End-stage Osteoarthritis Research Articles

Cohort profile: Worldwide Collaboration on OsteoArthritis prediCtion for the Hip (World COACH) – an international consortium of prospective cohort studies with individual participant data on hip osteoarthritis

PurposeHip osteoarthritis (OA) is a major cause of pain and disability worldwide. Lack of effective therapies may reflect poor knowledge on its aetiology and risk factors, and result in the...

Clinical phenotypes of comorbidities in end-stage knee osteoarthritis: a cluster analysis

ObjectivesComorbidities, as components of these heterogeneous features, often coexist with knee osteoarthritis, and are particularly prevalent in end-stage knee osteoarthritis. Here, we attempted to identify the different clinical phenotypes of comorbidities in patients with end-stage knee osteoarthritis by cluster analysis.MethodsA total of 421 inpatients diagnosed with end-stage knee osteoarthritis who underwent inpatient surgery were included in this cross-sectional study. 23 demographic, comorbidity, inflammatory immune and evaluation scale variables were collected. Systematic clustering after factor analysis and separate two-step cluster analysis were performed for individual comorbidity variables and all variables, respectively, to objectively identify the different clinical phenotypes of the study patients.ResultsFour clusters were finally identified. Cluster 1 had the largest proportion of obese patients (93.8%) and hypertension was common (71.2%). Almost all patients in cluster 2 were depressed (95.8%) and anxiety disorders (94.7%). Cluster 3 combined patients with isolated end-stage knee osteoarthritis and a few comorbidities. Cluster 4 had the highest proportion of patients with rheumatoid arthritis (58.8%).ConclusionsPatients with end-stage knee osteoarthritis may be classified into four different clinical phenotypes: "isolated end-stage knee osteoarthritis"; "obesity + hypertension"; "depression + anxiety"; and "rheumatoid arthritis", which may help guide individualized patient care and treatment strategies.

PLOD2 gene expression in infrapatellar fat pad is correlated with fat mass in obese patients with end-stage knee osteoarthritis

ObjectiveTo investigate associations between obesity-linked systemic factors and gene expression indicative for the inflammatory and fibrotic processes in the infrapatellar fat pad (IFP), in a population of obese patients with end-stage knee osteoarthritis (KOA). MethodsWe collected human IFPs from 48 patients with a mean body mass index (BMI) of 35.44 ​kg/m2 during total knee replacement procedures. These patients were part of a randomized controlled trial and met the criteria of having OA and a BMI of ≥30 ​kg/m2. Blood samples were collected to assess serum levels of glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, and leptin. Total body composition was measured using dual-energy X-ray absorptiometry. Gene expressions of IL6, TNFA, COL1A1, IL1B, ASMA, PLOD2 in the IFP were analyzed. ResultsUnivariate analysis resulted in a positive correlation between BMI and procollagen-lysine,2-oxoglutarate 5-dioxygenase 2 (PLOD2) expression (r2 ​= ​0.13). In univariate analyses of obesity-linked systemic factors and PLOD2, significant correlations were found for lean mass (r2 ​= ​0.20), fat mass (r2 ​= ​0.20), serum cholesterol (r2 ​= ​0.17), serum triglycerides (r2 ​= ​0.19) and serum leptin (r2 ​= ​0.10). A multiple linear regression model indicated fat mass to be a strong predictor of PLOD2 production in the IFP (r2 ​= ​0.22, P ​= ​0.003). ConclusionOur study demonstrates the positive association between fat mass and PLOD2 expression in the IFP of obese end-stage knee OA patients. This may indicate that within this patient population the fibrotic process in the IFP is influenced by systemic adipose tissue, next to local inflammatory processes.

Patients with High Pre-Operative Physical Activity Take Longer to Return to Baseline

Patients with end-stage osteoarthritis are recommended to engage in physical activity (PA) to reduce pain and improve function but may avoid PA due to joint pain. Our goal was to investigate patient-reported outcomes and objective mobility metrics (step counts) in total hip arthroplasty (THA) patients as a function of pre-operative PA levels. In total, 1647 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation that underwent THA and were included in analysis. The entire cohort’s step count was divided into quartiles to categorize patients with low, moderate, and high baseline PA. Outcomes including pain, EQ-5D-5L, HOOS JR, and step counts were compared according to activity group by ANOVA. Pre-operative pain scores were lowest, with smallest improvements, in the high-baseline PA group. Low-PA patients demonstrated the greatest improvements in EQ-5D-5L, while changes in EQ-VAS, HOOS JR, and satisfaction were similar between groups. Low- and moderate-PA patients increased physical activity by six weeks, reaching 180% and 114% of pre-operative steps; high-PA patients did not return to full step counts until one-year post-operation. Patients who perform high levels of PA undergoing THA report lower levels of pain and higher function pre-operatively but may appreciate less improvement in PA up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations prior to surgery.

Agreement Analysis on Postoperative Care Between ChatGPT and a High-Volume Foot and Ankle Surgeon

Introduction/Purpose: ChatGPT is an Artificial intelligence (AI) algorithm based on a user-friendly interface that does not requires advanced programming skills. Since its release to the public, it has made AI more accessible. As a result, the Patient refers to chat GTP for medical inquiries. This study compares the postoperative (PO) information provided by chatGPT to those of a high- volume foot and ankle orthopedics surgeon. Methods: The study includes 251 patients treated for end-stage osteoarthritis with total ankle arthroplasty. Postoperative emails containing inquiries about their PO status were uploaded to chatGTP. We then evaluated the agreement in simple (SA) and complex (CA) answers. The SA abbreviated the answer provided into "yes" or "no" Its agreement analysis was made using Cohens Kappa. In contrast, CA contained detailed information, and answers were classified into complete agreement, partial agreement, or complete disagreement. Additionally, in partial agreement answers, we calculated the percentage of agreement. Finally, we measured the cases where the surgeon added additional information unrelated to the inquiry. Results: There was only a slight agreement in the SA category (K=0.08). In the CA category, we found 27 percent of complete agreement; in 52 percent, we found complete disagreement; in 20 percent, we found only partial agreement. In 50 % of the cases, the surgeon added information unrelated to the question. Conclusion: We found limited agreement between chat GPT and the primary surgeon regarding postoperative information. Indicating that chat, GPT is currently an unreliable source for postoperative management. Table 2 Distribution of agreement percentage between a High-volume foot and ankle surgeon and ChatGPT response to postoperative inquiries from patients with total ankle arthroplasty in those with partial agreement

Metabolomic Profiles and Pathways in Osteoarthritic Human Cartilage: A Comparative Analysis with Healthy Cartilage.

Osteoarthritis (OA) is a chronic joint disease with heterogenous metabolic pathology. To gain insight into OA-related metabolism, metabolite extracts from healthy (n = 11) and end-stage osteoarthritic cartilage (n = 35) were analyzed using liquid chromatography-mass spectrometry metabolomic profiling. Specific metabolites and metabolic pathways, including lipid and amino acid pathways, were differentially regulated in osteoarthritis-derived and healthy cartilage. The detected alterations in amino acids and lipids highlighted key differences in bioenergetic resources, matrix homeostasis, and mitochondrial alterations in OA-derived cartilage compared to healthy cartilage. Moreover, the metabolomic profiles of osteoarthritic cartilage separated into four distinct endotypes, highlighting the heterogenous nature of OA metabolism and the diverse landscape within the joint in patients. The results of this study demonstrate that human cartilage has distinct metabolomic profiles in healthy and end-stage OA patients. By taking a comprehensive approach to assess metabolic differences between healthy and osteoarthritic cartilage and within osteoarthritic cartilage alone, several metabolic pathways with distinct regulation patterns were detected. Additional investigation may lead to the identification of metabolites that may serve as valuable indicators of disease status or potential therapeutic targets.

Coronal Knee Alignment and Tibial Rotation in Total Knee Arthroplasty: A Prospective Cohort Study of Patients with End-Stage Osteoarthritis.

Several studies have found a relationship between the rotational anatomy of the distal femur and the overall coronal lower limb alignment in knees with osteoarthritis (OA). Less is known about the rotation of the proximal tibia, especially in the context of total knee arthroplasty (TKA), where one of the goals of the surgery is to achieve the appropriate component-to-component rotation. The aim of this study was to investigate the relationship between the coronal alignment of the lower extremity and the relative proximal tibial rotation. A prospective cohort study of patients with an end-stage OA scheduled for TKA was conducted. All patients underwent a computed tomography (CT) scan and a standing X-ray of both lower limbs. A relative femorotibial rotation was measured separately for mechanical and kinematic alignment. A statistically significant correlation was found between the tibial varus and the external tibial rotation (p < 0.001). Out of 14 knees with high tibial varus (>5°), 13 (93%) and 7 (50%) knees had >10° of femorotibial rotation for the mechanical and kinematic alignment landmarks, respectively. In order to keep the component-to-component rotation within the 10° margin, more internal rotation of the tibial component is required in knees with higher tibial varus.

Genu Recurvatum in Total Knee Arthorplasty: A Review

Abstract Genu recurvatum is a rare knee deformity that can be linked with osteoarthritis. The main causes of this deformity include neuromuscular disorders, rheumatoid arthritis, inverted tibial slope, or conditions associated with coronal deformities such as genu valgum. In cases of end-stage knee osteoarthritis, total knee arthroplasty is the indicated management to reduce pain and improve functionality and quality of life. Genu recurvatum is associated with an imbalance in the flexion and extension gaps, which is why it is necessary to have important considerations in the preoperative evaluation, implant selection, and surgical technique. We conducted a review in electronic databases including MEDLINE, EMBASE, and LILACS from 1990 to June 28, 2023. Two authors independently reviewed the titles and abstracts to identify studies that met the inclusion criteria. Thirty-four literature sources were included to address our inquiries. Results are presented in a narrative format, focusing on the design and study population for each specific research question. Genu recurvatum is a rare knee deformity which needs special considerations. Accurate assessment of the deformity magnitude and quadriceps weakness is crucial during the preoperative evaluation. The choice of implant should be tailored to the individual patient’s characteristics. Surgical technique plays a critical role in achieving soft tissue and gap balance. Literature highlights an increased incidence of complications associated with this deformity, particularly in cases of poliomyelitis. Navigation and robotics offer promising alternatives to enhance surgical precision and appear to show a lower recurrence rate.

A comprehensive comparative study on mid-term clinical and functional outcomes in Indian patients following bilateral total knee arthroplasty: assessing the impact of body mass index on post-total knee arthroplasty results

Background: Limited research exists on Indian obese patients undergoing simultaneous bilateral total knee arthroplasty (bTKA), necessitating a comprehensive and comparative analysis with non-obese counterparts. This study presents an observational and prospective assessment of Indian patients who underwent cruciate retaining/posterior stabilized (CR/PS) metal-backed implant surgeries from 2016 to 2019. Methods: The study encompassed 190 patients (380 knees) undergoing bTKA, classified by World Health Organization (WHO) weight stratification: normal weight (cohort 1, n=51), overweight (cohort 2, n=85), and obese (cohort 3, n=54). Primary endpoints were implant survivorship and revision rates, with secondary endpoints including range of motion (ROM), knee society score (KSS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and SF-36 scores. Results: Female representation dominated all groups (88.24%, 87.06%, and 90.74%). End-stage osteoarthritis occurred in 94.12%, 96.47%, and 98.15%, respectively. Over the 3-year follow-up, four fatalities occurred, with 186 patients completing the study. ROM showed significant improvement after three years, with baseline values increasing from 93.29°±18.29° (cohort 1) to 123.97°±2.28°, 122.86°±5.03°, and 122.67°±4.77°, respectively (p&lt;0.001). KSS demonstrated substantial improvement (cohort 1: 89.87±6.48, cohort 2: 90.47±8.40, cohort 3: 90.52±8.07) after three years. A 100% success rate and no revisions indicated implant durability. WOMAC and SF-36 questionnaires exhibited significant improvements in pain, stiffness, and overall well-being (p&lt;0.001) after bTKA. Conclusions: This mid-term CR/PS knee survival analysis underscores 100% implant functionality, improved knee function, and enhanced quality of life for all patients, irrespective of their body mass index (BMI). Simultaneous bilateral TKA with CR/PS implants demonstrates favourable outcomes, affirming its efficacy as a viable treatment option.

Predicting the onset of end-stage knee osteoarthritis over two- and five-years using machine learning

ObjectiveIdentifying participants who will progress to advanced stage in knee osteoarthritis (KOA) trials remains a significant challenge. Current tools, relying on total knee replacements (TKR), fall short in reliability due to the extraneous factors influencing TKR decisions. Acknowledging these limitations, our study identifies a critical need for a more robust metric to assess severe KOA. The end-stage KOA (esKOA) measure, which combines symptomatic and radiographic criteria, serves as a solid indicator. To enhance future trials that use esKOA as an endpoint, our study focuses on developing and validating a machine-learning tool to identify individuals likely to develop esKOA within 2 to 5 years. DesignUtilizing the Osteoarthritis Initiative (OAI) data, we trained models on 3,114 participants and validated them with 606 participants for the right knee, and similarly for the left knee, with external validation from the Multicentre Osteoarthritis Study (MOST) involving 1,602 participants. We aimed to predict esKOA onset at 2-to-2.5 years and 4-to-5 years, defining esKOA by severe radiographic KOA with moderate/severe symptoms or mild/moderate radiographic KOA with persistent/intense symptoms. Our analysis considered 51 candidate predictors, including demographics, clinical history, physical examination, and X-ray evaluations. An online tool predicting esKOA progression, based on models with ten and nine predictors for the right and left knees, respectively, was developed. ResultsExternal validation (MOST) for the right knee at 2.5 years yielded an Area Under Curve (AUC) of 0.847 (95 % CI 0.811 to 0.882), and at 5 years, 0.853 (95 % CI 0.823 to 0.881); for the left knee at 2.5 years, AUC was 0.824 (95 % CI 0.782 to 0.857), and at 5 years, 0.807 (95 % CI 0.768 to 0.843). Models with fewer predictors demonstrated comparable performance. The online tool is available at: https://eskoa.shinyapps.io/webapp/. ConclusionOur study unveils a robust, externally validated machine learning tool proficient in predicting the onset of esKOA over the next 2 to 5 years. Our tool can lead to more efficient KOA trials.

Favorable early outcomes of medial unicompartimental knee arthroplasty in active patients presenting a degenerative medial meniscus root tear with meniscal extrusion and mild radiographic osteoarthritis.

There is only limited literature available evaluating the preferable treatment for active mid-age or elderly patients presenting with a degenerative medial meniscus root tear (d-MMRT) with medial meniscal extrusion (MME) and early-phase radiographic osteoarthritis (OA), failing to provide solid evidence. The aim of this study was to evaluate early outcomes of medial unicompartimental arthroplasty (mUKA) in active patients presenting a d-MMRT with meniscal extrusion and mild radiographic OA of the knee. To prove this claim we hypothesized that (1) patients with a d-MMRT with initial grade 1-3 KL OA of the medial compartment of the knee present the same pre-operative symptoms as patients with an end-stage grade 4 K-L OA, and that (2) those patients with d-MMRT and low-grade OA achieve the same early clinical and functional outcomes when treated with mUKA compared to patients with end-stage medial OA. We reviewed the prospectively collected data of 185 patients undergoing robotic-assisted image-based mUKA from January 2021 to July 2022 at a single Institution. We identified two different cohorts of non-consecutive patients: a group of 24 patients undergoing mUKA surgery following d-MMRT combined with K-L grades 1-3 OA (group 1), and a group of 161 patients who underwent mUKA but presenting with an end-stage bone-on-bone K-L grade 4 OA (group 2). Preoperative and postoperative clinical assessments at one-year follow-up included the Oxford Knee Score (OKS), 5-level EQ-5D version (EQ-5D-5L score), and a standard weight-bearing X-ray protocol. The pairedt-test was used to compare clinical outcomes and radiologic values of the two cohorts and in-between the two cohorts. Statistical significance was set at p < 0.05. The mean follow-up for group 1 was 16.4 ± 2.5 months, and the mean age at the time of operation was 63 ± 8.6 years with a mean time from diagnosis to intervention of 53 ± 47.5 days. Preoperative impairment was greater in group 1 compared to group 2, but with no significant difference. Postoperatively, both groups showed excellent mean outcomes at 1-year follow-up, with no significant difference. The mean preoperative HKA, mPTA, and LDFA were 176.3 ± 3.1, 88.1 ± 2.3, and 86.6 ± 1.7 respectively. The mean postoperative HKA, coronal femoral component angle, and coronal tibial component angle were 179.1 ± 2.6, 87.2 ± 2.3, and 87.2 ± 3.3. No difference was found between preoperative age, BMI, between the two cohorts. Favorable early clinical outcomes were obtained after mUKA in active mid-age and elderly patients presenting with degenerative medial meniscus root tear and mild isolated medial OA. Patients with mild no bone-on-bone OA but with degenerative medial meniscus root tear and medial meniscal extrusion presented the same or worse pre-operative symptoms as patients with end-stage medial OA and benefit the same from mUKA.

Champions in usage of medial unicompartmental knee arthroplasty : The story behind the Danish success.

Historically, the use of medial unicompartmental knee arthroplasty (mUKA) as treatment for end-stage anteromedial osteoarthritis (AMOA) of the knee was limited by contraindications due to age, weight, and activity level; however, now evidence-based, validated, and less selective criteria are used rendering nearly 50% of end-stage OA patients eligible for mUKA. Recent studies have showcased benefits, such as shorter hospital stays, cost efficiency, and comparable functional outcomes to total knee arthroplasty (TKA). Notably, revision rates have been shown to markedly decrease with increased usage, with an ideal usage of > 30% but an acceptable usage of 20-60%. The usage of unicompartmental knee arthroplasty (UKA) varies among countries, with Denmark achieving anotably higher usage compared to Sweden, the UK, the Netherlands, the USA and Germany. This article investigates potential factors contributing to Denmark having ahigher national usage of mUKA, surpassing the recommended threshold of ausage > 20%. We explore the tradition for national alliances and streamlined surgical education as possible explanations of this development. These insights offer valuable perspectives for potentially optimizing surgical approaches and implant choices in the surgical treatment of end-stage AMOA of the knee across diverse healthcare settings, underscoring the impact of collective strategies in advancing knee arthroplasty practices, ultimately benefiting patients.

Successful medial unicompartmental knee arthroplasty-What are the most important surgical tricks?

Unicompartmental knee arthroplasty (UKA) is an established surgical treatment option for end-stage anteromedial osteoarthritis with excellent functional outcomes and implant survival. Routine preoperative varus and valgus stress views are crucial for the selection of patients for unicompartmental or total knee arthroplasty. UKA is asoft-tissue based operation that aims to reconstruct the individual joint line and pre-arthritic alignment by restoring the physiological tension of the medial collateral and the cruciate ligaments. Current data for medial UKA show excellent results for both mobile and fixed bearing implant designs with the correct indication and surgical technique. Cementless fixation offers potential advantages over cemented implants. Registry data demonstrate that institutions and surgeons specializing in partial knee replacement (> 30cases/year per surgeon, > 100/year per institution) with ahigh percentage of UKA relative to the total number of knee implants (> 20%) have significantly lower revision rates.

Individuals with knee osteoarthritis show few limitations in balance recovery responses after moderate gait perturbations

BackgroundKnee osteoarthritis causes structural joint damage. The resultant symptoms can impair the ability to recover from unexpected gait perturbations. This study compared balance recovery responses to moderate gait perturbations between individuals with knee osteoarthritis and healthy individuals. MethodsKinematic data of 35 individuals with end-stage knee osteoarthritis, and 32 healthy individuals in the same age range were obtained during perturbed walking on a treadmill at 1.0 m/s. Participants received anteroposterior (acceleration or deceleration) or mediolateral perturbations during the stance phase. Changes from baseline in margin of stability, step length, step time, and step width during the first two steps after perturbation were compared between groups using a linear regression model. Extrapolated center of mass excursion was descriptively analyzed. FindingsAfter all perturbation modes, extrapolated center of mass trajectories overlapped between individuals with knee osteoarthritis and healthy individuals. Participants predominantly responded to mediolateral perturbations by adjusting their step width, and to anteroposterior perturbations by adjusting step length and step time. None of the perturbation modes yielded between-group differences in changes in margin of stability and step width during the first two steps after perturbation. Small between-group differences were observed for step length (i.e. 2 cm) of the second step after mediolateral and anteroposterior perturbations, and for step time (i.e. 0.01–0.02 s) of first step after mediolateral perturbations and the second step after outward and belt acceleration perturbations. InterpretationDespite considerable pain and damage to the knee joint, individuals with knee osteoarthritis showed comparable balance recovery responses after moderate gait perturbations to healthy participants.

Total knee arthroplasty survivorship and outcomes in young patients: a review of the literature and 40-year update to a longitudinal study.

Growing numbers of younger patients are electing to undergo total knee arthroplasty (TKA) for end-stage osteoarthritis. The purpose of this study was to compare established literature regarding TKA outcomes in patients under age 55, to data from an ongoing longitudinal young patient cohort curated by our study group. Further, we aimed to provide a novel update on survivorship at 40years post-TKA from our longitudinal cohort. A literature search was conducted using the electronic databases PubMed, Embase, and Cochrane Library, using terms related to TKA, patients under age 55, and osteoarthritis. Demographic and outcome data were extracted from all studies that met the inclusion criteria. Data were divided into the "longitudinal study (LS) group," and the "literature review (LR) group" based on the patient population of the study from which it came. After screening, 10 studies met the inclusion criteria; 6 studies comprised the LR group, and 4 studies comprised the LS group. 2613 TKAs were performed among the LR group, and 114 TKAs were longitudinally followed in the LS group. The mean patient ages of the LR and LS groups were 46.1 and 51, respectively. Mean follow-up was 10.1years for the LR group. Mean postoperative range of motion was 113.6° and 114.5° for the LR and LS groups, respectively. All-cause survivorship reported at 10years or less ranged from 90.6% to 99.0%. The LS cohort studies reported survivorship ranges of 70.1-70.6% and 52.1-65.3% at 30 and 40years, respectively. Young TKA patients demonstrated improved functionality at each follow-up time point assessed. Survivorship decreased with increasing lengths of follow-up, ultimately ranging from 52.1-65.3% at 40years post-TKA. The paucity of literature on long-term TKA outcomes in this patient population reinforces the necessity of further research on this topic.

Total shoulder arthroplasty in patients with factor V Leiden

BackgroundAnatomic and reverse total shoulder arthroplasty (TSA) are effective treatment options for end-stage glenohumeral osteoarthritis. However, consideration for pre-existing conditions must be taken into account. Factor V Leiden (FVL), the most common inherited thrombophilia, is one such condition that predisposes to a prothrombotic state and may affect perioperative and longer-term outcomes following TSA. MethodsAdult patients undergoing primary TSA for osteoarthritis indication were identified in the 2010 through October 2021 PearlDiver M157 database. Patients with or without FVL were matched at a 1:4 ratio based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events and five-year revision rates were assessed and compared with multivariable logistic regression and rank-log tests, respectively. Finally, the relative use and bleeding/clotting outcomes were assessed based on venous thromboembolic (VTE) prophylactic agents utilized, with categories defined as (1) warfarin, heparin, or direct oral anticoagulant (DOAC) or (2) aspirin/no prescriptions found. ResultsOf 104,258 TSA patients, FVL was identified for 283 (0.27%). Based on matching, 1,081 patients without FVL and 272 patients with FVL were selected. Multivariable analyses demonstrated that those with FVL displayed independently greater odds ratios (ORs) of deep vein thrombosis (DVT, OR=9.50, p<0.0001), pulmonary embolism (PE, OR = 10.10, p<0.0001), and pneumonia (OR=2.43, p=0.0019). Further, these events contributed to the increased odds of aggregated minor (OR = 1.95, p=0.0001), serious (OR=6.38, p<0.0001), and all (OR=3.51, p<0.0001) adverse events. All other individual 90-day adverse events, as well as 5-year revision rates, were not different between the study groups. When compared to matched patients without FVL on the same anticoagulant agents, FVL patients on warfarin/heparin/DOAC agents demonstrated lesser odds of 90-day DVT and PE (OR=4.25, p<0.0001 and OR=2.54, p=0.0065) than those on aspirin/no prescriptions found (OR=7.64 and OR=21.95, p<0.0001 for both). Interestingly, those on VTE prophylactic agents were not at greater odds of bleeding complications (hematoma or transfusion). Discussion and ConclusionsTSA patients with FVL present a difficult challenge to shoulder reconstruction surgeons. The current study highlights the strong risk of VTE that was reduced but still significantly elevated for those with stronger classes of VTE chemoprophylaxis. Acknowledging this risk is important for surgical planning and patient counseling, but also noted was the reassurance of similar 5-year revision rates for those with versus without FVL.

Osteochondral Allograft Transplantation in the Knee

Osteochondral injuries of the knee can be a frequent source of debilitating pain and dysfunction. Significant chondral (>1.5-2 cm2) lesions of the femoral condyles can be especially difficult to manage with nonsurgical measures. Fresh osteochondral allograft (OCA) transplantation has been shown to be a reliable surgical procedure to manage a wide array of high-grade focal chondral lesions, with or without subchondral bone involvement. OCA transplantation affords the transfer of a size-matched allograft of mature hyaline cartilage with its associated subchondral bony scaffold. Indications include primary or secondary management of large, high-grade chondral or osteochondral defects secondary to trauma, developmental malformation, osteonecrosis, or other focal degenerative disease. Contraindications include end-stage osteoarthritis, uncorrected malalignment, ligament or meniscus deficiency, and inflammatory joint disease. Improvements in surgical technique, allograft storage, and tissue availability have created more reproducible clinical results and increased chondrocyte viability. Long-term (>10 year) graft survival rates have been shown to be between 70% and 91%, and the procedure has been shown to be cost-effective based on cost per quality-adjusted life year. Finally, OCA transplantation has been shown to provide excellent return to play rate for athletes with medium-to-large cartilage lesions. OCA transplantation is therefore an important option in the treatment algorithm of articular cartilage injuries.

An Innovative Clinical Evaluation Protocol after Total Ankle Arthroplasty: A Pilot Study Using Inertial Sensors and Baropodometric Platforms

Background: Total ankle arthroplasty (TAA) has grown in popularity and indications, with encouraging results over time. Today, preoperative and postoperative evaluations are mainly performed using clinical test and diagnostic imaging, but there is a deficiency in objectively evaluating the biomechanics of the foot and ankle, which serve as the functional markers for monitoring the effectiveness and outcomes of surgery. Inertial measurement units associated with plantar pressure measurements may provide an accurate and reliable method of evaluating function through the analysis of gait and ankle joint mobility. The aim of this study was to introduce an innovative technology, to assess its accuracy and feasibility compared to standard clinical assessment methods and to objectify kinematic outcomes in patients with end-stage ankle OA before and after TAA surgery. Methods: A consecutive series of eight patients with symptomatic end-stage osteoarthritis and treated with TAA was prospectively evaluated using clinical scores (AOFAS, MOxFQ, VAS, SF-36, 17-IFFI), physical tests (FPI, ALT), plantar pressure measurements with FLEX EPS/R2 Letsense® baropodometric platform, gait analysis and wearable sensors-based ankle motion and kinematic outcomes using Wiva Science inertial sensors by Letsense®. Data were collected preoperatively and 4 months after surgery. Results: All PROMs exhibited statistical significance in improvement from pre- to postoperative periods, except for one. Physical examinations showed no significant changes of the foot shape and alignment. Plantar pressure analyses revealed no significant changes in static and dynamic evaluations, but a more uniform distribution of plantar pressure was observed between the two periods. Inertial sensor parameters demonstrated no significant differences, except for a significant reduction in stride length and step length for the operated foot after surgery. Conclusions: Gait analysis using inertial sensors and plantar pressure measurements offer ease of handling, cost effectiveness, portability and swift data reading, making them highly appealing for widespread clinical use. Integrating these tools into the routine assessments of patients with TAA holds promise for advancing precision of treating this condition and our depth of its understanding, contributing to more comprehensive and insightful patient care.

Research progress of lower extremity alignment in total knee arthroplasty

Knee osteoarthritis has become one of the common diseases of the elderly, total knee arthroplasty （TKA） is the most effective treatment for end-stage knee osteoarthritis at present. In TKA, the effective restoration of the lower extremity alignment is one of the key factors for the success of the operation, which greatly affects the postoperative clinical effect and prosthesis survival rate of patients. Mechanical alignment is a TKA alignment method which is first proposed, recognized and widely used in TKA. In recent years, with the in-depth research on the lower limb alignment and the rapid development of computer technology, the alignment technology in TKA has realized the transformation from "unified" to "individualized", two-dimensional to three-dimensional. New alignment methods, such as adjusted mechanical alignment, anatomic alignment, kinematic alignment, inverse kinematic alignment, restricted kinematic alignment and functional alignment have been proposed to provide surgeons with more choices. However, there is no conclusion on which alignment method is the best choice. This paper summarizes the current research status, advantages and disadvantages of various alignment methods in TKA, and aims to provide some reference for the selection of alignment methods in TKA.

Why Kinematic Alignment Makes Little Sense in Valgus Osteoarthritis of the Knee: A Narrative Review.

There is a debate about the best alignment strategies in total knee arthroplasty (TKA). Mechanical alignment (MA) targets in combination with necessary soft tissue releases are the gold standard for TKA in end-stage valgus osteoarthritis. Some authors propagate kinematic alignment (KA) with the aim of restoring the patient's native alignment and minimizing the need for soft tissue releases. Our previous studies showed that MA with standardized soft tissue release produces reproducible results, and that the preoperative phenotype does not influence the results of patients with valgus osteoarthritis. These data suggest that there is no functional advantage to preserving valgus alignment in patients with valgus osteoarthritis. Many patients with valgus osteoarthritis present with a compromised medial collateral ligament and leaving the knee in valgus could increase the risk of secondary instability. The current literature supports MA TKA with soft tissue release as the gold standard. While using more sophisticated enabling technologies like robotic surgery might allow for aiming for very slight (1-2°) valgus alignment on the femoral side, any valgus alignment outside this range should be avoided. This review paper summarizes our current knowledge on the surgical techniques of TKA in patients with valgus osteoarthritis.