Cementless knee arthroplasty has seen a recent resurgence in popularity due to conceptual advantages, including improved osseointegration providing biological fixation, increased surgical efficiency, and reduced systemic complications associated with cement impaction and wear from cement debris. Increasingly younger and higher demand patients are requiring knee arthroplasty, and as such, there is optimism cementless fixation may improve implant survivorship and functional outcomes.Compared to cemented implants, the National Joint Registry (NJR) currently reports higher revision rates in cementless total knee arthroplasty (TKA), but lower in unicompartmental knee arthroplasty (UKA). However, recent studies are beginning to show excellent outcomes with cementless implants, particularly with UKA which has shown superior performance to cemented varieties. Cementless TKA has yet to show long-term benefit, and currently performs equivalently to cemented in short- to medium-term cohort studies. However, with novel concepts including 3D-printed coatings, robotic-assisted surgery, radiostereometric analysis, and kinematic or functional knee alignment principles, it is hoped they may help improve the outcomes of cementless TKA in the long-term. In addition, though cementless implant costs remain higher due to novel implant coatings, it is speculated cost-effectiveness can be achieved through greater surgical efficiency and potential reduction in revision costs. There is paucity of level one data on long-term outcomes between fixation methods and the cost-effectiveness of modern cementless knee arthroplasty.This review explores recent literature on cementless knee arthroplasty, with regards to clinical outcomes, implant survivorship, complications, and cost-effectiveness; providing a concise update to assist clinicians on implant choice.Cite this article: Bone Jt Open 2021;2(1):48–57.

Conventional bone replacement surgeries have always been associated with different critical drawbacks. Deviation of the implant from its original position is one of the most important problems associated with surgery. The emergence of computer-aided design/computer-aided manufacturing technology opened a new opportunity for the solution of this problem by the use of patient-specific surgical guides. These 3D-printed surgical guides provide a specific cut and therefore reduces the drawbacks associated with surgical techniques including the fixation difficulties. In this review, 3D-printed guides for knee arthroplasty, pedicle screw placement and mandibular reconstruction will be discussed covering both the progress and the drawbacks.

Three-dimensional (3D) printing was introduced firstly for industrial use, but it gained popularity in different medical fields, including orthopedic surgeries. Particularly, 3D-printed models have been used in the pre-operative planning for spine surgery, oncology, acetabular fracture treatment and complex primary total hip arthroplasty (THA) or revision THA. In knee surgery, some authors described good accuracy with 3D-printed wedge for Opening Wedge High Tibial Osteotomy (OWHTO), but there are no studies describing its application in Total Knee Arthroplasty (TKA). In both primary and revision TKA, a 3D-printed model may be useful to better evaluate knee morphology and deformity, implants, bone losses and the compatibility between different components used. Furthermore, some companies provide a bone thickness evaluation, which may be useful to identify zones at risk of intra-operative fracture, especially in those cases in which a cone or sleeve must be used. The first aim of this manuscript was to evaluate possible application of 3D-printed model in pre-operative planning of both complex primary and revision TKA, compared to standard planning. Two clinical cases will also be described to show how these models can be used for planning purposes.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed surgeries worldwide. The number of joint replacement surgeries being performed has increased considerably over the past two decades, but it has also seen an increase in litigation associated with it. The purpose of our study was to review and consolidate literature regarding medico-legal issues pertaining to THA and TKA cases. We looked at the causes of litigation, medico legal aspects of pre-operative requirements, optimisation of medical condition, indications and contraindications for arthroplasty, informed consent, implants, mixing of components from different manufacturers and post-operative rehabilitation. We also wanted to analyse available literature and legal proceedings regarding these cases in India specifically.

Rising costs will likely be the focus of our healthcare debate for the foreseeable future1. Orthopaedic implants and procedures are a major cost contributor2. Recent evidence shows that the numbers of hip and especially knee arthroplasties are increasing in the United States3,4. If orthopaedic implant device companies followed usual economies-of-scale principles, the cost of implants would decrease with the increasing number of procedures every year. However, implant costs remain high, which is one of the reasons that arthroplasty is an expensive procedure. Robinson et al. analyzed 10,155 patients undergoing total knee arthroplasty and 5013 patients undergoing total hip arthroplasty from sixty-one hospitals that participated in a value-based purchasing initiative. The authors based their analysis on hospital and implant costs—data that are often difficult to obtain. Implants were major contributors to variation in joint replacement surgery costs across hospitals. Most medical device cost variation (36% for hip replacement and 61% for knee replacement) was attributable to hospital characteristics, and only …

Unicompartmental knee arthroplasty(UKA) is an important surgical technique for the treatment of end-stage knee osteoarthritis, which has high requirement for the position and angle of the prosthesis. The application of three-dimensional(3D) printed in UKA reflects several characteristics such as accuracy,efficiency and safety,but the current research results show that there is still lack of consistency in the design of 3D printed guides and the standard of prosthetic position parameters. This article reviews the history, manufacturing requirements and process of 3D printed guides during UKA surgery, as well as the results of current clinical research. Whether 3D printed guides can safely and effectively improve the placement accuracy of inexperienced doctors during UKA surgery,and whether the long-term results are worthy of clinical promotion need further verification.

Robotic-assisted hip and knee arthroplasty represents cutting-edge advancements in orthopedic surgery, harnessing robotic technology to enhance precision, improve clinical outcomes, and facilitate intra-operative procedures. In these robotic-assisted surgeries, the robotic systems assist surgeons in planning and executing joint replacement surgeries, thereby facilitating personalized implant positioning and optimizing the fit and alignment of hip and knee implants. Despite the increasing attention garnered by robotic-assisted hip and knee arthroplasty in recent years, a comprehensive bibliometric analysis using the Scopus database has yet to be conducted. This bibliometric analysis reviews the Scopus database from 1961 until 2022 to investigate the literature on the field of robotic-assisted hip and knee arthroplasty. A total of 577 articles that satisfied the selection criteria were included in this review. The majority of the articles focus more on total knee replacement, compared to total hip replacement and unicompartmental knee arthroplasty. The overwhelming majority of the articles were authored by researchers and clinicians from the United States of America (USA) and the United Kingdom (UK). Similarly, most of the articles with the highest number of citations were authored by researchers and clinicians from these regions. This comprehensive bibliometric analysis using Scopus in the domain of robotic-assisted hip and knee replacement has the potential to act as a roadmap for researchers, clinicians, and policymakers, facilitating informed decision-making, promoting collaborative initiatives, and guiding the development of future studies to further advance the field of robotic-assisted hip and knee arthroplasty.

ABSTRACT The artifi cial knee is used in the bone resurfacing of the arthritis-affected knee using a procedure called Total Knee Arthroplasty or Total Knee Replacement. The article discusses the existing artifi cial knees that are in the Indian market and the market share analysis of different players in this market. The article also forecasts the expected sales of this orthopaedic implant until the year 2010. The article compares the international artifi cial knee implant technology scenario with that of the Indian market. The international artifi cial knee market is compared with the Indian knee implants market. The article concludes with the requirements of an ideal artifi cial knee that would suit not only the Indian market, but also the Eastern world. Journal of Medical Marketing (2010) 10, 115 – 121. doi: 10.1057/jmm.2009.29; published online 19 February 2010 Keywords: Indian orthopaedic market ; artifi cial knee ; market share analysis ; market estimate ; total knee replacement Downloaded from mmj.sagepub.com

Aim: Arthritis is a degenerative condition characterized by the progressive deterioration of the knee joint, leading to aches, rigidity, and decreased mobility. Total knee arthroplasty (TKA) surgery is performed to alleviate pain for restoring activity in these patients. TKA is carried out due to natural wear of the cartilage and meniscus or by sudden impact at the knee joint area. The surgical procedure involves careful planning, precise bone cuts, and insertion of artificial components made of metal alloys and high-density polyethylene. However, conventional manufacturing of customized knee implants involves time and cost. This work aims to present the application of three-dimensional (3D) printing for developing individualized knee implants for TKA and the challenges faced during it. Methods: Morphometry of the knee joint varies among different populations, including Indian and Western, which pose challenges during the surgery as accurate alignment and implant sizing are crucial for optimal outcomes. A female patient’s pre-surgery computed tomography (CT) scan is considered to identify the disease and to find region of interest (ROI) such as knee joint. Process involves converting scanned data to a file format for 3D printing via computer-aided design (CAD). Results: The patient’s CT scan data is processed to obtain the CAD models of knee joint and standard triangulation language (STL) file. Additional geometries and noise present near the region are removed to get ROI. Open loops and overlapping triangles are rectified in the STL file. Based on the morphometry of the bone, resection is done to obtain the CAD models of knee implants. 3D printing of the knee joint and implant prototypes is then obtained using fused deposition modelling (FDM). Line layers on the printed implant prototype are seen. Conclusions: Patient-specific 3D printed knee joint implant prototypes are successfully obtained using FDM. Challenges faced during the work are successfully worked out.

Total knee arthroplasty (TKA) is currently one of the most common orthopedic surgeries due to the ever-increasing average life expectancy. The constantneed for effective and accurate techniques was contributed to the development of three-dimensional (3D) printing in that field, especially for patient-specific instrumentation (PSI) and custom-made implants fabrication. PSI may offer numerous benefits, such as resection accuracy, mechanical axis alignment, cost-effectiveness, and time economy. Nonetheless, the results of existing studies are controversial. For this purpose, a review article of the published articles was conducted to summarize the role of 3D-printed PSI in TKA.