial osteotomy by compression testing and finite element analysis

2025-06-17

Yi‐Sheng Chan , Alvin Chao-Yu Chen , Chun‐Chieh Chen +2 more | Journal of Orthopaedic Surgery and Research

Medial open-wedge high tibial osteotomy (MOWHTO) is effective for treating medial-compartment knee osteoarthritis but carries a risk of lateral hinge fractures (LHF), compromising stability and outcomes. Hinge holes and protective … Medial open-wedge high tibial osteotomy (MOWHTO) is effective for treating medial-compartment knee osteoarthritis but carries a risk of lateral hinge fractures (LHF), compromising stability and outcomes. Hinge holes and protective K-wires reduce LHF by lowering stress and enhancing lateral support. However, their combined effect has not been evaluated. This study investigates whether using both techniques together can more effectively reduce lateral cortical bone stress and prevent LHF during MOWHTO. This study combined finite element analysis (FEA) and in-vitro compression testing to evaluate stress distribution and fracture behavior during MOWHTO. Three-dimensional models reconstructed from osteoarthritic CT images were used, with consistent definitions of wedge, hinge, and protective K-wire placement. Compression testing models were 3D-printed for cost efficiency and repeatability. FEA simulated stress during wedge opening, while compression testing measured load-gap curves, fracture load, and fracture patterns. Hinge holes alone reduced hinge stress by 14.4% and maximum loading by 34%. Protective K-wires improved maximum load capacity by 48-60%, increasing lateral hinge resistance. However, K-wires alone raised the risk of Type III fractures, especially in corrections > 10 mm. The combined use of hinge holes and K-wires reduced lateral cortical stress by 22% and significantly lowered the incidence of Type III LHF to 11.1%, compared with 16.7% for hinge holes alone and 77.8% for K-wires alone. Combining hinge holes and protective K-wires provides superior mechanical support and reduces the risk of Type II and III lateral hinge fractures, offering a promising strategy to improve MOWHTO outcomes.

Value in Knee Arthroplasty: A Comparative Patient-Level Value Analysis of Cost and Cost-Effectiveness for Unicompartmental Knee Arthroplasty and Primary Total Knee Arthroplasty in the United States

2025-06-17

Nicholas Sauder , Michael Booth , Perry L Lim +2 more | Journal of the American Academy of Orthopaedic Surgeons

Background: Value-based health care emphasizes streamlining costs and improving outcomes. We used time-driven activity-based costing and patient-reported outcome measures to perform a patient-level value analysis. We compared the cost and … Background: Value-based health care emphasizes streamlining costs and improving outcomes. We used time-driven activity-based costing and patient-reported outcome measures to perform a patient-level value analysis. We compared the cost and cost-effectiveness of unicompartmental knee arthroplasty (UKA) and primary total knee arthroplasty (TKA). Methods: We sourced cases from a prospectively maintained, multi-institutional arthroplasty registry. A total of 422 UKAs were matched 1:3 to 1,266 primary TKAs, on baseline characteristics. Revision, conversion, and robotic cases were excluded. Time-driven activity-based costing was used to calculate total procedure facility costs. Costs were converted from United States dollars to cost units (CUs) by dividing all costs by an undisclosed constant. Knee Osteoarthritis Outcome Score Physical Function Short-Form (KOOS-PS) scores were collected preoperatively and 1 year postoperatively. Value KOOS-PS was calculated for each patient. Value KOOS-PS was defined as the quotient of 1-year improvement in KOOS-PS and total procedure facility cost. Value KOOS-PS was converted to a scale with a maximum of 100. Results: UKA had higher mean Value KOOS-PS than primary TKA (UKA: 18.3 vs. primary TKA: 15.8; P = 0.009). KOOS-PS scores were not the primary driver of differences in value, as the procedures did not differ significantly in 1-year change in KOOS-PS (UKA: +16.5 vs. primary TKA: +16.1; P = 0.641). Instead, substantial differences in costs drove the observed differences in value. Primary TKA facility costs were 20.3% more expensive than UKA (811 CUs vs. 674 CUs; P < 0.001). When only outpatient procedures were considered, outpatient primary TKA facility cost was 8.3% more expensive than outpatient UKA (720 CUs vs. 665 CUs; P < 0.001). Conclusion: UKA offers higher value that primary TKA, driven primarily by lower cost structure rather than differences in patient-reported outcomes. To maximize health care value, patients with single compartment disease should be treated with UKA, as they will have similar outcomes with reduced cost, as compared with primary TKA. Outpatient surgery can considerably—but not entirely—reduce the facility cost discrepancy between primary TKA and UKA.

CORR Synthesis: What Is the Role of Robotic-assisted Technology in Knee Arthroplasty?

2025-06-17

Mark Richards , Randall E. Marcus | Clinical Orthopaedics and Related Research

Fatores de risco de ilc após artroplastia do joelho: scoping review

2025-06-17

Luciana Forte , Sónia Novais | Revista de Investigação & Inovação em Saúde

Enquadramento: os fatores de risco de infeção do local cirúrgico (ILC) após Artroplastia do Joelho têm impacto na segurança e qualidade de vida da pessoa em situação perioperatória e no … Enquadramento: os fatores de risco de infeção do local cirúrgico (ILC) após Artroplastia do Joelho têm impacto na segurança e qualidade de vida da pessoa em situação perioperatória e no aumento de custos para as unidades de saúde. Verifica-se que este tema é maioritariamente estudado conjuntamente com os fatores de risco de ILC após artroplastia da anca. É imprescindível abordá-lo de forma isolada, para criar instrumentos de identificação de risco que permitam identificar as pessoas mais vulneráveis às infeções do local cirúrgico nesta cirurgia. Objetivos: mapear a evidência sobre os fatores de risco de ILC nas pessoas submetidas a Artoplastia do Joelho. Metodologia: revisão scoping orientada pela metodologia do Joanna Briggs Institute. Aplicado limite temporal 2018 a 2024, a partir de uma revisão identificada sobre essa temática. Resultados: foram incluídos 27 artigos na revisão, e identificados fatores de risco modificáveis e não modificáveis no período perioperatório. As competências avançadas do enfermeiro especialista para minimizar/eliminar o risco da ILC são fundamentais principalmente nos fatores de risco modificáveis. Conclusão: os fatores de risco estão presentes no período perioperatório, sendo alguns intrínsecos à própria pessoa e outros decorrentes das práticas dos próprios profissionais de saúde colocando em risco a segurança cirúrgica.

A new strategy for the selection of patients with hip osteoarthritis to avoid inappropriate total hip replacement based on imaging and clinical characteristics

2025-06-17

Kazuo Hayashi , Yves Henrotin , Toshiharu Tsunoda +1 more | Current Medical Research and Opinion

Total hip replacement (THR) is extremely common and generally results in excellent patient satisfaction. However, 36% of patients with hip osteoarthritis who undergo THR reportedly experience long-term postoperative pain. Furthermore, … Total hip replacement (THR) is extremely common and generally results in excellent patient satisfaction. However, 36% of patients with hip osteoarthritis who undergo THR reportedly experience long-term postoperative pain. Furthermore, only 20% of patients attempt exercise before surgery, despite the recommendation for 3 to 6 months of conservative treatment before surgery. Despite these facts, the number of THRs performed annually is currently increasing. To propose and discuss a new strategy based on clinical and radiological characteristics for selecting candidates for Pericapsular Soft Tissue and Pelvic Realignment (PSTP-R) therapies to avoid inappropriate THR. The PubMed electronic database was searched to identify publications reporting data from clinical studies on the diagnosis and treatment of osteoarthritis in humans published between 1995 and 2023. This narrative review summarizes the findings of these previous studies. A previous study reported that PSTP-R therapy comprising pelvic realignment, muscle strengthening, and stretching was effective for patients with a Harris Hip Score (HHS) below 60 points, even those with complete loss of cartilage on radiography. A post hoc study showed that the risk of discontinuation of PSTP-R therapy increased with increasing frequency of pain in the buttock at baseline. Cartilage loss was not a risk factor for withdrawal from PSTP-R therapy. Patients should be better informed regarding the benefits of THR and the possibility of persistent postoperative pain. If the patient has complete loss of cartilage on radiography but no buttock pain, PSTP-R therapy might improve their pain and avoid THR.

Effectiveness Of Muscle Strengthening Interventions In Patient With Grade 4 Osteoarthritis Following Total Knee Replacement Surgery : A Systematic Review And Meta-Analysis

2025-06-17

Putu Krisna Maharani Purnama Dewi , Made Suariastawa Putra , Indra Prasetya | Indonesian Journal of Physical Medicine and Rehabilitation

ABSTRACT Background: Osteoarthritis (OA) is the most prevalent kind of arthritis affects joints and one of the main causes of disability. Patients diagnosed with advanced OA in their knees typically … ABSTRACT Background: Osteoarthritis (OA) is the most prevalent kind of arthritis affects joints and one of the main causes of disability. Patients diagnosed with advanced OA in their knees typically undergo total knee arthroplasty (TKA). Strength training is tool for reducing muscle weakness, enhancing ability in functional ambulation after TKA, according to many systematic reviews and meta-analyses. Objective: The aim is to investigate the importance of muscle-strengthening in individuals who had TKA surgery. Methods: A systematic literature search of three online databases was performed for randomized controlled trials (RCT) evaluating effects of strength training on functional ambulation by six-minute walk test (6MWT)/ timed-up and go (TUG) test after TKA surgery. Data were pooled by random-effect meta-analyses and presented as standard mean difference (SMD). PRISMA criteria and Cochrane risk-of-bias approach was applied to each research determine the evidence quality. Results: Eleven RCT were identified. A meta-analysis indicated that post operative 6MWT showed no significant difference between standard therapy and muscle-strengthening, but demonstrated that muscle-strengthening produced better outcomes in TUG test than standard therapy. Conclusion: Based on existing studies, moderate-certainty evidence suggests that strength training could decrease time to complete TUG after TKA. Keywords: Muscle strengthening, Osteoarthritis, Total Knee Replacement, Post operative, Effectiveness. ABSTRAK Latar Belakang: Osteoartritis (OA) adalah jenis artritis yang paling umum yang memengaruhi sendi dan merupakan salah satu penyebab utama kecacatan. Pasien yang didiagnosis dengan OA lanjut pada lutut mereka menjalani artroplasti total lutut (TKA). Latihan kekuatan merupakan alat untuk mengurangi kelemahan otot, meningkatkan kemampuan atletik dalam ambulasi fungsional setelah TKA, menurut tinjauan sistematis dan meta-analisis. Tujuan: Tujuan literature ini adalah menyelidiki pentingnya penguatan otot pada individu yang telah menjalani operasi TKA. Metode: Pencarian literatur sistematis pada tiga database online dilakukan untuk uji coba terkontrol secara acak (RCT) yang mengevaluasi efek latihan kekuatan pada ambulasi fungsional dengan uji jalan enam menit (6MWT)/ uji bangun-dan-jalan (TUG) setelah operasi TKA. Data dikumpulkan dengan meta-analisis efek acak& disajikan sebagai perbedaan rata-rata standar (SMD). Kriteria PRISMA dan pendekatan risiko bias Cochrane diterapkan pada setiap penelitian untuk menentukan kualitas bukti. Hasil: Sebelas RCT diidentifikasi. Meta-analisis menunjukkan bahwa 6MWT pasca operasi tidak menunjukkan perbedaan signifikan antara terapi standar& penguatan otot, namun menunjukkan bahwa penguatan otot menghasilkan hasil yang lebih baik pada uji TUG dibandingkan terapi standar. Kesimpulan: Berdasarkan studi, bukti dengan kepastian sedang menunjukkan bahwa latihan kekuatan dapat mengurangi waktu untuk menyelesaikan uji TUG setelah TKA. Kata Kunci: Penguatan otot, Osteoartritis, Penggantian Lutut Total, Pasca operasi, Efektivitas.

Anteroposterior Radiography Demonstrates Higher Diagnostic Sensitivity for Detecting Medial Compartment Joint Space Narrowing Compared to the Rosenberg View in Knees with Anteromedial Osteoarthritis

2025-06-17

Seyed Mohammad Javad Mortazavi , Sina Hajiaghajani , Mohammad Poursalehian +4 more | Research Square (Research Square)

<title>Abstract</title> <bold>Purpose: </bold>The most common radiographic views for diagnosing knee osteoarthritis (KOA) are full-extension anteroposterior (AP) and standing 45° flexion posteroanterior (Rosenberg) radiographs. Previous studies consistently suggest that the Rosenberg … <title>Abstract</title> <bold>Purpose: </bold>The most common radiographic views for diagnosing knee osteoarthritis (KOA) are full-extension anteroposterior (AP) and standing 45° flexion posteroanterior (Rosenberg) radiographs. Previous studies consistently suggest that the Rosenberg view has greater diagnostic sensitivity. However, in some patients with medial KOA, we observed that AP radiographs outperformed the Rosenberg view in detecting joint space narrowing (JSN). We hypothesized that this discrepancy could be attributed to distinct wear patterns of the medial tibial condyle. Therefore, this study aimed to evaluate the diagnostic sensitivity of AP and Rosenberg radiographs across different medial KOA wear patterns. <bold>Methods: </bold> In this prospective study, 318 patients (360 knees) who underwent total knee arthroplasty (TKA) were included. Five distinct wear patterns were assessed. Wear patterns and ligament integrity were evaluated and recorded intraoperatively. Preoperative AP and Rosenberg radiographs were analyzed to measure the medial joint space width (JSW). JSN was diagnosed based on criteria derived from JSW values. The diagnostic sensitivity for each wear pattern was calculated and compared between AP and Rosenberg views. Additionally, the frequency of intraarticular damage and medial meniscus injuries was evaluated across different wear patterns. <bold>Results: </bold> The AP view demonstrated higher diagnostic sensitivity compared to the Rosenberg view in knees with an anteromedial osteoarthritis (AMOA) wear pattern. JSW analysis revealed that the AP view showed significantly lower JSW values than the Rosenberg view in AMOA knees. Conversely, the Rosenberg view exhibited higher diagnostic sensitivity and lower JSW values in other wear patterns and across the overall patient cohort. Furthermore, patients with AMOA exhibited a greater prevalence of intact anterior cruciate ligaments (ACLs) compared to those with other wear patterns. <bold>Conclusion: </bold> Although the Rosenberg view generally provides greater diagnostic sensitivity, the AP view outperforms the Rosenberg view in detecting JSN in knees with AMOA wear patterns. This study highlights the complementary roles of AP and Rosenberg views in diagnosing JSN. Clinicians should perform both views when evaluating medial KOA. Level of Evidence: II

Patellar Resurfacing as a Prognostic Factor in Total Knee Arthroplasty: 20-Year Cohort Study

2025-06-17

D. Osorio , Luis David Marcial Barba , Nelva Garduza Leyva +4 more | Research Square (Research Square)

<title>Abstract</title> Background The decision to perform patellar resurfacing (PR) during total knee arthroplasty (TKA) is based on patient and implant characteristics. This study aims to evaluate PR as a prognostic … <title>Abstract</title> Background The decision to perform patellar resurfacing (PR) during total knee arthroplasty (TKA) is based on patient and implant characteristics. This study aims to evaluate PR as a prognostic factor for revision in primary TKA with 20 years of follow-up experience. Methods This is a retrospective, comparative, observational cohort study of patients who underwent TKA at a high-specialty hospital in Mexico between 2000 and 2020. A total of 334 patients who underwent TKA were evaluated. For our TKA population we divided in two groups of interest: those with patellar PR and without patellar resurfacing (WPR). Functionality was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS) scales. Pain was evaluated using the numeric rating scale (NRS). We determined the survival of TKA using the Kaplan-Meier method, and to evaluate prognostic variables, we used measures of association, such as the odds ratio (OR) and risk ratio (RR), along with the hazard ratio test (HR), with a 95% confidence interval (IC). A p-value of less than 0.05 was considered statistically significant. Results TKA with PR was associated with improved clinical and functional outcomes. There were fewer reported complications and fewer cases of prosthetic failure or revision surgery in patients receiving PR. Trial registration Not applicable, this study is an observational retrospective cohort no prospective registration was required.

Recovery of Patient-Reported Outcome Measures vs Gait Parameters Obtained by Instrumented Insoles After Tibial and Malleolar Fractures: Prospective Longitudinal Observational Study

2025-06-16

Elke Warmerdam , Marianne Huebner , Christian Stoll +2 more | JMIR mhealth and uhealth

Background New technologies from the field of mobile health (mHealth) are increasingly used to improve patient monitoring during rehabilitation. While in recent years, mobile phones, health apps, personal digital assistants, … Background New technologies from the field of mobile health (mHealth) are increasingly used to improve patient monitoring during rehabilitation. While in recent years, mobile phones, health apps, personal digital assistants, and smartwatches opened up new diagnostic and monitoring opportunities for patients, the development of innovative sensor devices, such as instrumented insoles, has now reached a sufficient level of usability with promising opportunities for clinical practice. According to research on the best method for monitoring recovery after musculoskeletal injury or surgery, the Patient-Reported Outcome Measurement Information System (PROMIS) and wearables such as instrumented insoles are among the most promising newer options. However, it is unknown how a patient’s health perception and improvements in instrumented insole-derived gait parameters correlate after surgery for tibial or malleolar fractures. Objective This study aimed to compare the longitudinal trajectories in separate PROMIS (sub)scores with gait and further patient-specific parameters, as well as associations between PROMIS scores and gait parameters. It was also aimed to determine the influence of anthropometric parameters and comorbidities. Methods A total of 85 patients (39 women and 46 men; average age 50.8, SD 17.1 years) requiring surgery after tibial or malleolar fractures were included in this prospective longitudinal observational study. In the hospital and during follow-up visits, the patients completed the PROMIS Global Health and Pain Interference questionnaires. During the same visits, individually fitted instrumented insoles with 16 pressure sensors, an accelerometer, and a gyroscope each were used to assess the maximal force, pressure distribution, and angular velocity during walking with data being recorded at 100 Hz. Statistical analyses were conducted using linear mixed effect models, pairwise Spearman correlation coefficients, and generalized additive models. Results The gait parameters assessed via the instrumented insoles quickly improved during the first 3 months after surgery, followed by a slowing of further improvement. After surgery, the PROMIS scores increased or decreased to extrema that were reached after 6 weeks to 3 months, followed by a return to preinjury values. Between 3 and 6 months, no significant improvements in PROMIS scores were observed. Between 6 months and 1 year, the Physical Health and Mental Health scores still improved significantly (P=.003 in both cases). Men had better Physical Health and lower Pain Interference scores than women (P=.01 and P=.03, respectively). Hypertension had a negative effect on the Physical Health score (P=.03). The associations between the PROMIS score and gait parameters were strongest at approximately 3 months after surgery, predominantly between the Pain Interference score and gait parameters. Conclusions The patients’ perception improved later than the objective gait parameters obtained by instrumented insoles did. When the gait pattern improved, pain perception correlated with the gait parameters. Trial Registration German Clinical Trials Registry DRKS00025108; https://drks.de/search/en/trial/DRKS00025108

SHORT-TERM CLINICAL AND FUNCTIONAL OUTCOMES FOLLOWING ARTHROSCOPIC DEBRIDEMENT AND LAVAGE IN EARLY TO MODERATE KNEE OSTEOARTHRITIS: A PROSPECTIVE LONGITUDINAL STUDY

2025-06-16

Dr Aniket Koley , Dr Gopinath Maiti , Dr Arumoy Bhuimali +4 more | Journal of Population Therapeutics and Clinical Pharmacology

Comparing 90-day morbidity and mortality after unilateral versus simultaneous bilateral total knee arthroplasty in a Saudi population. A retrospective cohort study

2025-06-16

Ali Alyami , Raad M. M. Althaqafi , Alwaleed A. Alyami +4 more | European Journal of Orthopaedic Surgery & Traumatology

Risk of postoperative complications following total knee or hip arthroplasty associated with patients who consume alcohol: a systematic review protocol

2025-06-16

Mary Nguyen , Cheryl Vanier , Connor J. Peck +3 more | JBI Evidence Synthesis

Objective: The objective of this review will be to evaluate the risk of declining functional outcomes and postoperative complications following total knee or hip arthroplasty in patients who consume moderate … Objective: The objective of this review will be to evaluate the risk of declining functional outcomes and postoperative complications following total knee or hip arthroplasty in patients who consume moderate to heavy amounts of alcohol in the postoperative period compared with patients who abstain. Introduction: The World Health Organization states that alcohol consumption increases the risk of cancer and heart disease as well as mental health and behavioral conditions. Acute or binge exposure to alcohol affects multiple systems in the body, slowing skin and bone healing after accidents or surgery. Due to the prevalence of alcohol use and its effects on the body, it is important to investigate the risks associated with alcohol consumption and their effect on the recovery of patients undergoing total hip and knee arthroplasty. Inclusion criteria: The review will consider adults aged 18 years or older; from any ethnic or racial background; who underwent a total knee or hip arthroplasty; irrespective of geographical location. Methods: The review will be conducted in accordance with the JBI methodology for systematic reviews of etiology and risk. Peer-reviewed and gray literature will be searched for in various databases including PubMed, Embase, Scopus, and CINAHL, as well as Google Scholar, MedNar, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. There will be no language restrictions. Study selection, data extraction, and data synthesis will be performed independently by 2 reviewers. A customized data extraction table will be used. Systematic review registration number: PROSPERO CRD42021285319

Running and Jumping After Muscle Fatigue in Subjects with a History of Knee Injury: What Are the Acute Effects of Wearing a Knee Brace on Biomechanics?

2025-06-16

Tobias Heß , Thomas L. Milani , Josefine Stoll +1 more | Bioengineering

The knee is one of the most frequently injured joints, involving various structures. To prevent reinjury after rehabilitation, braces are commonly used. However, most studies on knee supports focus on … The knee is one of the most frequently injured joints, involving various structures. To prevent reinjury after rehabilitation, braces are commonly used. However, most studies on knee supports focus on subjects with anterior cruciate ligament (ACL) injuries and do not account for muscle fatigue, which typically occurs during prolonged intense training and can significantly increase the risk of injury. Hence, this study investigates the acute effects of wearing a knee brace on biomechanics in subjects with a history of various unilateral knee injuries or pain under muscle fatigue. In total, 50 subjects completed an intense fatigue protocol and then performed counter-movement jumps and running tests on a force plate while tracking kinematics with a marker-based 3D motion analysis system. Additionally, subjects filled out a visual analog scale (VAS) to assess knee pain and stability. Tests were conducted on the injured leg with and without a knee brace (Sports Knee Support, Bauerfeind AG, Zeulenroda-Triebes, Germany) and on the healthy leg. Results indicated that wearing the knee brace stabilized knee movement in the frontal plane, with a significant reduction in maximal medio-lateral knee acceleration and knee abduction moment during running and jumping. The brace also normalized loading on the injured leg. We observed higher maximal knee flexion moments, which were associated with increased vertical ground reaction forces, segment velocities, and knee flexion angles. Subjects reported less pain and greater stability while wearing the knee brace. Therefore, we confirm that wearing a knee brace on the injured leg improves joint biomechanics by enhancing stability and kinematics and reducing pain during running and jumping, even with muscle fatigue. Consequently, wearing a knee brace after a knee joint injury may reduce the risk of reinjury.