Knee Arthroplasty Research Articles

Health-Related Quality of Life, Body Mass Index and the 10-Metre Walk Test in Patients Awaiting Total Knee or Hip Arthroplasty: A Cross-Sectional Data Analysis with Matched Controls

The study compares the body mass index (BMI), 10-m walk test results, and self-rated health-related quality of life (HRQoL) of patients awaiting total knee or hip arthroplasty with age and sex-matched controls. Additionally, we investigated relationships between these variables to better understand how mobility impairments and HRQoL contribute to the need for surgical intervention. Forty-three patients (age: 66.7 ± 8.7 years) awaiting total knee arthroplasty (n = 23) or total hip arthroplasty (n = 20) and 54 healthy control individuals (age: 65.6 ± 1.5 years) participated in this study. Weight and height were measured, the BMI was calculated, the 10 m walk test was performed, and HRQoL was assessed using the EQ-5D-5L questionnaire. Patients had a significantly higher BMI than controls (p = 0.037), with the majority of both groups classified as overweight or obese (patients, 86%; controls, 73%). Patients also walked significantly more slowly than controls (p < 0.001). HRQoL was significantly lower in patients across all dimensions (p < 0.001), with the greatest impairments observed in mobility, usual activities, and pain. Significant but weak correlations (p = 0.001–0.042, rs = 0.31–0.48) were found between the HRQoL, BMI, and 10 m walk test results. These findings confirm that patients awaiting total knee or hip arthroplasty exhibit an increased BMI, reduced locomotor function, and impaired HRQoL, highlighting the extent of functional limitations in individuals with end-stage osteoarthritis. The strong association between mobility impairments and HRQoL further underscores the impact of osteoarthritis on daily life and the increasing need for surgical intervention.

Effects of kinesio taping in patients undergoing knee or hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

To assess the effects of kinesio taping on pain, oedema, range of motion, and joint function following knee or hip arthroplasty. Eight databases were searched up to 9 January 2024. Patients undergoing rehabilitation after knee or hip arthroplasty were included. The intervention group received kinesio taping with postoperative rehabilitation, while the control group received postoperative rehabilitation alone. Outcomes for knee arthroplasty patients, included pain, oedema, range of motion, and the Hospital for Special Surgery knee score. For hip arthroplasty, the outcome focused on pain. Eleven randomized controlled trials involving 774 participants met the inclusion criteria. In knee arthroplasty patients, kinesio taping significantly reduced pain (standardized mean difference [SMD] = -0.53, 95% CI -0.91 to -0.14, p = 0.007), and relieved thigh (SMD = -0.38, 95% CI -0.65 to -0.12, p = 0.005) and ankle circumferences (SMD = -0.53, 95% CI -0.95 to -0.12, p = 0.01). It improved the total range of motion (SMD = 1.26, 95% CI 0.93 to 1.60, p < 0.00001) and Hospital for Special Surgery knee score (SMD = 2.17, 95% CI 1.70 to 2.65, p < 0.00001). No significant pain intensity reduction was observed in hip arthroplasty patients (p = 0.25). Kinesio taping combined with postoperative rehabilitation effectively reduces oedema and pain, and improves joint function in knee arthroplasty patients, but does not alleviate pain in patients following hip arthroplasty.

Effect of a tailor-made hydrotherapy on physical functions in patients after unilateral unicompartmental knee arthroplasty-A feasibility study.

Unicompartmental knee arthroplasty (UKA) is one of the treatment options for patients whose osteoarthritis involves one out of the 3 compartments. Patients who underwent UKA benefited from shorter hospital stays, better range of motion, and lower risk of postoperative complications compared with patients who underwent total knee arthroplasty (TKA). Hydrotherapy is being introduced complementary to conventional postoperative rehabilitation programs. No report on the use of hydrotherapy evaluating physical functions on patients who underwent UKA leads us to carry out the present study. This is a feasibility study to investigate the effects of hydrotherapy on physical functions in patients after primary unilateral UKA. A retrospective cohort study recruited 68 patients who underwent primary unilateral UKA. Nineteen patients were allocated to the hydrotherapy group and 49 patients were in the convention group. Patients in the hydrotherapy group received hydrotherapy and conventional physiotherapy, and the convention group was given conventional physiotherapy only. The primary outcome was Knee Society Function Score (KFS) measured before surgery, six months, and one year after UKA. Self-reported walking tolerance, Timed Up and Go Test (TUGT), and 30-s Chair Stand Test (30CST) were conducted before and after the completion of rehabilitation. Pain and range of motion were also covered. Hydrotherapy group showed significantly higher KFS at 6months (P = 0.038) and one year (P = 0.030) after operation. Range of motion flexion and extension in the hydrotherapy group were significantly improved at postoperative 4 weeks and the last session of rehabilitation. Self-reported walking tolerance in the hydrotherapy group was significantly longer at the last session (P = 0.011). No significant difference was found in TUGT, 30CST, and pain between the two groups after rehabilitation. In both groups, all outcomes were significantly better as compared to preoperative findings. Patients who underwent UKA after hydrotherapy complementary to conventional physiotherapy showed significant improvements in functions, range of motion, and time to tolerating walking before rest. Pain, mobility, balance, leg strength, and endurance were comparable between the two groups. Combination of hydrotherapy with conventional postoperative physiotherapy rehabilitation yielded even better outcomes than conventional physiotherapy alone. Further research with advanced study design, larger sample size and longer follow-up periods for patients who underwent UKA is recommended. NCT06459960, retrospectively registered on 13.06.2024 (ClinicalTrials.gov).

Robotic functional alignment in knee arthroplasty minimizes impact on ankle alignment: Role of MPTA and LDFA preservation.

Alignment strategies in knee arthroplasty have a profound influence not only on knee biomechanics but also on the biomechanics of adjacent joints, particularly the ankle. Functional alignment (FA) represents a flexible alignment strategy aimed at achieving patient-specific balance. However, predefined boundaries are often applied to ensure mechanical stability, leading to adjustments in the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) while still respecting the patient's native alignment as much as possible. FA is a patient-specific strategy that seeks to respect the patient's preoperative phenotype or constitutional alignment while achieving a balanced and stable knee. The hypothesis is that FA strategies can protect the ankle from excessive biomechanical stress. A retrospective cohort analysis was conducted on 300 consecutive patients who underwent robotic-assisted knee arthroplasty. Preoperative and 6-month post-operative radiographic evaluations measured key ankle parameters, tibial plafond inclination (TPI), talar inclination (TI) and Talar Tilt (TT). Statistical analyses evaluated the influence of alignment strategies on these parameters, with particular focus on whether MPTA and LDFA crossed the 90° threshold, indicating a shift from varus to valgus or vice versa. FA demonstrated smaller changes in ankle parameters compared to mechanical alignment (MA). In the FA group, mean changes were 1.8° for KTPA (standard deviation [SD] = 1.1°, p = 0.03), 2.4° for TPI (SD = 1.0°, p = 0.04), 2.1° for TI (SD = 1.3°, p = 0.05) and 1.7° for TT (SD = 0.9°, p = 0.04). The MA group showed greater deviations: 3.9° for KTPA (SD = 1.5°, p = 0.01), 5.2° for TPI (SD = 1.2°, p = 0.02), 4.8° for TI (SD = 1.4°, p = 0.03) and 3.6° for TT (SD = 1.1°, p = 0.04). Alterations in LDFA and MPTA exceeding 2° were significantly associated with worsening ankle alignment. Furthermore, FA, with its goal of maintaining Coronal Plane Alignment of the Knee (CPAK) classification, was associated with minimal modifications to ankle angles, suggesting potential biomechanical benefits as reported in the literature. FA was associated with smaller changes in ankle alignment parameters, indicating its ability to better preserve native joint positioning. Future research should focus on longitudinal studies to confirm these benefits and further establish the FA strategy as a standard in knee arthroplasty, particularly its capacity to maintain CPAK classification alignment. Level III.

Physiotherapists’ Experiences with the Hip Disability and Knee Injury Osteoarthritis Outcome Score Following Total Hip and Knee Arthroplasty: A Qualitative Interview Study

Background: Clinical guidelines for physiotherapy following total hip and knee arthroplasty (THA/TKA) recommend using Patient-Reported Outcome Measures (PROMs) like the Hip disability and Knee injury Osteoarthritis Outcome Score (HOOS/KOOS). However, it remains unclear how physiotherapists use these PROMs in daily clinical practice. Objective: To explore primary care physiotherapists’ experiences with the HOOS/KOOS in daily clinical practice following THA and TKA. Methods: Thirteen physiotherapists in the Netherlands were recruited via convenience sampling. Data were collected through semi-structured interviews, which explored HOOS/KOOS use in clinical practice, administrative regulations, and applications beyond patient care, as well as think-aloud interviews to capture perceptions of the content of these PROMs and interpretations of hypothetical patient scores. Interviews were analysed using reflexive thematic analysis. Results: The physiotherapists’ ages ranged from 25 to 54y, with annual THA/TKA volumes from 5 to 50 patients. Three themes emerged, as follows: (1) “Physiotherapists use the HOOS/KOOS for various purposes in daily clinical practice”, including complementing history taking and monitoring patient progress; (2) “Perceptions of the relevance of the HOOS/KOOS for daily clinical practice vary per item, domain, and version,” with items related to daily life activities and psychosocial factors being perceived as more valuable; and (3) “Practical aspects of HOOS/KOOS administration influence their use in daily clinical practice,” with electronic health records (EHRs) that facilitate PROM administration enhancing their use, while administrative regulations limit this. Conclusions: Physiotherapists experience HOOS/KOOS items related to daily life activities and psychosocial factors useful for history-taking and monitoring patient progress, particularly when embedded in EHRs that facilitate PROM administration.

ChatGPT’s role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study

Background: Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored. Methods: In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires. Results: Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P&lt;.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels. Conclusions: ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.

Current AWMF guidelines on knee and hip arthroplasty- individual risks

In the year 2022, more than 300,000 total hip and knee primary arthroplasties were recorded in the German Arthroplasty Registry. The ever-increasing number of interventions naturally leads to an increase in the absolute number of possible complications. The abundance of internationally available data makes it possible to determine risk factors for postoperative complications. Professional societies involved in the German guidelines in the field of orthopedics place great emphasis on modifiable risk factors, as their adequate management can consequently reduce the likelihood of postoperative complications. One of the most common modifiable risk factors is obesity, with its prevalence remaining consistently high in most developed countries. In the field of orthopedics, the Association of the Scientific Medical Societies in Germany focuses on modifiable risk factors including obesity, diabetes mellitus and smoking. In the case of obesity in particular, the guidelines for knee and hip arthroplasty recommend aweight loss attempt for patients with aBMI > 30 kg/m2. ABMI ≥ 40 kg/m2 is considered a"relative contraindication" in the guidelines. Shared decision making is emphasized in both guidelines. Ultimately, the particularly critical individual assessment of risk and benefit for each obese patient remains crucial for the final decision.

Septic vs. aseptic revision knee arthroplasty: are scoring systems effective in communicating the nuances?

In comparison to primary TKA, outcomes of revision TKA will always appear inferior. When trying to assess outcomes of revision TKA for PJI, a group of aseptic revisions can serve as a reliable control, as compared to primary TKA. Our primary aim was to compare functional outcomes of septic versus aseptic revisions by using 5 scoring systems. We retrospectively reviewed 45 revision knee arthroplasty cases. Of the 45 cases, 17 belonged to the septic group and 28 to the aseptic group. The scores obtained were assessed for differences between the two groups using the Mann-Whitney U test. Pearson correlation coefficient (r) was calculated to assess the correlation between the PCS and MCS of the SF-36 score vs. other scores. The mean WOMAC score in the septic group was 38.88 ± 6.35 and in the aseptic group was 44.96 ± 10.07. With regards to the SF-36 score, the RE component (role limitations due to emotional problems) showed a significant difference, being poorer in the septic group (51.06 ± 31.57) as compared to the aseptic group (69.18 ± 28.62). We found a higher incidence of rest pain and nocturnal pain in the septic group. None of the scoring systems showed correlation with the SF-36 score. In our study, there was a significant difference in the outcome of revision TKA based on etiology only with regards to the WOMAC score. Moreover, our study brings to the fore the importance of not just surgical management of patients with septic failure but also the importance of paying heed to the emotional and social problems encountered by these patients which has an impact on their outcome as a whole and diminishes their perception of benefit from revision surgery in spite of equivocal knee scores as compared to their counterparts.

Comparative study of outcomes with total knee arthroplasty: medial pivot prosthesis vs posterior stabilized implant. Prospective randomized control.

Total knee arthroplasty (TKA) is an effective procedure for pain relief and restoration of function in patients with symptomatic end-stage knee arthritis. Kinematic problems due to conventional implant design have been postulated. The objective of this study is to determine if there was any difference in postoperative ROM and outcomes between patients undergoing MP-TKA vs PS-TKA. We prospectively colected the records of 600 consecutive patients with TKA performed by six senior orthopaedic surgeons between 2017 - 2021. We compared the ROM and patient-reported outcomes (Western Ontario McMaster Osteoarthritis Index WOMAC, Oxford Knee Score OKS, Knee Society Score KSS, Forgotten Joint Score FJS) between MP TKA and PS TKA. There were no specific criteria for implant selection as the two groups were consecutive cohorts of patients and implant selection depended on surgeon preference. Demographics, comorbidities, diagnosis and severity of osteoarthritis were similar between MP and PS groups. The trend for OKS in our study is the same in both groups, but with higher mean values in the MP group. The trend of WOMAC pain, stiffness and disability score is the same in both groups, but with higher mean values in the PS group at one year and two years. KSS clinical and functional score is the same in both groups, but with higher mean values in the MP group. The most important score is forgetten joint score which is favourable for the MP group. The patients who underwent the MP-TKA scored better than those who underwent the PS-TKA, particularly regarding deep knee flexion and stability of the prosthesis. This may be related to better replication of natural knee kinematics with MP-TKA.

Effect of Resurfaced Patellar Thickness on Outcomes after Total Knee Arthroplasty: Paper for Salman and Karen to process.

Total knee arthroplasty (TKA) is the gold standard for treatment of end stage knee osteoarthritis. Patellar resurfacing is an optional step in the procedure and remains a controversial topic of discussion. This retrospective study aims to assess the impact of over-resecting and under-resecting the patella during resurfacing on patient reported outcomes (PROMs) and range of motion (ROM) after surgery. 438 (92.2%) of 475 patients who underwent TKA between August 2017 and November 2019 at a single center by a single surgeon were included in the analysis. Patients were split into three study groups based on reconstructed patellar thickness; normal resection (NR) was defined as within 2 mm native thickness, over-resected (OR) was defined as ≤ -2 mm, and under-resected (UR) was defined as ≥ 2 mm. Statistical analyses included chi-squared test, mixed effect models, and cox proportional hazards models. There were 364, 41, 33 patients were in NR, OR, UR group respectively. The cohort mean age at time of surgery was 67.1 ± 9.1 and had mean length of follow-up of 2.1 ± 1.7 years with no difference among cohorts. Significant differences were found in gender (p<0.001) and BMI (p=0.0134) with UR having less males, OR having more males, and OR having lower BMI. At 6 months, the complete cohort ROM improved from 108.7 ± 14.4 degrees to 111 ± 11 degrees, objective Knee Society Score (KSS) increase from 15.4 ± 11.2 to 36.2 ± 12, functional KSS increase from 47.3 ± 18.9 to 65.6 ± 22.2, and knee injury and osteoarthritis outcome score increase from 46.1 ± 15 to 70.7 ± 15 with no significant differences among cohorts. There were no patellofemoral related complications. This study supports that while it is important to restore the anatomy in the anterior compartment of the knee, minor changes in patellar thickness from patellar resurfacing likely have minimal impact on outcomes for patients. Further studies with a larger sample size are necessary to further validate these findings.

Resolution of Fixed Flexion Contracture Following Kinematically Aligned Manual Total Knee Arthroplasty Without Raising the Joint Line

Background Persistence of fixed flexion contracture (FFC) following total knee arthroplasty (TKA) is a common occurrence, resulting in poor postoperative outcomes. Soft tissue releases and distal femoral resection have been previously studied in attempts to address this issue. There is a scarcity of literature on the resolution of FFC following primary kinematically aligned (KA) manual TKA without raising the joint line. In this study, we evaluated post-operative range of motion (ROM) in patients with a preoperative FFC following primary KA TKA without raising the joint line. Methods Eighty-five patients with preoperative FFC who underwent a primary KA TKA without distal femoral resection by a single arthroplasty-trained surgeon were identified. Demographics and pre-operative range of motion were obtained. Primary outcomes included post-operative range of motion at 6-weeks and one-year. Secondary outcomes included infection, revision rates, manipulation under anesthesia, and wound complications. Results A total of 85 patients were included, with an average pre-operative extension of 5.5° (std dev, 2.2°). Of the 85 patients, 5 had a flexion deformity within 5° of full extension, with the other 80 patients having extension ≥5° to 20°. Post-operatively, 21.2% and 5.9% of patients had a flexion contracture at 6-weeks and one-year respectively. Average post-operative extension at 6-weeks was 1.5° (std dev, 4.1°) and 0.5° (std dev, 2.3°) at one-year. Conclusion In this study, we found improvement in flexion deformity at 6-weeks and 1-year following primary KA TKA without raising the joint line. There were two cases of manipulation under anesthesia for post-operative joint stiffness.

Robotic-assisted partial knee surgery performances: A 10-year follow-up retrospective study.

Robotic surgery has emerged as an advanced technique for facilitating knee prosthesis implantation, especially in cases requiring high precision. However, due to the recent introduction and implementation of this approach, long-term data on its outcomes remain limited in the literature. This study aims to assess implant survival, complications and reoperation rates resulting from robotic arm-assisted partial knee arthroplasties, with a long-term follow-up period. A retrospective analysis was conducted on 236 patients who underwent robotic arm-assisted partial knee arthroplasty, with a minimum follow-up of 10 years. Clinical outcomes were evaluated, focusing on implant survival, complications, reoperation rates, and overall patient satisfaction. The study primarily examined medial unicompartmental knee arthroplasty (UKA), with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS) Part 1 and KSS Function scores assessed preoperatively and at the last follow-up. Among the 236 patients, 212 were available at the last follow-up; satisfaction rates were overall positive, with 210 patients reporting being 'satisfied' or 'very satisfied'. Both WOMAC score and KSS showed statistically significant improvement postoperatively, both globally and in UKA patients specifically. The study demonstrates excellent long-term satisfaction rates, improved clinical outcomes and implant survival with minimal surgical morbidity. These findings offer valuable insights into the effectiveness of robotic arm-assisted knee arthroplasty. Level III, retrospective comparative study.

Total Knee Arthroplasty in a Knee Locked in Extension: A Case Report

Total Knee Arthroplasty in a Knee Locked in Extension: A Case Report

Investigation of customized total knee implant with articular cartilage under loading conditions using finite element analysis.

Knee osteoarthritis (KOA) is a degenerative joint disease predominantly affecting the elderly and is often managed through knee replacement surgeries. West Asians, who frequently engage in activities involving bending and kneeling during their prayers, tend to exhibit distinct bone anatomy compared to the Caucasian population. This research posits that patient-specific, customized knee implants with articular cartilages may lead to reduced post-surgical discomfort and a better implant fit compared to conventional standard implants. This study presents a novel concept and approach for the development of a customized total knee implant with articular cartilages, specifically tailored to simulate loading conditions using finite element analysis (FEA) for the Saudi Arabian population. The research analyses patient-specific customized knee implants with articular cartilages under both pre- and post-implant conditions using a finite element model (FEM). Computed tomography (CT) images of patients were utilized to create a solid model, which was then analysed under various constraints and conditions. The meshing process employed tetrahedral elements, converging with 76,197 nodes and 43,009 elements. The analysis was conducted under different body weights, specifically 75-80 kg and 100-105 kg. Two sets of force and moment were applied: the first with a force of 1000 N and a moment of 1.5 N-m, and the second with a force of 750 N and a moment of 0.8 N-m. The results indicated a 5% reduction in stress with implants designed for a 100 kg body weight, along with a significant reduction in ligament strain when compared to conventional knee joint stresses. This study offers a promising pathway toward reducing post-surgical discomfort. The proposed innovative solution has the potential to revolutionize total knee implant technology, offering enhanced functionality and improved patient outcomes for the Saudi Arabian population.

Smartphone-Based Care Platform Versus Traditional Care in Primary Knee Arthroplasty in the Unites States: Cost Analysis.

Cost savings were achieved with the use of a smartphone-based care management platform, considering several health care resources following knee arthroplasty procedures without negatively impacting clinical outcomes.

Current trends of unicompartmental knee arthroplasty (UKA): choosing between robotic-assisted and conventional surgeries and timing of procedures

BackgroundWith robotic advancements in UKA technology, we sought to explore if robotic-assisted UKA could translate to clinical benefits such as reduced hospital stays and lowered emergency readmissions. Also, current utilization trends of UKA and choice of procedure timing (unilateral [uUKA] vs. one-staged bilateral UKA [biUKA]) could be explored.MethodsThis was a retrospective study utilizing the Clinical Data Analysis and Reporting System (CDARS) for data retrieval. All patients who had undergone primary UKA in all Hospital Authority (HA) hospitals in HK from 2021–2023 were included. Primary outcomes included utilization of UKA compared to TKA and percentage utilization of different UKA systems, namely, conventional, Mako, and Cori/Navio systems, from 2021–2023. Secondary outcomes involved: (1) patient demographics, (2) postoperative average length of stay (ALOS), (3) 30-day and 90-day postoperative Accident and Emergency Department (AED) attendance, (4) surgical times (skin-to-skin) and (5) 90-day mortality and reoperation. Differences in outcomes between uUKA and biUKA and between different robotic systems were examined. Regression analysis was performed to study if utilization of robotic-assisted systems could contribute to reduced hospital stays.ResultsUKA accounted for 15.2% of primary knee arthroplasties throughout 2021–2023. Robotic-assisted UKA (Mako and Navio/Cori) has shown an increasing utilization since 2022 in both unilateral (16.0% to 25.9%) and bilateral operations (17.8% to 29.0%). Mako had shorter ALOS than Navio/Cori (2.9 ± 1.6 vs. 3.6 ± 2.6 days; P = 0.006) and significantly shorter ALOS than conventional UKA (2.9 ± 1.6 vs. 3.6 ± 2.6 days; P = 0.004). Utilization of Mako was predictive of shortened ALOS on multi-linear regression (β = − 0.056; P = 0.049). Interestingly, biUKAs, especially conventional ones, showed a lower attendance rate than uUKAs at 30-day (2.9% VS 6.9%; P = 0.036) and 90-days (7.8% VS 15.7%; P = 0.004). Robotic-assisted surgery was associated with a prolonged surgical time of 16.4 min in uUKA and 29.1 min in biUKA compared to conventional operations.ConclusionUKA utilization has dropped since 2021 but the percentage of robotic-assisted UKA has risen. Mako yielded promising results in reducing hospital stays compared to conventional operations. Sub-group analysis (Mako versus Cori/Navio) highlighted the importance of distinguishing between different robotic platforms. For patients with bilateral unicompartmental OA, biUKA was shown to be a safe and effective alternative to unilateral operations.Trial RegistrationRegistered (HKU/ HA HKW IRB; Ref No: 24–373).

Association Between Surgeon Volume and Patient Outcomes After Elective Patellofemoral Arthroplasty: A Population-Based Cohort Study Using Data from the National Joint Registry and Hospital Episode Statistics for England.

The objective of this study was to determine the relationship between surgical volume and patient outcome after arthroplasty of the patellofemoral joint, to improve patient outcomes and inform future resource planning. All patellofemoral arthroplasty (PFA) records in the National Joint Registry from January 2003 to December 2021 were linked to the Hospital Episode Statistics database for England. The main outcome measure was revision surgery. Secondary outcome measures were serious adverse effects, patient selection characteristics, and implant designs used. Associations of early and late revision with surgical volume were examined based on surgical volume, and reasons for revision were explored. Of the knee arthroplasty surgeons in the database, 858 (26%) performed ≥1 PFA during the study period; 14,615 PFA cases were available for analysis. The modal caseload was 2 per year. High-volume surgeons were defined as surgeons performing >5 PFAs per year. The hazard ratio (HR) for a high-volume surgeon was 0.98 per additional PFA per year, and the patients treated by these surgeons had a lower risk of revision than than those treated by low-volume surgeons irrespective of the patient's age. High-volume surgeons were more likely to identify and treat patients with patellar disorders than low-volume surgeons (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.09 to 1.77; p < 0.05), and their patients were less likely to have serious adverse effects as these surgeons' experience increased (OR per additional PFA per year, 0.97; 95% CI, 0.95 to 0.99; p = 0.02). Inlay implants had a higher risk of revision than onlay implants irrespective of surgical experience: for low-volume surgeons, inlays had an HR of 1.68 (95% CI, 1.23 to 2.30; p = 0.01), and for high-volume surgeons, inlays had an HR of 2.38 (95% CI, 1.83 to 3.11; p = 0.01). The most common reason for revision was progressive osteoarthritis. High-volume surgeons' patients were less likely than low-volume surgeons' patients to have an early revision (<2 years postoperatively) (OR, 0.72; 95% CI, 0.55 to 0.93; p < 0.05). An association was found between surgeons performing >5 PFAs per year and a lower revision rate. This study should inform surgical planning services to improve the outcomes of PFA. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Personalized Prediction of Total Knee Arthroplasty Mechanics Based on Sparse Input Data—Model Validation Using In Vivo Force Data

Background/Objectives: Computational models are increasingly used in orthopedic research, such as in the context of total knee arthroplasty (TKA). However, the models’ actual integration in clinical practice is far from routine. Major limitations include the amount of input data, effort, and time required for personalization and simulation. In this paper, we present and validate a patient-specific multi-body musculoskeletal TKA model based on sparse input data to address these limitations. Methods: The simulation model was individualized based on the patients’ bone and knee implant 3D geometries, predicted bony landmarks, and soft tissue attachments using annotated statistical shape models, a statistical squat motion pattern, and a statistically based load case. For the validation, we used publicly accessible in vivo knee contact forces during squatting from four patients of the Grand Challenge Competitions (GCCs). Results: The prediction accuracy was quantified using several error metrics, including the root mean square error (RSME). For GCC3 and GCC5, both the range and trend of the mean in vivo contact forces were well matched by the simulation (RMSE lateral: 8.2–26.1% of body weight (BW); RMSE medial: 15.9–42.7 %BW). In contrast, there were relevant deviations between the experiment and simulation in the trend of contact forces for patient GCC2, as well as in the range of medial contact forces for patient GCC6 (RMSE medial: 52.6 %BW). The model setup time was at the magnitude of 15 min per patient, and the simulation was completed in less than 4 min. Conclusions: When comparing our results with the literature, we found similar accuracy to state-of-the-art models in predicting knee contact forces. While remaining deviations between in vivo and simulation data still warrant investigation and evaluation for clinical significance, the model has already successfully addressed important limitations of these previous models, which represent significant barriers to clinical application.

The Influence of Multiple Modifiable Risk Factors on 30-day Readmissions and 90-day Major Complications After a Total Hip and Knee Arthroplasty: An Analysis of a Large Claims Database.

Preoperative optimization of modifiable risk factors (MRFs) for arthroplasty patients is a critical aspect of predicting and improving postoperative outcomes. This study evaluates the correlation between seven MRFs and postoperative adverse outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA). A retrospective review of primary TKA and THA were identified from a large medical claims database. Patients were categorized based on the number of MRF diagnoses present before surgery (anemia, malnutrition, obesity, opioid abuse/dependence, mental illness, type 2 diabetes mellitus, and tobacco use), from zero to seven. Adverse outcomes evaluated were surgical site infections (SSIs), venous thromboembolic events (VTEs), and readmissions. Of the patient records queried (THA = 303,857; TKA = 692,157), two or more MRFs were identified in 41% of THA patients and 47% of TKA patients. Patients with two or more MRFs were at an increased odds of developing an SSI, and patients with three or more MRFs had increase odds of having a 30-day hospital readmission. This study adds to the compendium of literature, which promotes preoperative optimization of MRFs in arthroplasty patients to decrease the risks of 90-day postoperative complications.

Associations between low sex steroid concentrations and incidence of knee and hip replacement for osteoarthritis in community-dwelling older women.

To examine whether low circulating sex steroid concentrations are associated with the incidence of knee and hip replacement for osteoarthritis in community-dwelling older women. This prospective cohort study examined 5535 Australian women recruited into the Aspirin in Reducing Events in the Elderly (ASPREE) trial, aged ≥70years, not taking medications affecting sex steroid concentrations, and with sex steroid concentrations measured by liquid chromatography-tandem mass spectrometry. The incidence of knee and hip replacement for osteoarthritis was determined by hospitalisations for knee and hip surgical procedures where osteoarthritis was recorded as the indication. With a mean follow-up of 3.9 (SD 1.4) years, 311 women underwent knee replacement and 242 underwent hip replacement. A greater incidence of knee replacement was observed in women with the lowest quartile concentrations of oestrone (HR 1.35, 95% CI 1.04-1.75, p=0.03) and testosterone (HR 1.35, 95% CI 1.05-1.72, p=0.02) compared with quartiles 2 to 4, after adjusting for age, body mass index, socioeconomic status, smoking, alcohol consumption, and comorbidities. A greater likelihood of hip replacement was seen for women with the lowest quartile concentrations of dehydroepiandrosterone compared with quartiles 2 to 4 (HR 1.37, 95% CI 1.03-1.82, p=0.03). Low concentrations of endogenous sex steroids were associated with a greater likelihood of lower-limb joint replacement for osteoarthritis in community-based women aged 70years or older. These findings suggest sex steroids contribute to musculoskeletal health in later life, although the mechanisms by which sex steroids might influence joint replacement remain unclear. gov NCT01038583. International Standard Randomized Controlled Trial Number Register ISRCTN83772183.