Knee Society Function Score Research Articles

Does robotic surgical assistant (ROSA) functionally aligned TKA lead to higher satisfaction than conventional mechanically aligned TKA: A propensity-matched pair analysis

ObjectivesTotal knee arthroplasty (TKA) is the established treatment for severe knee osteoarthritis, with robotic-assisted TKA (rTKA) proposed to enhance surgical precision and potentially improve outcomes. This study investigates whether functionally-aligned rTKA using the ROSA Knee System results in superior functional outcomes and patient satisfaction compared to conventional mechanically aligned TKA (mTKA). MethodsWe conducted a retrospective, propensity-score matched cohort study including 154 patients (46 rTKA, 108 mTKA) who underwent primary TKA by a single surgeon from October 2020 to October 2023. Functionally-aligned (FA) rTKA was performed using the ROSA Knee System. Patients were assessed using the Short-Form 36 (SF36), Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and Oxford Knee Score (OKS) preoperatively and at 6 months postoperatively. Immediate postoperative outcomes such as pain at rest and movement, ambulation distance, and range of motion were measured. Statistical analysis evaluated results at a 95 % confidence interval, with significance at P < 0.05. ResultsNo significant differences were observed in immediate postoperative pain at rest (P = 0.988), pain during movement (P = 0.634), ambulation distance (P = 0.243), and range of motion (P = 0.752) between the groups. At 6 months, there were no significant differences between rTKA and mTKA in achieving the minimal clinically important difference for SF36 (P = 0.996), KSKS (P = 0.150), KSFS (P = 0.091), and OKS (P = 0.949). No significant differences were noted for satisfaction levels (P = 0.315) and fulfilled expectations (P = 0.557) between both groups. ConclusionsAt 6 months postoperatively, FA rTKA demonstrated equivalent outcomes and satisfaction levels compared to mTKA. Future research should focus on examining longer-term follow-up outcomes, quantifying gap balance in MA mTKA to allow direct comparison with rTKA and studying alternative personalised alignment rTKA strategies to enhance patient outcomes.

New evidence on patella resurfacing in modern total knee arthroplasty for all inflammatory arthritis in a mixed Asian population

BackgroundTraditional teaching advocates for routine patella resurfacing (PR) during total knee arthroplasty (TKA) in patients with inflammatory arthritis. However, evidence on this topic remains limited in the Asian population. This study aims to evaluate the postoperative outcomes and complication of patella resurfacing (PR) during primary total knee arthroplasty (TKA) in Asian patients with inflammatory arthritis. MethodsA retrospective analysis was conducted using registry data from our institution. Patients with inflammatory arthritis who underwent primary TKA from August 2017 to December 2021 were included in the study. Patients were divided into two groups - patella resurfaced (PR, n = 25) and non-resurfaced patella (PNR, n = 31) groups. Demographics, operative data, patient reported outcome measures, and complications were compared. ResultsPreoperative range of motion (ROM) (PR:95.3 ± 23.6° vs PNR:105 ± 19.5°, p = 0.106), Knee Society Scoring System Knee score (KS-KS) (PR:44.6 ± 17.4 vs PNR:49.3 ± 17.7, p = 0.331) and Knee Society Function Score (KS-FS) (PR:40.9 ± 27.3 vs PNR:47.7 ± 27.0, p = 0.325) and Oxford Knee Score (OKS) (PR:25.0 ± 7.8 vs PNR:23.3 ± 10.3, p = 0.525) were similar in both groups. Outcomes between PR and PNR groups at the one-year mark in terms of ROM (PR:112.7 ± 18.1 vs PNR:114.6 ± 16.5, p = 0.455), OKS (PR:41.5 ± 3.9 vs PNR:41 ± 4.7, p = 0.954), KS-KS (PR:84.5 ± 13.2 vs PNR:89.2 ± 9.3, p = 0.095) and KS-FS (PR:73.6 ± 18.3 vs PNR:78.7 ± 19.3, p = 0.173) were also similar. Intraoperative complication (PR:0/25 vs PNR: 3/31 (9.6 %), p = 0.245) and re-operation rates (PR: 1/25 (4 %) vs PNR: 1/31 (3.2 %), p = 0.877) were also similar in both groups. ConclusionThis study conducted on a mixed Asian population with inflammatory arthritis demonstrated that the one-year postoperative ROM and functional outcomes, complication, and re-operation rates between PR and PNR groups were similar. Hence, routine patella resurfacing on all Asian patients with inflammatory arthritis undergoing TKA may not be necessary.

Effectiveness of Periarticular Pin Tracker Placement Through a Single Main Incision in Robotic-Assisted Total Knee Arthroplasty: Technical Note and Short-Term Results.

Background and Objectives: Robotic-assisted total knee arthroplasty (TKA) is gaining popularity worldwide, leading to a potential increase in the number of pin tracker-related complications. This study determined the effectiveness of periarticular pin tracker placement in the distal femur and proximal tibia through a single main incision during robotic-assisted TKA over a minimum follow-up period of 6 months. Materials and Methods: A consecutive series of 149 TKAs was performed in 108 patients using the triathlon posterior-stabilized total knee prosthesis with a robotic-assisted system at our hospital from December 2023 to February 2024. Clinical outcomes and complications associated with pin tracker sites, including pin-site infection, neurovascular injury, hematoma, soft-tissue morbidity, and pin-site fracture, were assessed. Results: The mean Knee Society knee score improved from 42.5 preoperatively to 76.3 points at the final follow-up, whereas the mean Knee Society function score improved from 43.1 preoperatively to 78.1 points at the final follow-up (both p < 0.05). No patient experienced any minor or major complications related to the use of pin trackers in the distal femur and proximal tibia. Conclusions: This periarticular technique that uses pin trackers in the distal femur and proximal tibia through a single main incision could be a useful option for orthopedic surgeons while performing robotic-assisted TKA.

Mid-term outcomes of medial metal backed and all-polyethylene unicompartmental knee arthroplasty in obese patients: a retrospective propensity-matched analysis

BackgroundThis retrospective study compares the outcomes of unicompartmental medial fixed-bearing knee arthroplasty (mUKA), involving a cemented metal-backed (MB) or an all-polyethylene (AP) tibial component, performed in obese patients with a body mass index (BMI) > 30 with a follow-up of at least 5 years.MethodsThe institutional database was mined for primary mUKAs involving an MB or an AP tibial component (MB-UKA and AP-UKA groups, respectively) performed from January 2015 to August 2019. Patient demographics and patient-reported outcome measures (PROMs) were compared and a propensity score matching (PSM) analysis (1:1) using multiple variables was conducted.ResultsPSM analysis yielded 37 pairs of obese MB-UKA and AP-UKA patients. At 5 years, the Knee Society Function Score (KSFS) was 75.1 ± 10.6 in MB-UKA and 79.4 ± 9.1 in AP-UKA patients (p = 0.029), and the Oxford Knee Score (OKS) was 38.1 ± 4.4 in MB-UKA and 40.6 ± 5.7 in AP-UKA patients (p = 0.011).ConclusionAt five-year follow-up, in a matched group of obese MB-UKA and AP-UKA patients, the AP-UKA group achieved better KSFSs and OKSs. Both the AP and the MB tibial components were able to bring about a significant improvement of the most widely used PROMs.

An Evaluation of Intra-articular Pathologies Accompanying Tibial Plateau Fractures Postoperatively.

Tibial plateau fractures are one of the most complex and common intra-articular fractures encountered in trauma surgery. This study aimsto evaluate the MRI intra-articular findings of patients with tibial plateau fractures treated surgically and the functional and radiological changes after surgical treatment. A total of 91 patients admitted to our clinic between 2010 and 2019 and operated for tibial plateau fracture were identified from the hospital information system. Patients were excluded fromthe study if aged <18 years, if the radiographs and MRIs were not suitable for the measurements, or if they could not be contacted by telephone. The study was completed with 49 operated knees and 49 healthy knees of 49 patients. The patients were evaluated with respect to demographic characteristics, KneeSocietyKneeScore (KSKS), KneeSocietyFunction Score (KSFS), KneeInjuryandOsteoarthritisOutcomeScore (KOOS) functional and clinical scores, Rasmussen, Kellgren-Lawrence, and Whole-OrganMagneticResonanceImagingScore (WORMS) radiological scoring, and meniscus and ligament pathologies examined on the follow-up MR images. The patients comprised 39 males and 10 females with a mean age of 45.9±11.89 years, and a mean follow-up of 58.2±30.7 months. The fractures were seen to be 49% (n=24)in the lateral plateau, 6.1% (n=4) in the medial plateau, and 42.9% (n=21) were bicondylar fractures involving both plateaux. The KSKS knee score was satisfactory in 85.7% of the patients, the KSFS functional score in 89.7%, and the Rassmussen radiological score in 93.8%. In the KOOS subjective questionnaire, the mean points obtained were 430.7, and the mean total WORMS points were 34.2. According to the Kellgren-Lawrence grades, severe osteoarthritis (grade 3-4) developed in 18.3% (n=9) of the patients. Meniscus injuries that are overlooked at the time of the first injury or which may develop in the subsequent process were not found to seriously affect the functional outcomes of tibial plateau fractures. It can be considered that even if a ligament injury is seen to be accompanying the fracture at the time of the first trauma, the effect is not great in terms of prognosis, and the treatment can remain conservative, especially for collateral ligament injuries.

Total knee replacement in severe genu recurvatum. High prosthetic survival rate without deformity recurrence, using rotating hinge prosthesis

IntroductionGenu recurvatum can originate from neurological and non-neurological causes. Its presence associated with knee osteoarthritis represents 1 % of the causes of total knee replacement (TKR). The aim of this retrospective study was to show the functional outcomes, recurrence rate and prosthetic survival in patients with genu recurvatum treated with articulated rotating hinge prostheses. Methodsbetween January of 2008 and December of 2021, we performed 3224 primary TKR, of which 34 (1 %) had recurvatum. This was defined as hyperextension ≥10°. Inclusion crirteria were patients with primary TKR and recurvatum that were treated with a rotating hinge prosthesis (Endo Model, Walderman Link, Ham, Germany), and completed a minimum follow-up of 24 months. Final series consisted in 23 patients with 25 TKR with 15 (65.22 %) females and a mean age of 66.8 ± 14.2 years old. The median follow-up was 5.0 (range 2.11–11.5). Clinical analysis was performed with the use of Knee Society Score (KSS) and Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Prosthetic survival rate was calculated with a Kaplan-Meier curve considering as the endpoint of the analysis revision due to any reason. Recurrence was defined as the presence of hyperextension ≥ 5° after surgery. Resultsof the 23 patients, 9 (39.13 %) had history of neurological disorders. Median recurvatum observed was 20.12° (range 13.0° - 30.2°). A median of 19.6° (range 10.1° - 55.4°) valgus misalignment was observed in 19 patients and 10.7° (range 2.0–23.5°) of varus was observed in 6 (24 %) patients. Clinical and functional KSS improved significantly after 12 months (from 34.2 ± 9.8 and 40.1 ± 12.6 to 82.1 ± 7.5 and 89.2 ± 6.8 respectively; p < 0.01) and at the end of the study (84.3 ± 7.5 and 90.0 ± 11.3; p < 0.01). Final mean WOMAC value was 24.1 ± 9.6. One (4.0 %) complication was registered after surgery (superficial infection). Four (16.0 %) patients had demarcation. Prosthetic survival rate was 100 % at the end of the study. ConclusionThe rotating hinge prosthesis restores joint function in patients with severe knee osteoarthritis with and without neurological disorders, without recurrence of misalignment and with excellent survival rates.

Evaluating the Effectiveness of a Structural Allograft in Medial Open Wedge High Tibial Osteotomy in Patients With and Without a Lateral Hinge Fracture.

A lateral hinge fracture is a common complication in medial open wedge high tibial osteotomy (MOWHTO) and is associated with delayed union or nonunion. A comparison of outcomes between patients with or without a lateral hinge fracture after MOWHTO with a structural allograft has not been investigated. To validate the outcomes of MOWHTO with a structural allograft, especially in the presence of a lateral hinge fracture. Case series; Level of evidence, 4. We conducted a single-surgeon cohort study at a tertiary referral hospital between April 2017 and August 2022 and included patients who had undergone MOWHTO with a structural allograft for isolated medial compartment osteoarthritis with genu varum. We compared the incidence of delayed union or nonunion events and functional scores between patients with a lateral hinge fracture and those without using the Fisher exact test and independent t test. A total of 88 MOWHTO procedures (77 patients) were analyzed. The overall incidence of lateral hinge fractures was 29.5% (n = 26), including type I (n = 20 [22.7%]) and type II (n = 6 [6.8%]). Notably, 42.3% (n = 11) of these fractures had not been detected intraoperatively but during the follow-up visits. The overall Knee Society Score (KSS), Knee Society Score-Function (KSS-F), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 90.0 ± 10.0, 93.4 ± 10.8, and 93.8 ± 7.1 points, respectively. None of the patients had delayed union or nonunion, and none underwent a reoperation because of bony union problems. The functional scores (KSS, KSS-F, and WOMAC) were not different between patients who had a lateral hinge fracture and those who did not (P > .05). The routine use of a structural allograft was associated with satisfactory outcomes after MOWHTO, regardless of whether there was a lateral hinge fracture.

Clinical outcomes of primary total knee arthroplasty in non-syphilitic neuroarthropathy of the knee.

Total knee arthroplasty (TKA) in syphilitic neuroarthropathy using earlier implant designs was associated with poorer outcomes. Literature on TKA for non-syphilitic neuroarthropathy using modern contemporary prosthesis is scarce. We aim to analyse the clinical and radiological outcomes of TKA in neuropathic joints. A final cohort of 17 patients (21 knees) with the diagnosis of neuropathic joint undergoing primary TKA between January 2013 to January 2019 were included in the study. The preoperative ambulatory status, range of motion, type of prosthesis, level of constraint and any augmentation used were retrieved from medical records. Radiological evaluation includes Koshino's staging, the magnitude of deformity defined by the Hip-Knee-Ankle (HKA) angle, and any progressive loosening. Pre and postoperative functional scores were obtained by the Knee Society (KSS) and Knee Society Functional Score (KSS-F). Any complications or reoperation were noted till the final follow-up. Preoperative and follow-up functional scores, HKA and range of motion were compared using the paired Samples test. The mean follow-up was 40.2 months (range, 15 to 75 months). Preoperatively, according to the Koshino staging, five knees were in stage 3 (23.8%). The mean HKA angle in valgus knees was 23.60 (range, 11.10 to 42.50) and for the varus knees was 19.30 (range, 4.90 to 39.60). The prosthesis used were posterior stabilized in 7 knees (33.3%), varus-valgus constrained in five knees (23.8%) and a rotating hinge was required in nine knees (42.8%). Metaphyseal sleeves were used along with hinge prosthesis in six knees (28.6%). The mean arc of motion improved from 102.4 ± 22.7 degrees to 105.7 ± 15.5 degrees postoperatively (p = 0.27). The knee society and knee society functional scores improved from 23.3 ± 9.3 and 28.3 ± 12.2 preoperatively to 81.1 ± 5.4 and 80.4 ± 8.5 during the follow up respectively (p < 0.001). There were no progressive radiolucent lines in any knees at the final follow-up. One patient had intraoperative bony medial collateral ligament injury, one patient had deep vein thrombosis after five days from the index surgery and another had postoperative periprosthetic tibial shaft fracture. According to our study, the clinical outcomes of TKA for neuroarthropathy show significant improvement with the diagnosis of non-syphilitic neuroarthropathy, utilization of modern constrained prostheses, and early rehabilitation, at medium-term follow-up. Tibial and femoral stems are preferred for equal stress distribution and to prevent early loosening.

Lateral unicompartmental knee arthroplasty: is really a good option?

Lateral unicompartmental knee arthroplasties (LUKA) account for only < 1% of all knee arthroplasties and for only 5-10% of all unicompartmental knee replacements. This means that there is less published literature on these procedures and that the surgeon's experience with them is smaller than with medial UKA. The aim of this study was to analyze the survival and the clinical-functional outcomes of LUKA according to the type of bearing surface (all-polyethylene versus metal-backed) used. This was a retrospective study including 42 LUKAs operated between 2009 and 2021. Two fixed polyethylene-bearing models were used: the all-polyethylene ACCURIS knee (38%) and the metal-backed Triathlon PKR system (62%). Demographic parameters, knee range of motion (ROM), tibiofemoral alignment, implant survival (as estimated with the Kaplan-Meier curve), and clinical-functional outcomes (as measured with the Knee Society Score) were analyzed. Average patient age was 65.5 (range, 36-87) years and mean follow-up was 8.2 (range, 2.1-12.8) years. Thirty LUKAs (71.4%) were implanted in women. The main reason for performing a LUKA was osteoarthritis (88.1%). No patient developed post-surgical complications or had to be re-operated. Overall LUKA survival was 100% at 1-year and 5-year's follow-up. Knee Society Score, knee ROM and tibiofemoral alignment all improved significantly post-surgery (p < 0.001). The clinical Knee Society Score increased from 46.5 ± 14.5 pre-surgery to 93.5 ± 10.3 post-surgery, the functional Knee Society Score increased from 48.1 ± 13.5 pre-surgery to 94.6 ± 9.3 post-surgery, maximum flexion increased from 108.5 ± 8.7 degrees pre-surgery to 121 ± 8.9 degrees post-surgery and tibiofemoral alignment was corrected from 13.1 ± 1.74 degrees pre-surgery to 5.7 ± 0.8 degrees post-surgery. There were no statistically significant clinical-functional improvement or knee ROM differences between groups (p < 0.05, respectively). LUKA is a valid and definitive option for patients with lateral tibiofemoral osteoarthritis, with a survival rate of > 95% at 5-years follow-up. Clinical-functional outcomes are the same, irrespective of the tibial component used.

Outcomes of total knee replacement versus unicompartmental knee arthroplasty in an enhanced recovery after surgery protocol

IntroductionUnicompartmental Knee Arthroplasty (UKA) has become popular due to faster recovery and improved range of motion. However, concerns have been made regarding increased risk of early failure. Furthermore, the use of Enhanced Recovery After Surgery (ERAS) protocols have shown to allow faster return to activities, improved satisfaction, and reduced complication rates.This study aims to compare the 6 month functional outcomes of patients undergoing Total Knee Replacement (TKR) versus UKA under the ERAS protocol. MethodsPatient characteristics and comorbidities, 30-day post-operation readmission and infection rates were analyzed. Patient reported outcomes measures namely the Knee Society Function and Knee Score (KSFS, KSKS), Oxford Knee Score (OKS) and both the Physical and Mental component of the Short-Form Health Survey (SF-36) were assessed pre-operatively and 6 months post-operatively.Univariate analysis was used to compare differences in characteristics and comorbidities between the 2 groups. Finally, a multiple linear regression was performed to compare the post-operative outcomes. ResultsUnivariate analysis showed significantly better preoperative and 6 month post-operative KSKS and SF-36 MCS in UKA patients. Multivariate analysis showed no difference in the 6 month post-operative functional outcome scores between UKA and TKR patients. No UKA patients required revision surgery while 4 TKR patients required revision surgery for infection. ConclusionUKA achieves equivalent functional outcomes at 6 months post-operatively as compared to TKR patients and has lower infection rates. UKA is a reasonable option to offer for unicompartmental knee osteoarthritis patients.

Magnetic Resonance Imaging Features and Functional Score in Patients Requiring Total Knee Arthroplasty.

Introduction Knee osteoarthritis (KOA) is a progressive degenerative disease, with an increasing prevalence among the population. The degenerative changes in KOA affect the cartilage, menisci, synovial tissue, and subchondral bone. The treatment for patients in advanced stages of the disease is total knee arthroplasty (TKA). The purpose of this descriptive study is to identify the MRI features in the case of patients with KOA who did not obtain an improvement in symptoms and joint function after the non-surgical treatmentsand who applied for surgical treatment, i.e. TKA. Also, we aimed to identify the correlations between the MRI changes and the functional score of the patients, as well as the inter-variable correlations. Materials and methods The study was conducted in the Department of Orthopedics and Traumatology at the University Emergency Hospital of Bucharest between January 1, 2023, and January 31, 2024. It included 50 patients who required TKA. This study is a prospective, observational, and descriptive analysis focusing on patients scheduled for TKA. Results The patients in the study group who required TKA had a Knee Society Score (KSS) ranging from 35 to 70and a KSS function score between 24 and 60. Among them, 98% had tricompartmental lesions of the articular cartilage, and 100% presented with osteophytes, even when they were not identifiable radiologically. Additionally, 58% of the patients had changes in the infrapatellar fat pad, 66% presented with joint effusion without any traumatic history, and 86% of the patients had partial or complete lesions of the anterior cruciate ligament. Conclusion TheMRI pattern of the patient who requires TKA consists of the presence of articular cartilage lesions in more than two compartments with exposure of the subchondral bone and diameter greater than 1 cm, meniscus lesions (>grade 2), meniscus extrusion (>grade 1), the presence of bone marrow lesions (BMLs) in the medial or lateral compartment of the femur or tibia, hyperintense signal of the infrapatellar fat pad, anterior cruciate ligament (ACL) lesions (>grade 2), and the presence of osteophytes together with the presence of effusion in the suprapatellar bursa. BMLs and changes in the infrapatellar fat pad may lead to the opening of new research perspectives explaining the complex changes in KOA in relation to the inflammatory process and gene expression.

Survivorship of total knee arthroplasty in poliomyelitis patients: long-term results from the R.I.P.O. registry and single-institution retrospective study.

The survival of total knee arthroplasty (TKA) in patients with poliomyelitis remains a debated topic due to the high recurrence of postoperative genu recurvatum. This study aims to report the long-term survival of TKA in patients with poliomyelitis, using data from the Italian Register of Prosthetic Implantology. A registry-based population study was conducted, utilizing data from the Emilia Romagna orthopedic arthroplasty implants registry (RIPO - Registro Implantologia Protesica Ortopedica). The cohort consisted of 71 patients with poliomyelitis-related arthritis who underwent TKA. The study assessed and analyzed demographic data, implant type, fixation method, insert type, and level of constraint. Additionally, variations in preoperative and postoperative both clinical and functional Knee Society Scores (KSS) were collected. Eight implants required revision surgery (16%), and three patients died (6.1%), resulting in a 10-year survival rate of 86.6% and a 15-year survival rate of 53.9%. Aseptic loosening was the primary cause of revision, accounting for 37.5% of failures, followed by insert wear (25%). No statistically significant correlation was found between the level of constraint and implant survival (p=0.0887, log-rank). Both the clinical and functional KSS improved postoperatively. TKA is a viable alternative to knee arthrodesis and, in properly selected patients, might represent the first-choice treatment for articular degeneration due to its high survivorship. Despite the complexity of these cases, TKA can effectively alleviate articular pain, instability, and angular deviation, thereby preserving knee functionality.

Midterm results for revision total knee arthroplasty for component malrotation

IntroductionAccurate positioning of components in total knee arthroplasty (TKA) is essential to a satisfactory outcome. Significant malrotation may lead to chronic pain, stiffness, and dysfunction. This study aims to quantify improvements in functional outcomes following revision surgery for malrotation of either one or both components in TKA versus revision for aseptic loosening. MethodsThis was a retrospective review of TKAs that matched and compared the two-year functional outcomes of the malrotation group to a functionally similar aseptic loosening group. Functional outcomes were compared between groups using Short Form (SF-12), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Knee Society Functional Score (KSFS). Student t-tests and chi-squared or Fisher’s tests were used for statistical analysis. ResultsOf the patients revised, 24 had malrotation and 57 had aseptic loosening. A total of 16 femoral and 17 tibial components were revised for malrotation. All 16 femoral components were internally malrotated (mean –4.8 ± 4.1 degrees; range, −0.5 to −16.6). Of the tibial components, 15 were internally malrotated, (mean −9.5 ± 6.6 degrees; range, −2.2 to –23.5) and 2 were externally malrotated (mean 4.6 ± 2.1 degrees; range, 3.1 to 6.0). All functional outcome measures significantly improved comparably within both groups preoperatively to 24 months postoperatively. At 24 months, functional outcome measures were comparable between the groups and WOMAC function scores were significantly higher in the malrotation group. ConclusionRevision TKA for malrotation can yield clinically and statistically significant functional improvements, similar in magnitude to those seen following revision TKA for aseptic loosening. Level of EvidenceLevel III

One-day surgery is safe and effective in unicompartmental knee arthroplasty: A prospective comparative study at 1 year of follow-up.

To compare the outcomes and complications of two perioperative protocols for the management of patients who underwent medial unicompartmental knee arthroplasty (UKA): 24 h (1-day surgery [OS]) versus 72 h (enhanced recovery after surgery [ERAS]) of the length of hospital stay (LOS). In our hypothesis, the reduction of the LOS from 3 to 1 day did not influence the outcomes and complications. A total of 42 patients (21 in each group) with isolated anteromedial knee osteoarthritis and meeting specific criteria were prospectively included in the study. Clinical outcomes included Knee Society Score (KSS) and Forgotten joint score while pain evaluation was performed using a Visual Analogue Scale (VAS). Functional outcomes were assessed measuring the knee range of motion (ROM) while radiographic outcomes were evaluated measuring the amelioration of the varus deformity through the hip-knee-ankle angle (HKA). Clinical and functional outcomes did not significantly differ between the two groups. Complications occurred in 9.5% of OS and 4.7% of ERAS group patients. Significant improvements in knee ROM, VAS pain, KSS and HKA angle were observed postsurgery, with no significant differences between groups except in KSS expectations and function trends. The OS protocol is safe and effective and LOS, in a well-defined fast-track protocol, did not significantly impact clinical and functional outcomes. OS may lead to reduced hospitalisation costs and potential reductions in complications associated with prolonged stays, benefiting both patients and healthcare facilities. However, further research with larger sample sizes and longer follow-up periods is needed to confirm these findings. Early mobilisation and rehabilitation protocols are key components of successful patient recovery following UKA procedures. Level II.

Application of Autologous Bone Graft versus Non Grafting in Medial Opening Wedge High Tibial Osteotomy Less than 14 mm: A Systematic Review and Meta-Analysis

Abstract Background Unicompartmental Knee osteoarthritis KOA due to varus malalignment is increased in young active patients which occurs predominantly in the medial compartment. Aim of the Work The objective of this study to compare MOWHTOs with autologous bone graft and without bone graft (wedge space mean less than 14 mm) in treatment of unicompartmental KOA and varus malalignment of the knee to determine which is better in decision-making according to outcomes. Patients and Methods Studies that matched the inclusion criteria were included in this meta-analysis. participants with medial compartmental knee osteoarthritis and varus malalignment were shown in the investigation. The age of the participants was unrestricted. Plate as a fixation method was the only option regardless of plate type. During 2000 and 2021, a research study of internet databases (Egyptian Universities Research, Medline, PubMed, Cochran library, medical journals) was conducted. Following that, the references from the user research were examined, and specialists were approached for assistance in locating other papers. Two independent reviewers extracted data separately and cross-checked it. Results The Knee Society Knee score (KSKS) and Knee Society Function score (KSFS) are most commonly used for the assessment of the knee joint reveled that there is no statically significant difference between bone graft vs non graft. Regarding this systematic review the radiological outcomes, the clinical bone union and the full weight bearing movement, are rendering any statistical analysis meaningless. Regarding complications presented, there was a similar tendency for complication rate when compared according to grafting or non- grafting. The use of autograft accelerates radiographic healing of the osteotomy gap after OWHTO while shorten the union time but confers no advantages in terms of functional or patient elated out comes at 3 or 12 months postoperatively. Conclusion MOWHTO can be performed without a graft with less operative time and avoiding graft harvest comorbidity with similar clinical and radiological results regarding bone union and posterior tibial slope alteration and knee scores.

Functional Outcome of Patients with Malignant Tumors around the Knee Treated by Modular Endoprosthesis: A Comparative Study between Patellar Resurfacing and Nonresurfacing

Abstract Background: Patellar resurfacing with knee arthroplasty has always been controversial. The literature contains data that support both resurfacing and not resurfacing the patella. However, the literature does not review a lot of studies that address the impact of patellar resurfacing on the functional outcome following resection of distal femur tumors and limb salvage using modular prosthesis. Questions/Purposes: Is patellar resurfacing better than nonresurfacing as regards functional outcome of modular prosthesis used for the treatment of tumors around the knee? Patients and Methods: Two groups of patients; both were subjected to wide excision of tumors around the knee and limb salvage using modular prosthesis. The first group underwent reconstruction with patellar resurfacing, while the second underwent reconstruction without patellar resurfacing. The age of these groups of patients ranged from 11 to 71 years. The patients were 17 males and 19 females. We evaluated patients using the musculoskeletal tumor society scoring system (MSTS), knee society final score, knee society function score, and anterior knee pain score. Results: We found that MSTS functional score, knee society final score and knee society function score, and anterior knee pain score were all better in patients who underwent patellar resurfacing compared to nonresurfacing patients. However, only the difference in anterior knee pain score was statistically significant (P = 0.030). Differences in other scores between these two groups were all statistically insignificant (P value of the MSTS difference = 0.103, P value of the knee society final score difference = 0.423, and P value of the knee society function score difference = 0.337). Conclusions: Patellar resurfacing could be helpful in decreasing anterior knee pain and the necessity to future surgeries addressing patellofemoral pain, especially in revision cases, patients with patellofemoral problems, and patients with extensor mechanism weakness and those with anterior knee pain. Since Anterior Knee Pain Scale was the only scoring system, among all scoring systems used, that confirmed a significant impact of patellar resurfacing on the outcome following resections and reconstructions; we cannot give an explicit strong recommendation favoring the routine patellar resurfacing in all cases undergoing resections and reconstructions using modular prosthesis. We recommend patellar resurfacing in older patients, based on our results, which show possible benefit of patellar resurfacing in older patients. We think that old age and the preexisting knee arthritis could be relative indications for patellar resurfacing.

The Patient Acceptable Symptom State (PASS) after proximal and distal femoral replacement

IntroductionFemoral megaprostheses are used for bone reconstruction surgery in patients with local tumors or who require multiple revisions. Patient reported outcome measures (PROMs) provide a subjective result and, like patient satisfaction, have become an integral part of the outcomes in orthopedics. However, the threshold of satisfaction (PASS: Patient Acceptable Symptom State) has not yet been defined in a French population after this type of arthroplasty. This led us to carry out a retrospective study on a population of patients who received a femoral reconstruction megaprosthesis in order to 1) define the PASS for the Harris Hip Score (HHS), Knee Society Score (KSS) and the Musculoskeletal Tumor Society score (MSTS), 2) study the complications. HypothesisThe PASS threshold for proximal femur and distal femur reconstruction prothesis for the HHS and the KSS, respectively, will be lower than the threshold for these same scores for primary arthroplasty. Materials and methodsForty-four patients who were operated on between 2009 and 2020 were included: 23 received a proximal femur prosthesis and 21 received a distal femur prosthesis. The PASS threshold was defined using an anchoring strategy by analyzing ROC curves for the HSS for the proximal femur, KSS for the distal femur and the MSTS for all the prostheses. Complications were classified according to Henderson. ResultsThe mean follow-up was 4.5 ± 3.6 (1–12.5) years. The PASS threshold was 47.5 (area under curve (AUC) 0.71 (0.45–0.97)) for the HHS, 69.5 (AUC 0.97 (0.92–1.0)) for the KSS knee and 62.5 (AUC 0.81 (0.61–0.99)) for the KSS function. Thirteen patients (29%) had complications, nine of whom required another surgery (20%). The most frequent were Henderson type 1 (soft tissue lesions, n = 5/44 [11%]) and type 2 (loosening, n = 5/44 [11%]) There was no relationship between satisfaction and postoperative complications (p = 0.071). DiscussionMost of the patients who undergo femoral resection and reconstruction (59%) are satisfied with their function, albeit reduced, despite a high complication rate (29%). Our hypothesis is confirmed for the PASS threshold for the HHS (47.5 versus 93) and the KSS knee and function (69.5 and 62.5 versus 85.5 and 72.5). Level of evidenceIV; retrospective observational single-center study.

Preoperative Medial Meniscus Extrusion on Magnetic Resonance Imaging Is Associated With a Tendency Toward Varus Shifting of Open-Wedge High Tibial Osteotomy: A Minimum 5-Year Follow-Up Study

PurposeTo investigate serial changes in postoperative alignment over 5 years after open-wedge high tibial osteotomy (OWHTO) and to identify risk factors associated with alterations in the postoperative weight-bearing line WBL ratio. MethodsPatients who underwent OWHTO during 2011–2017 were retrospectively reviewed. Inclusion criteria were (1) follow-up duration ≥5 years and (2) serial postoperative long-standing hip-to-ankle radiographs to evaluate alignment alterations. The WBL ratio was measured preoperatively and at 3 months, 6 months, 1 year, and 5 years postoperatively to evaluate serial changes. Alterations in the WBL ratio were analyzed using a linear mixed model, considering potential risk factors including International Cartilage Repair Society (ICRS) grades of each compartment, and medial meniscus extrusion (≥3 mm). Clinical outcomes were assessed using the Knee Society (KS) objective and functional scores, and the correlations between clinical outcomes and alignment alteration were examined. ResultsA total of 78 knees were investigated. During the study period, the overall WBL ratio decreased by 5.5 ± 7.2%, signifying varus shifting, from 58.6 ± 11.5% at 3 months post-surgery to 51.5 ± 12.7% at 5 years post-surgery. Based on univariate regression analyses, ICRS grade of the medial compartment and medial meniscus extrusion were included in a linear mixed model regarding alignment alteration. The model identified medial meniscus extrusion as a significant risk factor after adjusting for time (p <0.001). Medial meniscus extrusion also had a significant interaction with time (p <0.001), indicating greater alignment alteration in cases of medial meniscus extrusion. The extrusion was noted in 68 out of 78 knees. ConclusionIn the midterm following OWHTO, the overall alignment had a tendency toward varus shifting. A linear mixed model found that preoperative medial meniscus extrusion on magnetic resonance imaging is associated with the tendency.

Use of Hinged Implants for Multistage Revision Knee Arthroplasty for Severe Periprosthetic Joint Infection: Remission Rate and Outcomes After a Minimum Follow-Up of 5 Years

BackgroundIn severe periprosthetic joint infection after total knee arthroplasty (TKA), multistage procedures are indicated for ongoing signs of infection after implant removal during the spacer interval of an intended 2-stage exchange. In these cases, several additional debridement and spacer exchange surgeries may be necessary. Herein, we analyzed the complications, remission rates, and functional outcomes after multistage revision arthroplasty using hinged TKAs. MethodsPatients (n = 79) treated with multistage revision arthroplasty after chronic periprosthetic joint infection of the knee were included (2010 to 2018). During the prosthesis-free interval, a static spacer containing antibiotic-loaded bone cement was implanted. The mean number of surgeries, including implant removal and revision arthroplasty, was 3.8 (range, 3 to 8). The mean duration from implant removal to revision arthroplasty was 83 days (range, 49 to 318). Complications, remission, and mortality were analyzed after a minimum follow-up of 5 years. Outcomes were assessed based on the Knee Society Score (KSS) and the Western Ontario McMasters University Osteoarthritis Index. ResultsDuring follow-up, 24 (30.4%) patients underwent revision surgery, with a mean time to surgical revision of 99 weeks (range, 1 to 261). After follow-up, the infection-free remission rate and overall mortality were 87.3 and 11.4%, respectively. The mean KSS was 74.3 (range, 24 to 99), the KSS Function Score was 60.8 (range, 5 to 100), and the Western Ontario McMasters University Osteoarthritis Index 30.2 (range, 5 to 83). ConclusionsIn difficult-to-treat cases, multistage revision arthroplasty showed high remission rates and low mortality after a follow-up of 5 years. The overall revision rate was comparably high, accounting for early and late reinfections most of the time. In cases of implant survival, functional outcomes comparable to those of revision hinge TKA reported in the literature can be achieved. Therefore, multistage procedures with additional debridement steps should be performed in cases of ongoing infections in intended 2-stage procedures.

Long-term functional success and robust implant survival in lateral unicompartmental knee arthroplasty: A case series with a mean follow-up of twenty two and a halfyears.

Lateral unicompartmental knee arthroplasty (UKA) is an accepted treatment option in cases of end-stage lateral osteoarthritis. While lateral UKA has many proposed advantages compared to total knee arthroplasty, its technical challenges and relatively small number of cases make this an uncommon procedure. The aim of this study was to report the survivorship and functional outcomes beyond 20years of follow-up of isolated UKA. Between January 1988 and October 2003, 54 lateral UKAs were performed in a single center. The fitted prosthesis was a fixed plate and cemented polyethylene (PE). All patients had isolated lateral tibiofemoral osteoarthritis, including five open meniscectomies, three arthroscopies, and three open reductions of lateral tibial plateau fractures. Patients with a minimum of 20years of follow-up were included in the final analysis. Of the 54 UKA, 22 died before reaching the minimum follow-up period and four were lost to follow-up. Twenty-eight were included in the final analysis. Among them, 21 patients remained alive and an additional seven were deceased after 20years. The mean age at the last follow-up was 84.8 ± 11.9years with a mean follow-up duration of 22.5 ± 2.1years. Of the 28 knees, eight underwent revision surgery (5 for the progression of osteoarthritis; 2 for aseptic loosening; 1 for PE wear). Kaplan-Meier survival analysis revealed a survival rate at 20 and 25years of 72.3% (CI 59.1; 88.6). The average time to revision was 14.9 ± 4.9years. At the last follow-up, the mean function Knee Society Score (KSS) was 41.5 ± 32.9 and the mean objective KSS score was 79.4 ± 9.7. In the unrevised population, 94.7% of patients (n = 18) reported being satisfied or very satisfied with the surgery. Lateral UKA remains a viable treatment option for patients with isolated lateral tibiofemoral osteoarthritis, providing satisfactory 20-year implant survivorship and high patient satisfaction.