Knee Society Score Scores Research Articles

Can Met Expectations Moderate the Relationship Between Pain/Function and Satisfaction in Total Knee Arthroplasty?

BackgroundApproximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA) at 1-year post-surgery. Met expectations have been found by some to significantly predict satisfaction. The role of met expectations in determining patient satisfaction has not been exhaustively explored. The primary aim of this study is to evaluate if met expectations moderate the relationship between pain and function variables and satisfaction. MethodsPatients who underwent primary TKA for osteoarthritis were included in the study (n = 304). Patient-reported outcomes at pre-surgery and 1-year post-surgery were collected. The Knee Society Score (KSS) satisfaction subscale was used as the dependent variable. Candidate independent variables included the following: demographics, KSS, Knee injury and Osteoarthritis Outcome Score (KOOS), 12-Item Short Form Health Survey (SF-12), Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Self-Administered Comorbidity Questionnaire, and University of California Los Angeles activity score. Separate linear regression models were created to test interactions for KSS met expectations with pain and KSS met expectations with function. ResultsSignificant predictors of satisfaction were KSS symptoms (pain), KOOS activities of daily living (function), KSS met expectations, KOOS pre-surgery activities of daily living, body mass index, and SF-12 general health. A significant interaction between met expectations and pain was found (P = .043) and the met expectations and function interaction approached significance (P = .086). For both interactions, as met expectations increased, pain and function predicted satisfaction less strongly. ConclusionMet expectations were found to moderate the relationship between pain and satisfaction. There may be more value in improving pain for patients with low met expectations. Level of evidenceLevel IV.

V-Y turndown flap augmentation for acute quadriceps rupture after total knee arthroplasty: a prospective matched cohort study.

To evaluate the effectiveness of the quadriceps V-Y turndown augmentation for acute quadriceps tendon ruptures in the setting of TKA. Prospective cohort of 22 patients with quadriceps rupture after TKA were compared with 44 matched patients underwent TKA without quadriceps rupture. Quadriceps ruptures were treated within threeweeks after injury by suture augmented with Scuderi quadriceps V-Y turndown flap. Clinical evaluation was performed by the Knee Society Scores (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion. Patellar height was assessed by the Blackburne-Peel ratio. The mean follow-up was 3.3 (range, 3-4) years. At the final follow-up, there were significant improvements in mean KSS scores in both groups (p = 0.001). In the quadriceps group, the mean flexion for all patients, but one with arthrodesis for periprosthetic infection, was 100.1° (range, 90-110°) and mean extensor lag was 7.1° (range, 0-20°). There were significant differences between groups in KSS scores (p = 0.001). Active flexion (p = 0.020) and extension (p = 0.001) were significantly better in the control group. However, there was no significant difference in WOMAC scores (p = 0.252) or patient satisfaction (p = 0.352). There were no quadriceps reruptures. One patient with periprosthetic infection was treated with arthrodesis. The quadriceps V-Y turndown is an effective and safe procedure for quadriceps ruptures in the setting of TKA. Although the functional outcomes were lower than in TKA patients with no quadriceps rupture, the quality of life and satisfaction were successful in the TKA patients with quadriceps rupture.

Short-term Outcomes of 3D-Printed Titanium Metaphyseal Cones in Revision Total Knee Arthroplasty.

Recently, 3-dimensional (3D) printing technology has been used in the development of titanium metaphyseal cones to manage severe bone loss in revision total knee arthroplasty (rTKA). This study assessed (1) radiographs; (2) functional outcomes; (3) complications; and (4) 2-year implant survivorship in patients receiving 3D-printed titanium metaphyseal cones for moderate-to-severe tibial and femoral bone loss in rTKA. A single institution, retrospective chart review was performed for patients with large bone defects treated with a 3D-printed femoral or tibial titanium metaphyseal cone between 2015 and 2017 during rTKA (N=54). Paired sample t tests analyzed Knee Society Scores (KSS). Kaplan-Meier analyses determined implant survivorship when the endpoint was cone revision for aseptic loosening, cone revision for any reason, and reoperation for any reason. The authors found that 51 (98.1%) of 52 available radiographs demonstrated well-fixed components without any evidence of loosening or migration. Mean postoperative KSS scores were significantly higher when compared with preoperative scores (80.4 vs 52.0; P>.001). One patient experienced aseptic loosening of their cone. Seven additional cones were explanted as a consequence of reinfection, 1 of which was removed prior to arthrodesis. Cone survivorship was 98.5% when the endpoint was cone revision due to aseptic loosening, 88.2% when cone revision was due to any reason, and 77.9% for any reoperation. Metaphyseal cones appear to be well-suited for large bone defects during rTKA and the authors' findings suggest that cones may be a viable option for metaphyseal fixation during rTKA. Future studies should focus on their durability during a longer time period. [Orthopedics. 2021;44(1):43-47.].

Results of total knee arthroplasty for painless, stiff knees

BackgroundStiff knees, like completely ankylosed or arthrodesed knees, can be painless. Total knee arthroplasty (TKA) for these painless, stiff knees is technically demanding. However, it can correct the alignment and advance the range of motion to improve quality of life. So, we reviewed the preoperative and postoperative results of functional and pain scores, range of motion (ROM) and complications in painless, stiff knees treated by TKA.MethodsFifteen painless, stiff knees underwent TKA from January 1998 to January 2017. The mean follow-up period was 15.4 (2.4–22.2) years. All the knees were completely ankylosed or arthrodesed. Clinical outcome and complications were evaluated using medical record review, serial plan radiography, ROM assessment, Knee Society score (KSS), Knee Society function score (FS), and a visual analog scale for pain (VAS).ResultsAll patients were satisfied with their operated knees. Mean KSS and FS scores were improved from 36 and 50.9 to 76.9 and 67.2, respectively (P < 0.001 and P = 0.01). The mean ROM increased from 0º preoperatively to 77.6º (15–130) at the final follow-up (P < 0.001). The mean VAS had worsened from 0 preoperatively to 0.2 postoperatively, however it was not significant (P = 0.1). Major postoperative complications were reported in five of the knees (33.3%).ConclusionsThe results of TKA for painless, stiff knees were satisfactory with improved ROM and quality of life. Although some patients had mild pain and complications postoperatively, they were satisfied with the result. However, our study recommends that surgeons should consider the high rate of complications in the completely ankylosed or arthrodesed knees.Level of evidenceA retrospective case series, Level IV.

Application of quadriceps snip in complex total knee arthroplasty

To explore the safety and effectiveness of quadriceps snip in complex total knee arthroplasty (TKA). A clinical data of 19 cases (29 knees) with complex TKA assisted with quadriceps snip between January 2016 and May 2017 were retrospectively analyzed. There were 9 males (13 knees) and 10 females (16 knees). The age of patients ranged from 34 to 66 years (mean, 50.2 years). Four patients (8 knees) were ankylosing spondylitis, 5 patients (7 knees) were rheumatoid arthritis, and 10 patients (14 knees) were knee osteoarthritis. The average disease duration was 10.9 years (range, 8-15 years). There were 12 knees of Kellgren-Lawrence grade Ⅲ and 17 knees of Kellgren-Lawrence grade Ⅳ. The range of motion (ROM) of knee was (19.86±7.23)°. The clinical and function scores of knee society score (KSS) were 47.86±11.26 and 15.52±11.21, respectively. Postoperative complications, ROM, KSS scores, extensor lag, and prosthesis loosening were observed to evaluate the effectiveness. All incisions healed by first intention, and no infection or cardiovascular and cerebrovascular accidents occurred. All patients were followed up 25-39 months (mean, 30.3 months). At last follow-up, the ROM of knee was (91.03±7.30) °, the KSS clinical score was 83.62±9.99 and functional score was 66.38±7.89, showing significant differences when compared with preoperative ones ( P<0.05). Postoperative extensor lag (10°, 10°, 15°) occurred in 3 cases. There was no evidence of prosthesis loosening or osteolysis on X-ray films during follow-up. The application of quadriceps snip in complex TKA can effectively improve the operative field exposure and reduce incidence of complications such as patella tendon tearing, patella fracture, and quadriceps tendon injury. The surgical technique of Krackow tendon suture can effectively guarantee early rehabilitation without occurrence of other complications.

Joint line reestablishment in revision total knee arthroplasty

BackgroundIn this study, the traditional “Anatomical Landmark-Distance Method (AL-DM)” in the formation of joint line (JL) was compared with “Adductor Tubercle-Ratios method” (AT-RM), and the effect of reestablishment of JL on clinical and functional outcomes were evaluated.Materials and methods16 revision total knee arthroplasties (rTKAs) were performed by using “AT-RM” (group 1) and 16 rTKA by using “AL-DM” (group 2) in our clinic between 2015 and 2018. The data were prospectively collected and a total of 32 knees of 31 patients were analyzed. At the final follow-up, knee functions were evaluated by using Knee Society Score (KSS) knee and function, Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, Short Form-36 (SF-36) questionnaires and physical examinations.ResultsPostoperative flexion arc was higher in Group 1. KSS knee and function scores were better in group 1. In group1, JL was reestablished successfully in all revision rTKAs in terms of ATJL and the tibial tubercle TT-JL ratios. The improvement in KSS knee and function scores and WOMAC scores were also better in group 1. Measurements showed that the improvement in KSS scores increased as AT-JL and TT-JL distances approached the calculated values.Conclusion“AT-RM” was shown to be superior to the traditional distance method in terms of JL reestablishment. Functional results and patient satisfaction increased when JL was reestablished.

Clinical and Patient-Reported Outcomes of Medial Stabilized Versus Non–Medial Stabilized Prostheses in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

BackgroundThe aim of this systematic review and meta-analysis was to compare the clinical and patient-reported outcome measures (PROMs) of medial stabilized total knee arthroplasty (TKA) with non–medial stabilized TKAs. MethodsA systematic search of multiple databases was conducted in October 2019. A meta-analysis was conducted for the Knee Society Score (KSS), Knee Society Functional Score (KFS), range of motion (ROM), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Forgotten Joint Score (FJS). ResultsA total of 857 articles yielded 21 studies eligible for inclusion with 13 studies used for quantitative analysis. The meta-analysis revealed that the medial stabilized group had a mean FJS that was 13.8 points higher than that of the non–medial stabilized TKA (mean difference [MD]: 13.83, P ≤ .0001, 95% confidence interval [CI]: 8.90-18.76, I2 = 0%) which was less than the minimal clinically important difference of 14. The medial stabilized group also demonstrated a statistically significant difference in the postoperative ROM (MD = 2.52, P = .05, 95% CI: −0.03 to 5.07, I2 = 85%) and OKS when compared with the non–medial stabilized group (MD = 1.25, P = .02, 95% CI: 0.17-2.33, I2 = 27%), but these were not clinically significant. There was no statistically or clinically significant difference in the KSS, KFS, and WOMAC scores. ConclusionMedial stabilized knee prostheses demonstrated no clinically significant differences for the ROM, OKS, WOMAC, KSS, and KFS. The FJS demonstrated the greatest MD and warrants further investigation. Future research is required using patient-reported outcome measures with a lower ceiling effect such as the FJS.

The outcomes of mobile bearing unicompartmental knee arthroplasty and total knee arthroplasty on anteromedial osteoarthritis of the knee in the same patient.

Compared to total knee arthroplasty (TKA), mobile-bearing unicompartmental knee arthroplasty (UKA) is associated with better outcomes, such as an earlier recovery, less postoperative pain, lower morbidity and mortality, and a greater "feel" of a normal knee. However, no study has reported the clinical outcomes in patients with the same stage of osteoarthritis of the knee. The purpose of this study was to determine the clinical outcomes, including the Joint Forgotten Score (JFS), Oxford Knee Score (OKS), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Kujala score after UKA on one knee and TKA on the opposite knee in the same patient. We retrospectively reviewed 32 patients with anteromedial OA who underwent mobile-bearing UKA in one knee and TKA in the other knee from 2009 to 2017. The JFS, OKS, KSS, KOOS, and Kujala scores were recorded and compared between the groups. Patients' preferences between UKA and TKA and satisfaction were also recorded. The JFS and KOOS in the UKA group were significantly (p = 0.01, 0.01) higher than those in the TKA group: 97.01 ± 3.26 (89.58-100) vs. 94.92 ± 3.34 (87.80-100) and 91.16 ± 2.67 (85.25-96) vs. 89.24 ± 2.67 (84.50-94.71), respectively. The OKS, KSS, and Kujala scores were not different between the two groups (p = 0.82, 0.95, and 0.31, respectively) and neither was patient preference (p = 0.41) or satisfaction (p = 0.42). The mean follow-up was 48.36months (range 24.00-96.00months), during which there were no postoperative complications. UKA was associated with a better JFS and KOOS but was otherwise comparable to TKA and may be preferable.

Titanium Niobium Nitride Mobile-Bearing Unicompartmental Knee Arthroplasty Results in Good to Excellent Clinical and Radiographic Outcomes in Metal Allergy Patients With Medial Knee Osteoarthritis

BackgroundThe main purpose of the present study was to analyze the clinical and radiological outcomes of patients with positive skin patch tests who underwent medial mobile-bearing titanium niobium nitride unicompartmental knee arthroplasty (UKA) during a mid-term follow-up. MethodsThirty-seven patients with positive skin patch tests were included in this prospective study. The clinical evaluation consisted of Oxford Knee Score and Knee Society Score (KSS) reports. Each patient was clinically evaluated the day before surgery (T0) as well as at T1 (11.9 ± 1.3 months) and during the final follow-up T2 (67.2 ± 19.1 months). The positioning of the UKA was evaluated during the final follow-up using standardized radiographs (T2: 67.2 ± 19.1 months). ResultsOxford and KSS ranged from a respective mean preoperative value of 23.0 ± 2.7 and 51.5 ± 5.0 to 42.1 ± 1.7 and 87.6 ± 2.2, respectively, at T1 (P < .001) and to the final values of 45.0 ± 1.9 and 91.9 ± 3.4, respectively, at T2 (P < .001 both vs T1 and T2). At T2, the mean femoral angle was 7.0° ± 4.5°, mean tibial angle was 3.0° ± 2.1°, and mean tibial slope was 5.1° ± 3.2°. A significant difference was found between KSS and Oxford with ANOVA for repeated measures over time (P < .001). The Oxford and KSS scores showed significant improvements during each follow-up. No complications were found, and not a single patient required a revision surgery during the follow-up period. ConclusionThe hypoallergenic titanium niobium nitride mobile-bearing UKA showed comparable results to standard CoCr UKA regardless of the gender, age, BMI, and implant size of metal allergy patients with medial knee osteoarthritis. Careful patient selection processes and accurate medical histories played key roles in the choice of hypersensitivity-friendly implants.

Early effectiveness analysis of lateral hinge fracture during medial opening-wedge high tibial osteotomy

To compare the clinical and radiologic effectiveness in patients with versus without lateral hinge fracture during medial opening-wedge high tibial osteotomy (MOWHTO) to evaluate the effect of lateral hinge fracture on short-term effectiveness. The clinical data of 84 patients (97 knees) with medial compartment osteoarthritis who treated with MOWHTO between September 2015 and July 2018 was retrospectively analyzed. There were 10 males (10 knees) and 74 females (87 knees). The age ranged from 45 to 65 years with an average of 57.7 years. Lateral hinge fracture was recognized by the intraoperative fluoroscopy or immediate postoperative X-ray film. Fractures were classified into types Ⅰ, Ⅱ, and Ⅲ according to the Takeuchi classification. The healing of osteotomy was observed by radiographs during follow-up; the femur tibia angle (FTA), medialproximal tibial angle (MPTA), and hip-knee-ankle angle (HKA) were also calculated. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score and knee society score (KSS). The incision healed by first intention. All patients were followed up 15-48 months with an average of 24.8 months. No hinge fracture occurred in 78 knees (80.41%, group A), and lateral hinge fractures were observed in 19 knees (19.59%, group B) and were divided into the type Ⅰ (13 knees, 13.40%) and type Ⅲ (6 knees, 6.19%) groups. Type Ⅰ fractures were not additionally treated, type Ⅲ fractures were anatomic reduced fixed with additional lag screws. X-ray film and CT examination showed that all patients had bone healing at 3 months after operation without delayed healing or nonunion. During follow-up, there was no loosening or fracture of internal fixation plates and screws. HKA, FTA, and MPTA of patients in group A and group B (type Ⅰ and Ⅲ) were significantly improved at each time point after operation compared with preoperative values ( P<0.05); there was no significant difference between groups at each time point before and after operation ( P>0.05). After operation, the pain of knee joint was alleviated and the function of joint was improved. At last follow-up, KSS score and HSS score of groups A and B were significantly improved compared with those before operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). The lateral hinge fracture may occur during MOWHTO. As long as the treatment and rehabilitation were guided according to the fracture classification of the hinge, the effectiveness can be similar to those without the hinge fracture.

Prognostic Factors Influencing Outcomes of High Tibial Osteotomy in The Varus Knee: The Role of The Deformity

Objectives:High Tibial Osteotomy (HTO) is widely performed to treat early arthiritis in the varus knee. The aim of this prospective study is to evaluate different prognostic factors affecting the outcomes of HTO and, with special attention to the role of the site of deformity.Methods:231 Opening Wedge HTO (OWHTO) were performed in 202 patients and included in the study. Inclusion criteria were: 1) age > 18 years, 2) no major associated procedures (i.e. ACL reconstruction, major cartilage procedure, 3) only OWHTO, 4) pre-operative complete clinical and radiological evaluation available. Patients were evaluated with (1) the Knee Society score (KSS), (2) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, (3) another self-evaluation scale, (4) long-leg radiographs, and (5) plain radiographs. On the x-ray different angles were evaluated, including Join Line Congruence Angle. Furthermore, the location of deformity was established. Three main outcomes were identified: Indication to Total Knee Arthroplasty (TKA), KSS poor or fair and WOMAC < 76 points), and different prognostic factors were identified (Fig. 1). All the variables were firstly tested in a single regression model to evaluate the association with each outcome. All the variables with p<0.1 were re-tested in a multiple regression model.Results:32 patients were lost to follow-up and 31 patients did not meet the inclusion criteria, leaving 139 patients (156 OWHTOs) for the study. The average age was 52.9 ± 9.6 years, and the average follow-up was 97.7 ± 42.8 months. Post-operatively there was a significant improvement in both the KSS and WOMAC score compared to the pre-operative period (p<0.0001). The only variable related to TKA indication was a pre-operative JLCA ≥5° (OR=24.3, p=0.0483). Conversely, different variables were related to a worse KSS, including pre-operative BMI >30 Kg/m2 (OR=78.9, p=0.0028), pre-operative ROM <120° of flexion (OR=40.8, p=0.0421), pre-operative mLDFA ≥91° (OR=36,6,p=0.0401) and femoral pre-operative CORA ≥3° of varus (OR=39,9 p=0.0269). Furthermore, a pre-operative BMI >30 Kg/m2 (OR=29,5, p=0.0314) was associated to a worse WOMAC score. Conversely, patients with a pre-operative mMPTA ≤84° had lower risk to obtain a worse KSS oe WOMAC score (respectively OR= 0,2 p=0.0364 and OR=0,3 p=0.0071). The cumulative survivorship was calculated with the Kaplan-Meier method, and it resulted equal to 98.6% at 5 years and decreased to 85.5% at 10 years.Conclusion:OWHTO is a good treatment for early arthritis in the varus knee if the correct indications are applied. The outcomes can be considered good, with 85% of 10-year survivorship. It is mandatory to correctly address the location of the deformity, because the presence of a femoral varus deformity is related to worse outcomes. Similarly, presence of a pre-operative JLCA ≥5° is the only factor associated to TKA indication.Table 1.Pre-OperativeIntra-OperativeBMIAssociated proceduresAge (≥56 years)Cartilage damageGender Educational status Post-Operative Amount of deformityWeight bearing line (%)ROMI (Range of motion)JLCAKnee Society scoremLDTA (mechanical lateral distal tibial angle)Function score WOMAC scale Amount of medial arthritis Presence of lateral arthritis mLDFA (mechanical lateral distal femoral angle) mMPTA (mechanical medial proximal tibial angle) JLCA (Joint Line Congruence Angle) Femoral CORA (center of rotation and angulation)

Gait Analysis after Total Knee Arthroplasty Assisted by 3D-Printed Personalized Guide.

Background With the development of three-dimensional printing (3DP) technology, the patient-specific instrumentation (PSI) has been widely applied in total knee arthroplasty (TKA). The purpose of this study was to compare the gait parameters of patients with 3DP personalized guide-assisted and standard TKA. Methods Retrospective analysis of the advanced knee OA cases in our hospital between June 2017 and June 2018 was conducted. 30 cases received 3DP personalized guide-assisted TKA (group A), and 60 patients who underwent standard TKA during the same period were in group B and group C according to the computed tomography (CT) measurement results, each with 30 cases. Hip–knee–ankle angle (HKA), patella transverse axis-femoral transepicondylar axis angle (PFA), and gait parameters were statistically analyzed. The function was assessed by Hospital for Specific Surgery (HSS) and Knee Society Score (KSS). Results The mean follow-up period was 12.3 months in the three groups. The knee max flexion angle at the swing phase of group A was larger than group B and group C (P < 0.05), there was no statistically significant difference in other gait parameters. The mean PFA of group A was smaller than that of group B and group C (P < 0.05). While, the HKA, HSS, and KSS scores of three groups showed no significant difference. Conclusion 3DP personalized guide technology could improve the gait parameters after surgery, specifically reflected in the knee max flexion angle at the swing phase. It could also assist in the reconstruction of more accurate patellar tracking and rotational alignment in TKA, avoiding the occurrence of insufficient or excessive extorsion.

Comparative study on functional outcome, complication and readmission rate in bilateral simultaneous versus staggered versus staged total knee replacement: a retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; An important source of debate in orthopaedic practices is the choice of performing simultaneously, staggered or staged bilateral total knee arthroplasty (BTKA). Many studies are available which compare bilateral simultaneous vs staged TKA in terms of functional outcome. But still there are no studies which include staggered BTKA (done in a single hospital stay) and compared their functional outcome, associated complication with a 90 days readmission rate.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective review of 300 TKAs patients who underwent bilateral TKA. Patients were divided into three groups with 100 patients each in simultaneous, staggered, staged group. We use hospital electronic health records database to compare the complication and readmission rates in all three groups. Functional outcome was evaluated pre-operatively using knee society score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford knee score, Kujala score and range of motion.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The study consists of 234 females and 66 males, among which maximum females were in a simultaneous group while male where more in staggered group. Mean age group in our study was 62.25%. ASA score of 3 was significantly more in staged group. Patient in the staggered group had a better KSS and Kujala score with better range of motion and less readmission and complication rate. Simultaneous BTKA had slightly higher complication rate.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study demonstrates that there is not big significant in functional outcome when comparing simultaneous, staged and staggered bilateral TKA, but still staggered group shows better postoperative functional outcome.&lt;/p&gt;

Comparison of implant position and joint awareness between fixed- and mobile-bearing unicompartmental knee arthroplasty: a minimum of fiveyear follow-up study.

To compare the implant position and patient-reported outcomes (PROs) regarding joint awareness using the Forgotten Joint Score (FJS) following between fixed-bearing (FB) and mobile-bearing (MB) unicompartmental knee arthroplasty (UKA) with a minimum of fiveyears' follow-up. One hundred fifteen consecutive UKAs (58 FB UKAs and 57 MB UKAs) performed were retrospectively evaluated. We compared the radiographic parameters including component positions and relationships as well as lower extremity alignment. Post-operative clinical outcomes were assessed using Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Tegner activity score, and FJS. The MB UKA group showed more convergent componentry relationship between femoral and tibial components (p < 0.001). The joint line of the MB UKA group was restored significantly better (p < 0.05). In addition, the positioning of femoral and tibial components of the MB UKA group showed less deviation from the weight-bearing line (WBL) (p < 0.05). Although there were no differences in KSS, WOMAC, and Tegner activity scores between the groups, the MB UKA group showed significantly better FJS than did the FB UKA group atfive years post-operatively (p < 0.05). The MB UKA group had a more convergent componentry relationship, less deviation from WBL, better joint-line restoration, and reduced joint awareness than did the FB UKA group at fiveyears follow-up.

Concept verification of a Remote Automatic Scoring System for Evaluating Knee Function after Total Knee Arthroplasty.

The Knee Society Score (KSS) is the most commonly used scale for evaluating postoperative pain and physical function after total knee arthroplasty (TKA). However, this scale requires clinic visiting, which is not quite convenient. Our concept verification study demonstrated a remote automatic system for evaluating knee function after TKA using the KSS. The remote scoring system consists of two modules for data acquisition, an application for patients, a cloud server, and an application for doctors. The kinematic data are collected by the data acquisition modules and transmitted to the patient application via Bluetooth. The data acquisition module contains a motion sensor, a microcontroller unit, a power supply, and a Bluetooth module. The motion sensor consists of an accelerometer, a gyroscope, and a geomagnetic sensor, all of which are three-axis instruments. Using the nine-axis data, the three-dimensional (3D) angles are calculated according to the theory of attitude and heading reference system. The KSS score is calculated using a scoring algorithm in the patient application and transmitted to the doctor application through the cloud server. The knee function of 10 patients treated with unilateral TKA was evaluated by both a doctor and the remote scoring system. The consistency in KSS between the doctor and the system was analyzed using the paired t-test. The remote scoring system successfully recorded knee function data and transmitted the scores from the patient application to the doctor application through the cloud server. There was no significant difference in the KSS scores evaluated by the doctor and that by the system (p = 0.326). This remote automatic scoring system provides a reliable and convenient method for evaluating knee function after TKA at home.

Navigated, soft tissue-guided total knee arthroplasty restores the distal femoral joint line orientation in a modified mechanically aligned technique.

To investigate the femoral component alignment in patients undergoing soft tissue-guided, navigated total knee arthroplasty (TKA). It was hypothesized that with a mechanically aligned tibial component, the soft tissues tensioned and symmetric medial and lateral gaps in flexion/extension, the femoral component would be aligned to the preoperative distal femoral joint line, as measured on knee radiographs. Between 2015 and 2017, 77 patients (78 knees) underwent navigated soft tissue-guided TKA at a single centre. Pre and postoperative radiographs were collected and varus knees were taken into account. The tibial cut was performed with navigation in neutral alignment. The femoral cuts were adjusted based on tensioned soft tissues, aiming for equal medial and lateral gaps in flexion and extension. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Knee Society Score (KSS) were collected pre and postoperatively as a secondary outcome measure. A total of 58 TKAs on varus knees were assessed. On average, the femoral component was placed at 1.7° (SD 1.7) varus in the coronal plane. The comparison between the radiographic native distal femoral alignment and the orientation of the femoral component coronal cut demonstrated a statistically significant (p < 0.0001), linear inverse relationship (r = 0.5). Satisfactory knee function and excellent pain remission were demonstrated by KOOS and KSS scores at a mean of 2.8years (SD 0.5) follow-up. One TKA was revised, resulting in a 98.3% survivorship at three years. The proposed soft tissue-guided, navigated technique, aiming to preserve the integrity of the ligaments and a neutrally aligned tibial cut, provided a joint line respecting femoral coronal cut and encouraging short-term clinical results. III.

Primary Repair for Injury of Medial Collateral Ligament During Total Knee Arthroplasty

This study, we aim to determine whether intraoperative over-release of MCL that is treated with primary repair can achieve satisfactory clinical results when compared to those who did not have over-release of MCL. At the same time, we seek to look into the difference between two methods of primary repair (anchor suture and staple) in terms of clinical outcomes.Purposes:We determined whether, after TKA, patients with CIA versus patients with CACB demonstrated (1) decreased pain scores (2) greater ambulatory ability postoperatively (3) decreased daily opioid consumption and hospital length of stayMethods:3897 TKAs were performed from year 2003-2014. Sixty-five patients with MCL injury due to over-release during TKA who were repaired with suture anchor or staple (suture anchor: 36 vs. staple: 29) were studied whereas matched group of 65 patients without MCL injury were selected and served as the control group. Subjective feeling of instability and functional score were assessed using Knee Society Score (KSS) and Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Objective stability was evaluated through measurement of opening angles in extension and 30° of knee flexion on valgus stress radiographs. The clinical and stability results of repair between the suture anchor and staple were compared.Results:The KSS and WOMAC scores in patients with primary repair of MCL during TKA from 50.6±14.8 to 87.3±8.3 and 65.9±16.3 to 17.7±8.3, respectively. However, there were neither statistical nor clinical significant difference when comparing between the group with primary repair and the control group. Radiographic stability also showed no differences between repair and control groups in extension and 30° of flexion (p= .63 and p= .37). Regarding the subgroups, There were no significant differences between the suture anchor and staple in terms of the stability and clinical outcomesConclusion:Primary repair either with suture anchor or with staple for injury of the MCL in varus gonarthrosis during TKA provides a good stability and clinical outcomes as those of result with no MCL injury.

Evaluation of the "Minimal Clinically Important Difference" (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy.

Defining a Minimal Clinically Important Difference (MCID) value for Patient-Reported Outcome Measures (PROMs) is crucial for determining the effectiveness of a procedure and calculating the sample size for trial planning. The purpose of this study was to determine the MCID of several PROMs (Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and the SF-12) in patients who underwent medial opening-wedge High-Tibial Osteotomy (owHTO) with Patient-Specific Cutting Guides (PSCGs), using anchor-based methods. Patients undergoing isolated medial owHTO with PSCGs between January 2013 and January 2017 were enrolled in this single-center, prospective, observational study. Three outcome scores were collected pre-operatively and at the 2 years follow-up evaluation: KOOS, KSS and SF-12. The MCIDs were calculated using anchor-based method: at 2 years postoperatively: "Compared with before surgery, how would you rate operated joint now?" The responses were recorded using a five-point scale. Patients who answered "about the same" or "somewhat worse" were classified into the no change group, while those who answered "somewhat better" were classified into the minimal change group. A receiver operating characteristic (ROC) curve was used to define the cutoff point that best discriminated between the minimal change and no change groups for each PROMs RESULTS: 196 patients were included, 75 (somewhat better) and 24 patients (about the same and somewhat worse) were, respectively, assigned to the "no change" and "minimal change" groups. There was no significant difference between the two groups in terms of baseline characteristics and postoperative complications. At 24months follow-up all the PROMs (KOOS, KSS and SF-12) were significantly better for the "minimal change" group compared to the "no change" group. MCID was 15.4 for KOOS pain, 15.1 for KOOS symptoms, 17 for KOOS ADL, 11.2 for KOOS sports/recreation, 16.5 for KOOS QQL, 3 for KSS symptoms, 5.6 for KSS activity, 7.2 for SF-12 physical component and 6.3 for PCS mental component. This study determined the MCIDs of common used PROMs in patients undergoing owHTO. Prospective Cohort Study, Level II.

The metaphyseal sleeve: an unexplored option in the treatment of complex primary knee osteoarthritis

BackgroundIn an ever-aging society that as a whole has become more affluent, significant emphasis has been accorded to an improved quality of life. Knee osteoarthritis is ever-increasingly treated with total knee arthroplasty. The benefits and satisfaction experienced by those who have undergone total knee replacements (TKR) are well documented in the literature. The issue arises when osteoarthritis of the affected knee is more complex than simple osteoarthritis, i.e. the patient has complex primary osteoarthritis. This collective term encompasses conditions such as massive bone loss, ligamentous laxity, coronal defects and those with contractures. There are various classifications to describe massive bone loss but we utilized the Anderson Orthopaedic Research Institute (AORI) classification. Numerous treatment options are available and we report the use of metaphyseal sleeves as a highly successful treatment option.MethodsWe retrospectively reviewed all the patients at our centre who underwent primary TKR using the metaphyseal sleeves. Patients were assessed on symptoms and functional status, and radiographs were also taken to assess for osseointegration. Only patients who completed 2 years of follow up were included in our study.ResultsThe updated (2011) Knee Society Score (KSS) was used in conjunction with radiological assessments at each follow up. Mean KSS scores improved from 53.83 preoperatively to 193.39 postoperatively. All patients demonstrated increasing osseointegration throughout follow up.ConclusionThe metaphyseal sleeve is an excellent treatment option for complex primary osteoarthritic knees with good results objectively, functionally and radiologically and would be a great choice for all orthopaedic surgeons to include in their armamentarium.

Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection.

ObjectiveTo report on our clinical outcomes and on the experience of managing acute periprosthetic joint infection (PJI) with debridement, antibiotics, and implant retention (DAIR).MethodsWe performed a retrospective review of all patients who were diagnosed with acute PJI after primary hip or knee replacement surgeries and who were managed with DAIR in our prospective joint replacement registry from 2008 to 2019. The diagnosis of PJI was made according to the 2011 Musculoskeletal Infection Society (MSIS) criteria. The symptom onset duration, inflammatory marker levels (i.e. C‐reactive protein [CRP], erythrocyte sedimentation rate [ESR], white cell count [WBC], and synovial WBC count), functional scores including the Knee Society Score (KSS), the KSS functional score and the Harris Hip Score (HHS), bacteriology, and surgical outcomes of the patients were tracked and recorded. A paired sample of joint fluid and tissues was also sent for a metagenomic next‐generation sequencing (mNGS) test. A paired‐samples t‐test was used to compare the differences in the inflammatory markers and functional scores before and after surgery.ResultsA total of 24 patients with 7 infections after hip replacements and 17 infections after knee replacements were included. A total of 21 patients exhibited early postoperative infections, and 3 exhibited late acute hematogenous infections. During a mean follow‐up time of 29.2 ± 15.1 months, 22 patients were successfully treated, whereas 2 patients were unsuccessfully treated and required repeated DAIR. The overall success rate of DAIR was 91.7%. For staphylococcal infections, DAIR had a 100% success rate. Five patients who presented with symptoms between 4 and 8 weeks also achieved a 100% success rate. At the last follow‐up, the mean CRP level decreased from 52.6 ± 34.0 to 5.4 ± 3.5 (P < 0.001), and the mean ESR level decreased from 72.3 ± 34.3 to 20.2 ± 12.1 (P < 0.001). The mean KSS score increased from 44.8 ± 12.2 to 81.4 ± 9.2 (P < 0.001), and the mean KSS functional score increased from 38.1 ± 3.5 to 73.9 ± 23.0 (P < 0.001), and the mean HHS score increased from 34.4 ± 6.9 to 84.1 ± 15.1 (P < 0.001). The overall pathogen identification rate was 91.7% (22/24 cases). The success rates for Staphylococcus, Streptococcus, and the other pathogens were 100% (9/9 cases), 71.4% (5/7 cases), and 100% (6/6 cases), respectively.ConclusionDebridement, antibiotics, and implant retention has a high success rate for the treatment of acute PJI and may be performed in selected patients whose symptoms have been sustained for over 4 weeks. A high rate of success for staphylococcal infections was reported with the use of DAIR.