Knee Society Score Research Articles

EFFECT OF BLOOD FLOW RESTRICTION ON THE PAINFUL KNEE AFTER KNEE ARTHROPLASTY IN PATIENTS WITHOUT MECHANICAL FAILURE: PRELIMINARY RESULTS OF A PROSPECTIVE COHORT STUDY

7–20 % of the patients with a total knee arthroplasty (TKA) are dissatisfied without an indication for revision. Therapeutic options for this patient population with mostly a lack of quadriceps strength are limited. The purpose of this study is to evaluate the effect of six weeks low load resistance training with blood flow restriction (BFR) on the clinical outcome in these unhappy TKA patients.Thirty-one unhappy TKA patients (of the scheduled fifty patients) without mechanical failure were included in this prospective study since 2022. The patients participate in a supervised resistance training combined with BFR, two times a week during nine weeks. Patients were evaluated by the Knee Osteoarthritis Outcome Score (KOOS), Knee Society Score: satisfaction (KSSs) and the Pain Catastrophizing Scale (PCS). Functionality was tested using the Six Minute Walk Test (6MWT) and the 30-Second Chair Stand Test (30CST). Follow-up took place at six weeks, three months and six months after the start.Six weeks training with BFR provided statistically significant improvements in all the KOOS subscales compared to the baseline, especially for symptoms (55.1 (±15.4) versus 48.0 (±16.5); p<0.001), activities in daily living (50.3 (±21.1) versus 43.7 (±17.2); p<0.00) and quality of life (24.6 (±18.5) versus 17.3 (±13.0); p<0.001). The PCS reduced from 27.4 (±11.0) to 23.2 (±11.4) at six weeks (p<0.01), whereas the KSSs increased from 11.8 (±6.5) to 14.9 (±7.6) (p=0.021). Both the 6MWT and the 30CST improved statistically significant from respectively 319.7 (±15.0) to 341.6m (±106.5) (p<0.01) and 8.6 (±3.9) to 9.3 times (±4.5) (p<0.01).Blood flow restriction appears to enhance the quality of life and functional performance of unhappy TKA patients. Based on these preliminary results, BFR seems to be a promising and valuable alternative for these TKA patients with limited therapeutic options.

Preserving coronal knee alignment of the knee (CPAK) in unicompartmental knee arthroplasty correlates with superior patient-reported outcomes.

The optimal alignment target for unicompartmental knee arthroplasty (UKA) remains controversial, and literature suggests that its impact on patient-reported outcome measures (PROMs) varies. The purpose of this study was to identify the relationship between changes in the coronal plane alignment of the knee (CPAK) and PROMs in patients who underwent UKA. A retrospective analysis of 164 patients who underwent UKA was conducted. The types of CPAK types categorized into unchanged, minor (shift to an adjacent CPAK type, e.g., type I to II or type I to IV), and major changes (transitioning to a nearby diagonal CPAK type or two types across, such as type I to V or type I to III). PROMs were assessed preoperatively and 1 year postoperatively using the Hospital for Special Surgery (HSS) scores, Knee Society (KS) scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Forgotten Joint Scores (FJS). Comparison was performed between patients who experienced and who did not experience any changes in the CPAK. Patients with preserved native CPAK alignment demonstrated significantly superior 1 yearpostoperative outcomes, with higher HSS, KS knee, and WOMAC pain scores (p = 0.042, p = 0.009, and p =0.048, respectively). Meanwhile, the degree of change in CPAK did not significantly influence the PROMs, and patients who experienced minor and major changes in the CPAK showed comparable outcomes. Preserving the native CPAK in UKA procedures is important for achieving favorable clinical outcomes at 1year postoperative. The extent of change in the CPAK type exerted a limited impact on PROMs, thus emphasizing the importance of change in alignment itself.

Cruciate-retaining Arthroplasty in Patients with Severe Varus Deformity: A Retrospective Comparative Study

Introduction: There has been debate regarding the advantages of cruciate-retaining over posterior stabilized (PS) knee arthroplasty and vice versa. Many authors consider any coronal plane deformity >15° as a contraindication for cruciate-retaining total knee arthroplasty. We aimed to compare whether functional outcome, deformity correction, and survivorship of cruciate retaining knee arthroplasty (CR) for severe varus deformity are equivalent to that of posterior cruciate ligament substituting (PS) for 6 years. Materials and Methods: We conducted a retrospective comparative study among patients who underwent Total Knee Replacement in the Orthopedics Department of a tertiary care hospital between 2016 and 2018 August who had a varus deformity of more than 15°. The first author exclusively performed CR operation (Group A) for all complex knees. In contrast, the second author performed PS surgery (Group B) for any coronal plane deformity over 15°. Clinical evaluation included completing a Knee Society Score (KSS) Evaluation Form. Pre-operative scoring was collected from the hospital database. All clinical examinations and radiographs at the final follow-up were done by the third author, who was unbiased and not involved with the initial patient care. Results: There were 39 patients in Group A (CR) and 28 patients in Group B (PS). In Group A, the mean pre-operative varus was 22.05 ± 2.72° and the pre-operative KSS was 32.94 ± 6.79. Postoperatively, the deformity corrected to a mean valgus of 5.48 ± 1.8° and mean KSS of 89.17 ± 5.79. In Group B, the mean pre-operative varus was 22.14±3.82° and pre-operative KSS was 32.82 ± 5.98. Postoperatively, the deformity corrected to a mean valgus of 4.85 ± 2.1° and mean KSS of 90.17 ± 5.13. The mean insert thickness was 11.76 ± 1.75 mm and 11.42 ± 1.75mm among the CR and PS groups, respectively. Concerning deformity correction (P = 0.19) and functional outcome (P = 0.46), both groups showed equal improvement with a 100% survival rate for 6 years. Conclusion: We concluded that CR knee replacements are possible with excellent functional and radiological outcomes in severe varus arthritic knees with a 100 % survival rate. Keywords: Arthritis, total knee arthroplasty, cruciate retaining, posterior stabilizing, varus deformity.

Platelet rich plasma could replace tranexemic acid in total knee replacement? A comparative study between their postoperative- bleeding hemostatic effects

Background: The aim of the study is to detect whether platelet rich plasma (PRP) is equal to tranexemic acid (TXA) in reducing blood loss and transfusion rates following total knee arthroplasty (TKA), and compare clinical outcomes, complications, and cost effectiveness between the two groups. This is one of the first randomized, controlled trials that compare both materials in elective knee arthroplasty. Methods: 120 patients were randomized. Postoperative blood loss was determined and compared by measuring the total drainage suction together with the hemoglobin level and blood transfusion rate. Thromboembolic complications and knee society score were recorded. Results: The mean total drain output was 469 mL in the TXA group compared with 698 mL in the PRP group, with statistical significance. There were significant differences in reduction of hemoglobin level (TXA: 1.21 vs. PRP: 2.08). The rate of deep vein thrombosis (DVT) in patients given TXA was higher than those given PRP, however, there were no significant differences. No transfusions were required in either group, and no significant differences were found in the length of hospital stay, pain assessment and knee society score. Conclusions: Though the blood loss was significantly bigger in the custom-made PRP group, no transfusions were required. Meanwhile, the rate of DVT in the PRP group tends to be lower than those in TXA group. We concluded that PRP was not superior to TXA in reducing perioperative blood loss, however further large-scale randomized trials are crucial to confirm these results to be added to the calling literature.

Tibial Tuberosity Fixation in Complex Proximal Tibia Fractures Using Thin Profile Distal Fibular Plate: A Prospective Study with 12-month Outcomes

Introduction: Proximal tibial plateau fractures are common intra-articular injuries that result from either direct axial compressive trauma or indirect coronal trauma. The standard fixation method is bi-columnar dual plating. In cases with additional tibial tuberosity fractures, a thin-profile distal fibular plate can be used for repair. Aim: To assess the clinical outcomes of a combined posteromedial, anterolateral, and thin distal fibular plating of the tibial tuberosity fractures, and also to assess the radiological outcome in complex proximal tibia Schatzker type 5 and 6 fractures with additional tibial tuberosity fractures. Materials and Methods: This prospective study was carried out at the Orthopaedics Department of Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India from January 2017 to January 2022, on 18 patients with tibial plateau fractures (Schatzker type V or VI) associated with tibial tuberosity avulsion fractures. These fractures were fixed with thin-profile distal fibular plates. The functional outcome of the knee joint was assessed after one year, using the Knee Society score. Descriptive statistics were used to compute means, Standard Deviations, and ranges. Student’s t-tests and One-way Analysis of Variance (ANOVA) were used to compare the means. The p-value of ≤0.05 was considered statistically significant. Results: The average age of the study population was 39.4±5.6 years. Road traffic accidents were the most frequent mode of injury in 14 (77%) individuals. No perioperative complications were noted. The average duration of surgery was 114±10.4 minutes, and the average blood loss was 146±40 mL, throughout the procedure. The Knee Society score at 12 months postoperatively was excellent at 93.6 (range 92 to 98). Radiographic bone union was observed after an average of 12.4 weeks. Conclusion: Multiplanar complicated proximal tibia Schatzker type V and VI fractures with tibial tuberosity avulsion fractures may be effectively treated using a novel technique of thin-profile distal fibular plating. The bi-columnar plates combined with open reduction and internal fixation through two incisions with thin distal fibular plates showed satisfactory results.

Comparison the Effect of Rehabilitation at Home and Outpatient Physiotherapy after Total Knee Arthroplasty Surgery on Quality of Life and Knee Function: A Clinical Trial Study.

Primary total knee arthroplasty (TKA) is an effective procedure to better function and relief the pain in advanced osteoarthritis patients. This study aimed to evaluate the effectiveness and safety of outpatient clinic-based setting of physiotherapy versus home-based rehabilitation (HBR) for functional recovery immediately after primary TKA procedure. This randomized clinical trial study was conducted on patients underwent TKA in 2021-2022. Participants were randomly allocated to either "usual care" or a "home-based rehabilitation" in a 1:1 ratio. The primary outcome measurement of this study was the Knee Society Score (KSS). The secondary outcome was patient quality of life using the 36-item Short Form Survey Instrument (SF-36). Data were entered into the SPSS software 25 and analyzed. In this study, 80 patients who underwent TKA in equal proportion in two outpatient physiotherapy (36 women; average age 64.37 ± 5.12 years) and home rehabilitation (33 women; average age 62.4 ± 4.87 years) groups were examined. The findings our study showed that after the intervention (3 and 5 months after the operation), there was no significant difference between the two groups in terms of the quality of life (total score) (P > 0.05). KSS had no significant difference between the two groups (P > 0.05). This randomized controlled trial found no significant differences in the outcomes of rehabilitation using either a HBR or a traditional outpatient physiotherapy model.

GMK rotating hinge prosthesis. A valid option for complex revision knee prosthetic surgery

revision joint replacement surgery presents a surgical challenge. The use of rotating hinge prostheses is an option in patients with femorotibial bone defects, ligament insufficiency, or significant deformities. The aim of this study was to evaluate the clinical, functional, and radiological outcomes of a series of patients who underwent surgery using the GMK Hinge (Medacta®) rotational hinge model. a descriptive, retrospective, and analytical study was conducted on a series of 36 patients, with a mean age of 72.5 years (47-85), operated on by the same surgical team between January 2015 and January 2022. The etiology of revision was chronic infection in 38.9% of cases, instability in 33.3%, aseptic loosening in 19.4%, and stiffness in 8.4%. The Knee Society Score (KSS) and the Forgotten Joint Score (FJS) were used to assess functional outcomes. The degree of femorotibial bone defect was evaluated using the Anderson Orthopaedic Research Institute (AORI) classification. Postoperative complications are also recorded. a total of 36 patients, 17 males and 19 females, were included, with a mean follow-up of 30 months (12-66). Twelve patients had type 1 defects, ten had 2A defects, ten had 2B defects, and two had type 3 defects on the femoral side, with the use of wedges required for asymmetrical defects (21 patients). The predominant tibial defect was type 1 without the need for wedges. The majority achieved a satisfactory outcome on the KSS scale (72.2 ± 9.4), with significant differences compared to the previous KSS (54.3 ± 8.9). A score of 31 (12-67) was also obtained on the FJS scale. Postoperative complications were present in 16.7% of patients. complex prosthetic revision surgery using a rotating hinge prosthesis represents a suitable therapeutic option, yielding appropriate clinical and functional outcomes, albeit not without complications.

Transcutaneous electrical acupoint stimulation for rehabilitation after total knee arthroplasty: a systematic review and meta-analysis.

Rehabilitation after total knee arthroplasty (TKA) has become an indispensable part of the treatment strategy for degenerative joint disease. Despite some current research demonstrating efficacy of transcutaneous electrical acupoint stimulation (TEAS) for post-TKA rehabilitation, the evidence is not conclusive. To systematically assess the evidence supporting TEAS for rehabilitation after TKA. A literature search of the PubMed, Embase, The Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang, and Chinese Scientific Journal Data databases for relevant studies published up to October 16, 2023, was performed. Main indicators included visual analog scale (VAS) and functional scores; secondary indicators included range of motion (ROM), interleukin-6 (IL-6) and C-reactive protein (CRP) levels, and analgesia-related adverse events. Risk of bias was evaluated using the Cochrane Tool, and meta-analysis was performed using Review Manager version 5.4. Twenty RCTs with 1295 participants were included. TEAS improved several outcomes compared to control groups. The TEAS group had significantly greater pain reduction at postoperative 6 h, 12 h, 24 h, 48 h, 72 h, 7 days, and 14 days. Moreover, TEAS significantly improved the Hospital for Special Surgery Knee Score, Knee Society Score, and ROM. Patients who underwent TEAS exhibited a lower incidence of analgesia-related adverse events and lower IL-6 and CRP levels. Available evidence indicates that the application of TEAS in patients undergoing TKA is related to postoperative pain alleviation, functional improvement, and fewer adverse events associated with analgesia.

Progressive Late-Onset Genu Recurvatum Post-Total Knee Arthroplasty: Insights from a Spinal Stenosis-Related Case Series.

Knee osteoarthritis is common among older individuals, necessitating Total Knee Arthroplasty (TKA) for end-stage cases. The aging population has increased TKA demand, leading to a rise in revision surgeries. Genu recurvatum, a rare complication, often requires surgical intervention, with late-onset cases linked to neuromuscular conditions. This case series focuses on the infrequent occurrence of late-onset genu recurvatum resulting from spinal stenosis in patients without other predisposing conditions. A retrospective case series of 10 patients (11 knees) referred between February 2016 and August 2020 due to late recurvatum instability. Exclusion criteria encompassed neuromuscular diseases other than spinal stenosis, prosthetic joint infection, and pre-existing recurvatum deformity. Data, including demographics, medical history, imaging findings, and surgical details, were collected retrospectively. Patient performance was assessed using the Knee Society Score (KSS) at specified postoperative intervals. The study cohort, exhibiting hyperextension ranging from 11 to 30 degrees, underwent successful revision surgery using rotating hinge knee (RHK) implants after failed conservative measures. Follow-up assessments at 6, 18, and 24 months showed no recurrence of genu recurvatum. Late-onset genu recurvatum poses a challenge, necessitating surgical intervention. Identifying predisposing factors is crucial, with spinal stenosis emerging as a rare cause. The use of posterior stabilized (PS) implants in primary surgery aligns with higher revision rates, possibly linked to PCL removal. Limited literature explores the spinal-genu recurvatum relationship. A stepwise screening protocol is proposed for high-risk patients, emphasizing history, physical examination, and imaging. Strategic considerations include lower constraining, a tighter extension gap, and potential use of Hinge implants.

An observational study on the functional outcomes of 100 robotic total knee replacements performed by an Indian surgeon: Early experiences

Abstract Background: We aim to share our preliminary encounter with robotic knee replacements in Indian patients, focusing on the initial 100 cases. This report will delve into our observations regarding the learning curve and provide insights from a short-term follow-up at 6 months. Materials and Methods: Following institutional ethical clearance, we conducted an observational study involving 100 robotic-assisted total knee replacement cases performed from March 2022 to November 2022. These patients underwent a 6-month follow-up to evaluate functional outcomes. Our primary objective was to investigate the learning curve associated with robotic-assisted total knee arthroplasty (RATKA), specifically emphasizing operative time. Furthermore, we examined preoperative and postoperative alignment parameters as part of our analysis. Results: In our investigation, participants had a mean age of 64.68 years, with a female-to-male ratio of 43:22 and an average body mass index of 30.71 ± 4.88. Intraoperative blood loss was recorded at an average of 91.81 ± 21.63 mL. The mean surgical duration for the initial 25 cases was 102.5 ± 11.08 min, which improved to 65.65 ± 13.07 min for the subsequent 75 cases. The average hospital stay length was 2.88 ± 0.88 days. Notably, there was a significant enhancement in the Knee Society Score (KSS), with a preoperative mean of 38.90 ± 12.72 improving to a postoperative mean of 84.89 ± 4.10 (P = 0.001), as well as in the Oxford Knee Score (OKS), which saw a rise from 16.62 ± 16.42 preoperatively to 45.58 ± 4.97 postoperatively (P = 0.001). The accuracy of preoperative determination for femoral component sizes was 100%, while for tibial component sizing, it was 97%. Conclusion: The key finding from this observational study suggests that around 25 procedures are required to reach a learning plateau. During this process, an average decrease of 36.1 min in surgical time was observed from the initial to proficient stages. Notably, no learning curve was observed for lower limb alignment and implant placement, and no significant complication rates were documented.

Primary Total Knee Replacement using Rotating Hinge Implants in Poliomyelitis: A Case Series and Review of the Literature.

The results of primary total knee replacement (TKR) using hinge implants performed in the Indian population with post-polio residual paresis (PPRP) are unknown. The purpose of this study was to report the outcome of primary rotating hinge TKR in Indian patients with PPRP at a minimum follow-up of 12 months. We retrospectively reviewed the clinical and radiological records of six patients treated with primary rotating hinge TKR. Pre-and post-operative (at final follow-up) knee range of motion (ROM), knee sagittal deformity, knee society score (KSS), and Oxford knee score (OKS) were compared to determine improvement in function. Six rotating hinge TKRs (five female and one male patient) were analyzed for this study. At a mean follow-up of 27 ± 22 months (range, 12-71 months), the mean pre-operative KSS of 50.6 ± 2.5 significantly improved (P < 0.0001) to 72.5 ± 1.6, and the mean pre-operative OKS of 23.6 ± 1.6 significantly improved (P < 0.0001) to 35.3 ± 1.7. The mean pre-operative knee ROM of 94° ± 10° changed to 92° ± 4° (P = 0.64) and the mean pre-operative sagittal deformity of 7° ± 23.5° changed to -3° ± 2.5° (P = 0.32) at final follow-up. None of the knees had any intra- or post-operative complications or showed radiologic evidence of post-operative loosening, subsidence, or periprosthetic radiolucent lines at the final follow-up. Rotating hinge TKR gave excellent clinical and radiological results at a mean follow-up of 27 months in the present study. Despite TKR being a technically challenging procedure in patients with poliomyelitis-affected limbs, a rotating hinge design, along with meticulous surgical technique, can significantly improve function in such patients.

Short-term functional outcomes of robotic-assisted TKA are better with functional alignment compared to adjusted mechanical alignment.

Ligament balancing is essential to the functional outcome of total knee arthroplasty (TKA). The optimal method of alignment remains a controversial issue. The primary objective was to compare the clinical outcomes of TKA between functional and adjusted mechanical alignment techniques. The secondary objectives were to compare bone resection, robotic alignment, and radiological assessment. This was a retrospective case-control series comparing TKA performed with functional alignment (FA) and adjusted mechanical alignment (aMA). Sixty-four FA subjects were matched with 64 aMA controls. These two groups were matched for age, gender, body mass index (BMI), surgeon, and type of frontal deformity. Both surgical procedures were performed using the MAKO® haptic robotic system. Functional scores (Forgotten Joint Score (FJS), Knee Society Score (KSS), and Oxford Knee Score (OKS)) were measured at the final postoperative follow-up. A radiographic evaluation was performed at the same time. Mean FJS were respectively 63.4±25.1 [0-100] and 51.2±31.8 [0-100] in FA versus aMA group (p=0.034). Mean OKS were respectively 40.8±6.3 [21-48] and 34.9±11.8 [3-48] in FA versus aMA group (p=0.027). Mean KSS were respectively 184.9±17.0 [126-200] and 175.6±23.1 [102-200] in FA versus aMA group (p=0.02). The main residual symptom was "none" for 73.0% versus 57.8%, "instability" for 6.4% versus 21.9%, "Pain" for 19.1% versus 12.5%, and "effusion" for 1.6% and 7.8% respectively for FA and aMA group (p=0.016). There were 4 complications in the FA group versus 5 in the aMA group (p>0.999). Mean postoperative hip-knee-ankle (HKA) robotic assessment were respectively 177.3°±2.0 [172-180] and 178.2°±2.0 [173-180] for FA and aMA group (p=0.018). The median difference between HKA robotic and HKA radiological was -3.0° (IQR=3.0; p<0.001). With greater residual deformity and without release, functional alignment showed a statistically significantly better short-term clinical outcome than adjusted mechanical alignment. This difference may not be clinically significant.

Clinical and Radiological Outcomes of Computer-Assisted Navigation in Primary Total Knee Arthroplasty for Patients with Extra-articular Deformity: Systematic Review and Meta-Analysis.

Computer-assisted navigation surgery (CAS) during primary total knee arthroplasty (TKA) may help improve outcomes for patients with extra-articular deformity (EAD); however, this has not been extensively studied. Therefore, we aimed to investigate the clinical and radiological outcomes following primary TKA using CAS in patients with EAD. We searched Medline, Embase, and the Cochrane Library up to March 3, 2023 for studies investigating surgical outcomes of using the navigation system for TKA to treat patients with EAD. From 14 studies, 539 knees with EAD that underwent navigation TKA were enrolled. We investigated the knee range of motion (ROM), outcome scores at final follow-up (Knee Society Score [KSS] and Knee Functional Score [KFS]), and pre- and postoperative mechanical hip-knee-ankle (mHKA) angle using lower extremity scanogram. The meta-analysis was based on the single-arm method, and all data were pooled using a random-effects model. Following our meta-analyses, the mean knee ROM changed from 87.0° (95% confidence interval [CI], 75.9°-98.1°) preoperatively to 109.4° (95% CI, 97.9°-120.8°) postoperatively. The adjusted KSS was 93.45 points (95% CI, 88.36-98.54 points), and the adjusted KFS was 91.57 points (95% CI, 86.80-96.33 points) in knees with EAD that underwent CAS-TKA. As a radiological outcome, the mHKA angle changed from 169.53° (95% CI, 166.90°-172.16°) preoperatively to 178.81° (95% CI, 178.31°-179.30°) postoperatively. CAS-TKA yielded positive clinical results and demonstrated a satisfactory alignment of the lower limb's mechanical axis. CAS-TKA showed promise for primary TKA procedures, demonstrating favorable clinical and radiological outcomes even in complex cases involving EAD.

Prior medial meniscus arthroscopy is not associated with worst functional outcomes in patients undergoing primary total knee arthroplasty: A retrospective single-center study with a minimum follow-up of 5 years.

There have been controversial studies on the impact of prior knee arthroscopy (KA) on outcomes of total knee arthroplasty (TKA). The purpose of this comparative study is to investigate the impact of prior KA of medial meniscus on patients undergoing TKA by evaluating the International Knee Society Score (IKS), the complications, and revisions. This retrospective study reviewed 84 patients with TKA who had undergone prior KA of the medial meniscus and compared them to 84 cases, without a history of prior KA as a control group. Outcomes were assessed with the original IKS scores and complications. The mean follow-up was 8years. There was no significant difference between groups with respect to demographics, or pre-operative IKS. The mean pre and postoperative IKS was not different between groups. The all-cause reoperation, revision, and complication rates of the KA group were not significantly higher than those of the control group. The present study seems to reveal that previous KA of the medial meniscus does not negatively affect a subsequent TKA. Nevertheless, larger studies may be necessary to confirm this observation.

Outcomes of Minimally Invasive Locking Plate Osteosynthesis for Periprosthetic Distal Femur Fractures following Primary Total Knee Arthroplasty

Abstract Introduction: Periprosthetic distal femur fractures have been on the rise with an increasing number of total knee arthroplasties being performed. In addition to regular fixation principles in distal femur fractures, periprosthetic fractures pose additional challenges due to osteoporotic bone and preexisting medical comorbidities. Materials and Methods: We retrospectively analyzed 31 patients who underwent surgical fixation with a locking plate using a minimally invasive technique for periprosthetic distal femur fractures at a single level 1 orthopedic hospital for 4 years. Results: Out of the 31 patients included in the study, 21 were female. The mean age of the study population was 65.63 years, ranging from 51 to 82 years. The mean time to union was 14.32 weeks, with a range from 12 to 22 weeks. The average Knee Society Score was 78.2, which is considered a good outcome. There was one case of implant failure in our case series, which could be attributed to immediate weight bearing. Conclusion: In conclusion, we found that fixation of supracondylar femur fractures associated with stable nonstemmed total knee arthroplasty with a locking plate using a minimally invasive technique yielded good results.

Comparative study of single vs. dual plating in distal femur fracture

Abstract Background: Despite recent advances in techniques and implants, the treatment of intra-articular, multifragmentary distal femoral fractures OTA type C remains a challenge. Fracture shortening with extension and varus deformities of the distal articular surface is typical. During the fixation of such injuries, the surgeon aims to achieve anatomical articular reduction and preserve the blood supply while providing rigid, stable, fixation that is strong enough to withstand early functional mobilization. Objectives: The purpose is to compare and evaluate the functional outcome, subjective outcome, radiological outcome of union, and complications of single vs. dual plating. Materials and Methods: An observational study was conducted from 2021 to 2022 among patients presenting with all distal femur fractures OTA type C in the age group 20–65 years. About 20 patients were managed by single plating with a lateral surgical approach, and 20 were managed by dual plating with a modified swashbuckler approach. Results: The dual plating group showed better functional results than the single plating group according to the knee society score. The age distribution of patients was bimodal, and there was no significant difference between the sex ratio of males and females in both groups. Comparing the range of motion, the dual plating group showed excellent results. The mean union time in the dual plating group was statistically significant. In the single plating group, complications such as varus deformity, wound dehiscence, and implant failure were observed in some cases.Complications in some cases of dual plating induced wound dehiscence and infection. Conclusions: On comparing the dual plating cases with the single plating, we found that the dual plating group is superior to that of the single plating group both in terms of functional outcome and the extent of complications. Also, the dual plating group has a better knee range of motion. The medial and lateral locking plate technique demonstrates a higher union rate with possible lower rates of revision surgery compared to a single lateral plate in highly comminuted distal femur fractures.

Comparative Study of Clinical and Radiological Outcomes of Conventional Total Knee Replacement (TKR) and Robotic-Assisted TKR in Patients with Bilateral Varus Deformity Knee OA within the Eastern Population

Background: Osteoarthritis (OA) of the knee, including bilateral varus deformity, presents unique challenges for treatment. This comparative study evaluates clinical and radiological outcomes of conventional total knee replacement (TKR) and robotic-assisted TKR in patients with bilateral varus deformity knee OA within the Eastern population. Methods: A prospective study was conducted on 84 bilateral varus deformity knee OA patients treated with two different surgical approaches: Group A (Conventional TKR) and Group B (Robotic-assisted TKR). Clinical outcomes, including pain relief, functional improvement, and patient satisfaction, were assessed using Visual Analog Scale (VAS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quality of life measures. Radiological outcomes, including alignment and component positioning, were evaluated. Statistical analyses compared outcomes between groups. Results: Both groups demonstrated significant improvements in clinical and radiological outcomes. Robotic-assisted TKR showed advantages with reduced pain (p &lt; 0.001), superior knee function (p &lt; 0.001), better pain relief and function (p &lt; 0.001), higher patient satisfaction (p &lt; 0.001), and improved quality of life (p &lt; 0.001) compared to conventional TKR. Radiologically, robotic-assisted TKR exhibited superior alignment (p &lt; 0.001) and component positioning (p &lt; 0.001). Implant survivorship remained excellent in both groups, with no revisions reported. Conclusion: Robotic-assisted TKR offers significant benefits in pain relief, functional improvement, and radiological outcomes for patients with bilateral varus deformity knee OA within the Eastern population. While both approaches are effective, the advantages of robotic assistance should be considered in surgical decision-making. Further research is needed to assess cost-effectiveness and long-term outcomes.

Functional and Radiological Outcomes of Total Knee Arthroplasty in Osteoarthritis with Varus Deformity of Knee: A Prospective Study

Introduction: Total knee replacement (TKR) is the most commonly performed orthopedic surgical procedure for treating severe arthritis of the knee joint either due to osteoarthritis or due to inflammatory arthropathy. There was cartilage damage in either the medial or patella femoral joint/lateral compartment. Severe pain through deformity develops, subsequently necessitating a total joint replacement. This study assessed the Functional and radiological outcomes of total knee arthroplasty in osteoarthritis with varus deformity of the knee. Materials and Methods: From February 2021 to July 2022, all patients with osteoarthritis with varus deformity of knee were subjected to total knee arthroplasty after obtaining approval from the Institutional Ethics Committee were required to enroll patients. Results: The age of the patients in our study was 63.58 years ranging from 52 to 79 years. In 72.09% of the patients were females while the remaining 27.91% were females. In our study, 45% of the patients were overweight while the remaining 59.48% were overweight. In our study, 55.81% of the patients get their left knee operated first while the remaining 44.19% of the patients get their right knee operated first. In 25.58% patella resurfacing was done. The p-value was found to be significant between the pre- and post-oper knee society scores. In our study, 5 patients had complications out of which 4.65% of the patients had superficial wound infection, 4.65% of them patient had anterior knee pain and 2.33% had popliteal artery thromboembolism. Conclusion: Total knee arthroplasty is a relatively safe procedure. Treatment with total knee arthroplasty resulted in greater pain relief and functional improvement after 6 months. It improves the functional ability of the patient and the ability of the patient to get back to pre-disease state, which is to have a pain-free mobile joint, There was a significant association between the knee clinical score and knee functional score at six months follow-up.

The Use of Plant-Based Polysaccharide (PSP) Agents May Improve Early Outcomes Following Total Knee Arthroplasty-A Proof-of-Concept Study.

Our study sought to investigate the effects of a topical plant-based polysaccharide (PSP) as an adjunctive hemostat to minimize blood loss and improve early clinical outcomes in patients undergoing primary TKA. In this multi-center and randomized proof-of-concept study, 61 patients undergoing TKA were randomly assigned to one of two groups: A) intraoperative utilization of PSP (n=31) or B) no intervention (n=30). The primary outcomes were blood loss and change in hemoglobin, measured preoperatively and 24 hours postoperatively. Other endpoints included postoperative complications, Knee Society Score (KSS), knee range of motion (ROM), and thigh circumference. There was no difference in postoperative change of hemoglobin or calculated blood loss between the PSP and control groups. The PSP group achieved elevated flexion at two weeks (100.1° vs. 86.6°, p<0.05) and better change in KSS from preop to 90 days (29.5 vs. 22.4, p<0.05) than the controls. Some early postoperative outcomes were improved, which suggests a potential benefit of using PSP in primary TKA. However, the clinical significance of these differences warrants further investigation in a larger randomized trial.

Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

ObjectivesRobotic knee arthroplasty procedures have emerged as a new trend, garnering attention from orthopedic surgeons globally. It has been hypothesized that the use of robotics enhances the accuracy of prosthesis positioning and alignment restoration. The objective of this study was to provide a high-level, evidence-based comparison between robotic total knee replacements and conventional methods, focusing on radiological and functional outcomes.MethodsWe searched five databases from their inception until June 1, 2022, specifically targeting randomized controlled trials (RCTs) that compared the outcomes of robotic and conventional total knee replacements. We were interested in outcomes such as knee range of motion, clinical and function knee society scores, the Western Ontario and McMaster University score (WOMAC), the Hospital of Special Surgery score, complications, and radiological alignment. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. We assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2).ResultsOur search returned seven RCTs suitable for our analysis, which included a total of 1942 knees; 974 of these knees were implanted using robotic arms while the remaining 968 utilized jig-based knee systems. Our findings indicated that robotic knees had significantly better post-operative anatomical (OR − 0.82; 95% CI, − 1.027 to − 0.58, p value < 0.00001) and mechanical restoration (OR − 0.95; 95% CI, − 1.49 to − 0.41, p value < 0.0006). While knee range of motion (OR − 2.23; 95% CI − 4.89–0.43, p value 0.1) and femoral prosthesis position (OR − 0.98; 95% CI, − 2.03–0.08, p value 0.07) also favored robotic knees, these differences did not reach statistical significance. Both clinical and functional outcomes, as well as the rate of complications, were found to be statistically similar between the groups undergoing robotic and traditional knee replacement surgeries.ConclusionThis meta-analysis indicates that robotic total knee replacements offer superior post-operative anatomical and mechanical alignment compared to conventional total knee replacements. Despite this, clinical and functional outcomes, as well as complication rates, were similar between the two. These findings should be considered in light of potential confounding factors. More randomized controlled trials with the latest robotic systems are needed to confirm any superior functional and clinical outcomes from robotic-assisted surgeries.Level of evidenceI.