Results Of Total Knee Arthroplasty Research Articles

Progress in Computer-Assisted Navigation for Total Knee Arthroplasty in Treating Knee Osteoarthritis with Extra-Articular Deformity.

Total knee arthroplasty (TKA) is a well-established treatment for end-stage knee osteoarthritis. However, in patients with concomitant extra-articular deformities, conventional TKA techniques may lead to unsatisfactory outcomes and higher complication rates. This review summarizes the application of navigated TKA for treating knee osteoarthritis with extra-articular deformities. The principles and potential benefits of computer navigation systems, including improved component alignment, soft tissue balancing, and restoration of mechanical axis, are discussed. Research studies demonstrate that navigated TKA can effectively correct deformities, relieve pain, and improve postoperative joint function and quality of life compared with conventional methods. The advantages of navigated TKA in terms of surgical precision, lower complication rates, and superior functional recovery are highlighted. Despite challenges like the learning curve and costs, navigated TKA is an increasingly indispensable tool for achieving satisfactory outcomes in TKA for knee osteoarthritis patients with extra-articular deformities.

Outcomes of total knee arthroplasty combined with the modified "overlap" technique in the treatment of knee osteoarthritis with permanent patellar dislocation

Objective: To investigate the clinical outcomes of total knee arthroplasty (TKA) combined with the modified "overlap" technique in the treatment of end-stage knee osteoarthritis with fixed patellar dislocation. Methods: This is a retrospective case series study. Clinical data of 19 patients (22 knees) who underwent TKA combined with the modified "overlap" technique for the treatment of end-stage knee osteoarthritis with permanent patellar dislocation from January 2011 to January 2022 in the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. The cohort included 5 males (6 knees) and 14 females (16 knees), with an age of (60.6±12.2) years (range:33 to 77 years) and a body mass index of (25.4±4.1) kg/m² (range:20.0 to 33.0 kg/m²). Among them, 11 cases (12 knee) had valgus deformity, with Keblish classification showing mild in 2 cases (2 knees), moderate in 6 cases (6 knees), and severe in 4 cases (4 knees). All cases were treated using a medial parapatellar approach, with lateral retinaculum release combined with the "overlap" technique to restore the patellar trajectory. Knee function was evaluated using the American Knee Society (KSS) Score. Paired sample t tests were used for intergroup comparisons. Results: All patients successfully completed the surgery. Postoperatively, patellar dislocation, knee valgus deformity, flexion contracture deformity, and extensor lag were all corrected. All patients were followed up, with a follow-up duration of (63.8±35.2) months (range:24 to 136 months). One patient experienced periprosthetic infection 2 weeks postoperatively, 1 patient had recurrent patellar dislocation 2 months postoperatively, 1 patient developed knee stiffness 3 months postoperatively and underwent closed manipulation. No other patients exhibited signs of patellar dislocation or subluxation. At the last follow-up, the KSS clinical score improved from (36.4±12.7) points preoperatively to (83.4±6.3) points postoperatively (t=-15.15, P<0.01), and the KSS functional score improved from (30.7±11.1) points preoperatively to (77.6±8.3) points postoperatively (t=-14.37, P<0.01). The range of motion of the knee increased from 81.7°±19.6° preoperatively to 107.6°±12.5° postoperatively (t=-4.85, P<0.01). Conclusion: TKA combined with the modified "overlap" technique is an effective surgical option for the treatment of end-stage knee osteoarthritis with permanent patellar dislocation, demonstrating satisfactory clinical outcomes.

Association Between Overhang of the Posterior Femoral Condyle and Restricted Postoperative Knee Flexion Related to Patient-Reported Stiffness in Medial-Pivot Total Knee Arthroplasty

BackgroundThe primary aim of this study was to investigate the association between the posterior longitudinal overhang in the femoral condyle (PLOF) in medial-pivot total knee arthroplasty (TKA) and a change in knee flexion angle (change in flexion). MethodsThis retrospective cohort study included 148 knees undergoing medial-pivot TKA for medial knee osteoarthritis. The primary outcome was the change in flexion (c-flexion) preoperatively and 1-year postoperatively. The component positions were evaluated using 3-dimensional measurements, where the PLOF was measured for each medial and lateral femoral condyle. The secondary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index scores taken preoperatively and 2 years postoperatively. A multivariate regression analysis was performed to determine predictors of c-flexion and risk factors for negative c-flexion (less than 0°). Furthermore, a receiver operating characteristic curve was utilized to determine the threshold for negative c-flexion. ResultsThe mean c-flexion was −3.2° ± 8.7, and lateral PLOF was significantly associated with c-flexion (β = −0.52; P < 0.001). Larger preoperative flexion angles (odds ratio, 1.10; P < 0.001) and larger lateral PLOF (odds ratio, 1.69; P = 0.001) were risk factors for negative c-flexion, with thresholds of 129° and 1.1 mm, respectively (sensitivity, 0.79; specificity, 0.72). Additionally, patients who had negative c-flexion (n = 91) demonstrated less improvement in preoperative and 2-year postoperative Western Ontario and McMaster Universities Osteoarthritis Index stiffness subscores than patients who had positive c-flexion (0° or more; n = 57) (P = 0.01). ConclusionsA larger lateral PLOF was associated with decreased and negative c-flexion after medial-pivot TKA. Patients who had negative c-flexion demonstrated less improvement in knee stiffness. Surgical strategies aimed at minimizing lateral PLOF may enhance postoperative knee flexion and overall patient outcomes in medial-pivot TKA.

Functional and radiological outcomes of total knee arthroplasty using posterior-stabilized U2 knee system: A retrospective study in 560 cases at five years of follow-up.

The purpose of this study was to assess clinical and functional outcomes as well as the prosthesis survival rates of the U2 Knee system in primary total knee arthroplasty (TKA) with a minimum follow-up of four years. We retrospectively analyzed 560 consecutively primary TKA performed between 2015 and 2019 due to osteoarthritis with a mean follow-up of 5.4 ± 1.1years. The clinical outcomes were assessed using the knee society score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic outcomes were assessed using the American knee society's roentgenographic evaluation system. Prosthetic survival was calculated using the Kaplan-Meier method. Postoperative KSS showed significant improvement at one year (Clinical: 37.4 ± 4.1 vs. 91.9 ± 3.7; p < 0.01; Functional: 41.2 ± 3.3 vs. 90.6 ± 4.8; p = < 0.01), with these improvements maintained throughout the follow-up period. The WOMAC score improved from 60 ± 10.1 preoperatively to 10.9 ± 8.3 (p = 0.02) at the end of the follow-up. There were 20 (3.7%) knees with radiolucent lines around the implant (< 2mm), and none showed evidence of loosening. There were six (1.1%) revisions-four due to prosthetic joint infections and two due to periprosthetic femur fracture. The prosthetic survival was 97.8% at the study closure. The U2 knee system demonstrates effective and safe performance for primary TKA with significant improvements in functional scores, patient-reported outcomes, and a promising prosthesis survival rate at mid-term follow-up. We will continue with the series analysis to assess the long-term outcomes.

Awareness and Underlying Factors for Total Knee Arthroplasty Reluctance in Saudi Arabia.

Background Total knee arthroplasty (TKA) is a successful surgical intervention for advanced knee arthritis. The efficacy of TKA in reducing pain and restoring joint function has been well documented. Despite the rewarding outcomes of TKA for knee osteoarthritis patients, their willingness to consider the procedure is limited. Aim This study aimed to assess patients' awareness and knowledge of total knee arthroplasty benefits and complications. Further, the reasons and factors contributing to reluctance among orthopedic patients in Saudi Arabia should be determined. Methods An online, structured, and self-administered questionnaire was used to collect data from adult orthopedic patients of both genders who were reluctant to undergo total knee arthroplasty despite surgeons' recommendations. The online questionnaire link was shared across multiple platforms, orthopedic forums, and healthcare social media channels. Qualitative data were presented as frequencies and percentages, while continuous data were reported as the mean (standard deviation [SD]). The statistical package for the social sciences software program was used for statistical analysis. Results A total of 629 participants were involved. The awareness of the expected benefits score, on a scale from 7 to 35, showed a mean (SD) of 20.9 (5.6). The score of the attitude towards expected complications, on a scale from 5 to 25, had a mean (SD) of 15.2 (3.6). The attitude towards the expected complications showed a significantly higher mean (SD) score in the older group aged >60 years than the younger one aged <40 years (15.7 (4.1) vs. 14.9 (3.5), respectively). Likewise, overweight and obese participants showed a significantly higher mean (SD) expected complications score compared to the healthy and underweight ones (15.4 (3.7) vs. 14.8 (3.5), respectively). The recorded reasons for refusal to undergo TKA were fear of anesthesia complications (317, 50.4%), followed by financial limitations (245, 39.0%), the unavailability of experienced surgeons (232, 36.9%), and fear of unfavorable outcomes (189, 30.0%). Conclusion There was a gap in knowledge and awareness of total knee arthroplasty among orthopedic patients in Saudi Arabia. Perceptions of benefits were inadequate, and there were misconceptions about the expected complications. The level of expected complications was higher among elderly and obese patients. Furthermore, fear of anesthesia complications and unfavorable outcomes, in addition to economic and financial problems, constituted major barriers to undergoing the procedure.

Preoperative Abnormal Posture Improves After Total Knee Arthroplasty: Knee–Hip–Spine Syndrome

BackgroundSpinal, pelvic, and lower extremity alignment is crucial for maintaining a healthy body posture. However, with aging, this posture becomes challenging to maintain due to muscle weakness and skeletal degeneration. Osteoarthritis (OA) of the hip and knee can also lead to abnormal posture, known as hip–spine and knee–spine syndrome. Total knee arthroplasty (TKA) can help relieve pain and improve lower extremity alignment. This may also improve abnormal posture, such as in knee–hip–spine syndrome. However, the condition of the contralateral knee may affect this improvement. This study evaluated the effects of TKA on clinical outcomes and radiographic body posture. MethodsPatients scheduled for primary one-sided TKA were divided into two groups: the unilateral group comprised patients who had contralateral knee OA conditions. The bilateral group included patients who had prior contralateral TKA. Knee range of motion (ROM), the Knee Injury and Osteoarthritis Outcome Score (KOOS), radiographic lateral femorotibial angle (FTA), hip and knee flexion angles, and sagittal vertical axis (SVA) while standing were measured 24 months after TKA. ResultsBoth groups showed improved knee extension, KOOS, and radiographical FTA and hip and knee flexion angles 24 months after TKA. The SVA also improved 6 months after TKA in both groups and was maintained in the bilateral group, while it deteriorated again in the unilateral group 24 months after TKA. ConclusionA TKA can improve abnormal body posture due to knee OA as in knee–hip–spine syndrome. However, the condition of a contralateral knee can affect TKA outcomes.

Racial and Ethnic Disparities in Primary Total Knee Arthroplasty Outcomes: A Systematic Review and Meta-Analysis of Two Decades of Research.

Racial disparities in outcomes following total knee arthroplasty (TKA) remain persistent. This systematic review and meta-analysis aims to comprehensively synthesize data between 2000-2020. An electronic search of studies was performed on PubMed, SCOPUS, and the Cochrane Library databases from January 1, 2000, and December 31, 2020. Random effects models were used to report unadjusted and adjusted estimates for a comprehensive list of care outcomes in TKA. 63 studies met PRISMA criteria. Black patients report greater odds of in-hospital mortality (odds ratio [OR]: 1.37, 95% CI: 1.00-1.59 (p = 0.049); adjusted OR [aOR]: 1.34, 95% CI: 1.09-1.64), in-hospital complications (OR: 1.31, 95% CI: 1.27-1.35), 30-day complications (aOR: 1.19, 95% CI: 1.07-1.33), infection (OR: 1.11, 95% CI: 1.07-1.16; aOR: 1.30, 95% CI: 1.16-1.46), bleeding (OR: 1.33, 95% CI: 1.03-1.71; aOR: 1.47, 95% CI: 1.23-1.75), peripheral vascular events (PVE) (aOR: 1.46, 95% CI: 1.11-1.92), length of stay (LOS) (OR: 1.20, 95% CI: 1.08-1.34), extended-LOS (aOR: 1.89, 95% CI: 1.53-2.33), discharge disposition (OR: 1.59, 95% CI: 1.29-1.96; aOR: 1.96, 95% CI: 1.70-2.25), 30-day (OR: 1.20, 95% CI: 1.13-1.27; aOR: 1.17 95% CI: 1.09-1.26) and 90-day (OR: 1.46, 95% CI: 1.17-1.82) readmission compared to White patients. Disparities in bleeding, extended-LOS, discharge disposition, PVE, and 30-day readmission were observed in Asian patients. Hispanic patients experienced disparities in extended LOS and discharge disposition, while Native-American patients had disparities in bleeding outcomes. Persistent racial disparities in TKA outcomes highlight a need for standardized outcome measures and comprehensive data collection across multiple racial groups to ensure greater healthy equity.

A new gap balancing technique with functional alignment in total knee arthroplasty using the MAKO robotic arm system: a preliminary study

BackgroundGap tension is an important factor influencing the clinical outcomes of total knee arthroplasty (TKA). Traditional mechanical alignment (MA) places importance on neutral alignment and often requires additional soft tissue releases, which may be related to patient dissatisfaction. Conversely, the functional alignment requires less soft tissue release to achieve gap balance. Conventional gap tension instruments present several shortcomings in practice. The aim of this study is to introduce a new gap balancing technique with FA using the modified spacer-based gap tool and the MAKO robotic arm system.MethodsA total of 22 consecutive patients underwent primary TKA using the MAKO robotic arm system. The gap tension was assessed and adjusted with the modified spacer-based gap tool during the operation. Patient satisfaction was evaluated post-operatively with a 5-point Likert scale. Clinical outcomes including lower limb alignment, Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were recorded before surgery, 3 months and 1 year after surgery.ResultsThe range of motion (ROM) was significantly increased (p < 0.001) and no patients presented flexion contracture after the surgery. KSS and WOMAC score were significantly improved at 3 months and 1 year follow-up (p < 0.001 for all). During the surgery, the adjusted tibial cut showed more varus than planned and the adjusted femoral cut presented more external rotation than planned (p < 0.05 for both). The final hip-knee-ankle angle (HKA) was also more varus than planned (p < 0.05).ConclusionsThis kind of spacer-based gap balancing technique accompanied with the MAKO robotic arm system could promise controlled lower limb alignment and improved functional outcomes after TKA.

Unveiling distinct kinematic profiles among total knee arthroplasty candidates through clustering technique

Background:Characterizing the condition of patients suffering from knee osteoarthritis is complex due to multiple associations between clinical, functional, and structural parameters. While significant variability exists within this population, especially in candidates for total knee arthroplasty, there is increasing interest in knee kinematics among orthopedic surgeons aiming for more personalized approaches to achieve better outcomes and satisfaction. The primary objective of this study was to identify distinct kinematic phenotypes in total knee arthroplasty candidates and to compare different methods for the identification of these phenotypes.Methods:Three-dimensional kinematic data obtained from a Knee Kinesiography exam during treadmill walking in the clinic were used. Various aspects of the clustering process were evaluated and compared to achieve optimal clustering, including data preparation, transformation, and representation methods.Results:A K-Means clustering algorithm, performed using Euclidean distance, combined with principal component analysis applied on data transformed by standardization, was the optimal approach. Two unique kinematic phenotypes were identified among 80 total knee arthroplasty candidates. The two distinct phenotypes divided patients who significantly differed both in terms of knee kinematic representation and clinical outcomes, including a notable variation in 63.3% of frontal plane features and 81.8% of transverse plane features across 77.33% of the gait cycle, as well as differences in the Pain Catastrophizing Scale, highlighting the impact of these kinematic variations on patient pain and function.Conclusion:Results from this study provide valuable insights for clinicians to develop personalized treatment approaches based on patients’ phenotype affiliation, ultimately helping to improve total knee arthroplasty outcomes.

Impact of systemic lupus erythematosus (SLE) on outcomes following aseptic and septic revision total knee arthroplasty: an analysis of the 2005-2018 nationwide inpatient sample.

Systemic lupus erythematosus (SLE) can adversely affect surgical outcomes, and the impact on revision total knee arthroplasty (TKA) outcomes is unclear. This study aimed to explore the impact of SLE on in-patient outcomes of revision TKA. The Nationwide Inpatient Sample (NIS) database from 2005 to 2018 was searched for patients aged ≥ 18years old who received revision TKA. Patients with and without SLE were propensity score matched (PSM) at a 1:4 ratio. Associations between SLE and in-hospital outcomes were examined using regression analyses. The study included 133,054 patients, with 794 having SLE. After 1:4 PSM, data of 3,970 patients were analyzed (SLE, 794; non-SLE, 3,176). Multivariate-adjusted analyses revealed that SLE patients had a significantly higher risk of postoperative complications (adjusted odds ratio [aOR] = 1.23, 95% confidence interval [CI]: 1.05-1.44, p = 0.011), non-routine discharge (aOR = 1.22, 95% CI: 1.02-1.46, p = 0.028), major blood loss (aOR = 1.19), respiratory failure/mechanical ventilation (aOR = 1.79), acute kidney injury (AKI) (aOR = 1.47), and wound dehiscence (aOR = 2.09). SLE patients also had a longer length of hospital stay (aBeta = 0.31) and greater total hospital costs (aBeta = 6.35) compared to non-SLE patients. Among those with aseptic failure, SLE patients had a significantly higher risk of postoperative complications (aOR = 1.23) and non-routine discharge (aOR = 1.36). SLE is independently associated with worse in-hospital outcomes in patients undergoing revision TKA. This study highlights the importance of heightened vigilance and tailored perioperative management for patients undergoing major surgeries in the background of SLE. Key Points • SLE significantly increases the risk of non-routine discharge, major blood loss, respiratory failure, acute kidney injury, and wound dehiscence, in patients undergoing aseptic and septic revision TKA. • Patients with SLE experience longer hospital stays and higher hospital costs compared to those without SLE. • The study's findings highlight the necessity for healthcare providers to consider the presence of SLE as a critical factor in preoperative planning and postoperative care to improve outcomes in revision TKA patients.

The Optimal Variation Range of Posterior Condylar Offset Associated with Positive Clinical Outcomes of Primary Total Knee Arthroplasty: A Retrospective Analysis.

Posterior condylar offset (PCO) and anterior condylar offset (ACO) exert an influence on the sagittal alignment in total knee arthroplasty (TKA). However, there is no common consensus that the variation range of posterior condylar offset (PCO) is associated with patient-reported outcome measures (PROMs) and the optimum variation range of PCO. This study aims to investigate the correlation between PCO and the PROMs of primary TKA for osteoarthritis (OA) and find out the optimal variation range of the PCO. In this study, we performed a radiographic analysis of 106 patients (112 knees) with primary TKA. Patients were divided into two cohorts (A and B) according to the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Correlations between the sagittal parameter and WOMAC were investigated using univariate and multivariate analysis. The receiver operating characteristic (ROC) curve was used to establish the cut-off value for the optimal variation range. We then further investigated how different variation range affects the WOMAC subscale score and forgotten-joint-score-12 (FJS-12). Univariate analysis revealed a correlation between the variation range of PCO (p < 0.01), ACO (p < 0.01) and PROMs. Multivariate analysis showed that only PCO was associated with PROMs. In the ROC graph, the cut-off value of the variation range of PCO is 2.85 mm (AUC = 0.66, Youden index = 0.26). The WOMAC functional ability score of the group outside the PCO variation range of 2.85 mm significantly increased compared to the group within the range. In this study, PCO variation was significantly associated with clinical outcomes in TKA and the optimal PCO variation range was within 2.85 mm. Maintaining the PCO variation within 2.85 mm could enhance functional recovery and patient satisfaction.

Does Proprioception-Based Rehabilitation Enhance Functional Outcome in Total Knee Arthroplasty? A Prospective Randomised Study.

Rehabilitation after Total Knee Arthroplasty (TKA) often includes proprioceptive exercises to prevent falls, but studies on proprioceptive training have yielded conflicting findings. This study aims to explore impact of proprioceptive training on functional performance after TKA. Eighty patients who underwent unilateral TKA were randomly assigned to a proprioceptive exercise (PE) group or a routine exercises (RE) group. The PE group received proprioceptive exercises in addition to routine physiotherapy. Osteoarthritis Research Society Internal (OARSI) recommended tests and Oxford Knee Score (OKS) were used to assess performance and outcome at 3 and 6months. In the 30-s chair sits test, the PE group outperformed the RE group at 3months (13.69 vs. 9.17) and 6months (21.07 vs. 18.63) (p < 0.001 and p = 0.030). Stair climbing favoured PE group at 3months (8.86 vs. 16.66, p = 0.037) and 6months (0.556 vs. 1.133, p = 0.001). At 6months in the 40-m fast-paced walk test, the PE group had a significantly shorter time (0.308min vs. 0.557min, p < 0.001). Timed up and go test at 6months favoured PE group (0.204min vs. 0.377min). In the 6-min walk test, the PE group covered significantly greater distances than the RE group at 3months (589.59 vs. 346.53m, p < 0.001) and 6months (649.60 vs. 448.32m, p < 0.001). OKS at 3months was 38 ± 2.0 for PE group and 38 ± 4 for RE group (p = 1). OKS at 6months was 42 ± 4 for PE group and 40 ± 2 for RE group (p = 0.94). This study highlights the importance of proprioception-based rehabilitation in improving functional performance for TKA patients, surpassing traditional rehabilitation programmes.

Total knee arthroplasty using a cemented single-radius, condylar-stabilized design performed without posterior cruciate ligament sacrifice.

Total knee arthroplasty (TKA) with a highly congruent condylar-stabilized (CS) articulation may be advantageous due to increased stability versus cruciate-retaining (CR) designs, while mitigating the limitations of a posterior-stabilized construct. The aim was to assess ten-year implant survival and functional outcomes of a cemented single-radius TKA with a CS insert, performed without posterior cruciate ligament sacrifice. This retrospective cohort study included consecutive patients undergoing TKA at a specialist centre in the UK between November 2010 and December 2012. Data were collected using a bespoke electronic database and cross-referenced with national arthroplasty audit data, with variables including: preoperative characteristics, intraoperative factors, complications, and mortality status. Patient-reported outcome measures (PROMs) were collected by a specialist research team at ten years post-surgery. There were 536 TKAs, of which 308/536 (57.5%) were in female patients. The mean age was 69.0 years (95% CI 45.0 to 88.0), the mean BMI was 32.2 kg/m2 (95% CI 18.9 to 50.2), and 387/536 (72.2%) survived to ten years. There were four revisions (0.7%): two deep infections (requiring debridement and implant retention), one aseptic loosening, and one haemosiderosis. Kaplan-Meier analysis demonstrated no difference in implant survival according to sex, age, or obesity status. Ten-year PROMs were available for 196/387 (50.6%) surviving patients and were excellent: mean Oxford Knee Score 34.4 (95% CI 32.7 to 36.1); mean Forgotten Joint Score (FJS) 51.2 (95% CI 16.1 to 86.3); mean EuroQol five-dimension five-level questionnaire score 69.9 (95% CI 46.8 to 93.0); 141/196 (71.9%) achieved the 22-point FJS patient-acceptable symptom state (PASS); and 156/196 (79.6%) were "very satisfied or satisfied". This is the only large study reporting ten-year implant survival and functional outcomes of TKA using a cemented single-radius design and with a CS tibial bearing construct. The findings of excellent implant survival, safety, and functional outcomes indicate that this combination is a safe and effective option in routine TKA. Further investigation of this single-radius design TKA with CS tibial bearings with well-matched patient study groups will allow further insight into the performance of these implants.

High Rates of Early Septic Failure, but Low Rates of Aseptic Loosening After Revision Total Knee Arthroplasty With Contemporary Rotating-Hinge Prostheses

BackgroundThe purpose of this study was to determine implant survivorship and functional outcomes for revision total knee arthroplasty (rTKA) with contemporary rotating-hinge knee implants. MethodsA retrospective review identified 115 rTKAs using contemporary rotating-hinge implants from 2014 to 2018 for the treatment of instability (34, 30%), reimplantation after periprosthetic joint infection (PJI) (33, 29%), aseptic loosening (25, 22%), arthrofibrosis (14, 12%), periprosthetic fracture (4, 3%), osteolysis (4, 3%), and femoral component fracture (1, 1%). There were 70 women (61%), and the mean age was 67 years (range, 27 to 94). The mean follow-up was 3 years (range, 2 to 6). Kaplan-Meier analysis and Cox proportional hazard models estimated survivorship. ResultsThe re-revision rate was 20% (23 of 115) at an average of 18 months postoperatively. Re-revision indications included PJI (n = 14), aseptic loosening (n = 4), arthrofibrosis (n = 2), instability/malalignment (n = 1), femoral stem fracture (n = 1), and hinge mechanism disruption (n = 1). At 2 and 5 years, survivorship free from all-cause re-revision was 86 and 64%, and survivorship free from re-revision for aseptic loosening was 100 and 87%, respectively. Use of a rotating-hinge implant in reimplantation after PJI was a risk factor for subsequent re-revision (hazard ratio = 2.4, P = 0.046). On a radiographic review of unrevised rotating-hinges, there were major radiolucent lines around 2 femoral and 5 tibial components. The mean Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement increased from 43 preoperatively to 60 at 1 year (P < 0.001). ConclusionsIn patients treated with a rotating-hinge implant for rTKA, there were relatively poor 2-year (86%) and 5-year (64%) survivorship free from all-cause re-revision, most commonly due to PJI. Midterm survivorship free from re-revision for aseptic loosening was modest (87%). There should be a goal to mitigate complications in complex rTKAs with rotating-hinge implants, namely PJI.

Tranexamic Acid Led to Improved Safety of Total Knee Arthroplasty in Jehovah’s Witness Patients: A Multicentered Matched Study

BackgroundThis study aimed to evaluate the safety of total knee arthroplasty (TKA) in Jehovah’s Witness patients compared to non-Jehovah’s Witness patients using standard perioperative TKA protocols and assess the role of tranexamic acid (TXA) in managing blood loss in this population. MethodsPatients undergoing TKA between 2011 and 2021 at 2 tertiary academic centers were retrospectively reviewed. Patient demographics, preoperative and postoperative hematologic laboratory values, intraoperative TXA use, 90-day postoperative complications, and subsequent revisions were collected. These variables were then compared between propensity score–matched cohorts at a 2:1 ratio of those who did not identify as Jehovah’s Witness to those who did. Regression analysis was used to determine the effect of intraoperative TXA on hemoglobin (hgb) shift. ResultsAfter applying exclusion criteria and matching, the TKA outcomes of 316 non-Jehovah’s Witness patients and 152 Jehovah’s Witness patients were analyzed. Univariate analysis suggested that non-Jehovah’s Witness patients and Jehovah’s Witness patients had similar preoperative and postoperative hgb, hgb shift, and hematocrit. Only 1 (0.8%) Jehovah’s Witness patient reached an hgb < 8.0 mg/dL postoperatively. Multivariate logistic regression suggested that Jehovah’s Witness patients did not have increased odds of reaching an hgb < 8.0 mg/dL (odds ratio = 0.99 [0.96, 1.02]; P = 0.42). Multivariate linear regression suggested that intraoperative TXA was positively correlated with hgb shift and thus a smaller decrease in hgb from pre-TKA to post-TKA (β = 0.38 [0.06, 0.69]; P = 0.02). Additionally, Jehovah’s Witness patients had excellent revision-free (95% [91, 99]) and infection-free (98% [95, 100]) survival at 8 years. ConclusionsStandard perioperative TKA protocols are safe for Jehovah’s Witness patients who do not have the need for transfusion, especially with appropriate preoperative hgb levels and the use of intraoperative TXA. Furthermore, these patients have excellent survivorship at 5 and 8 years of follow-up. Level of EvidenceLevel III.

MCID achievement in staged bilateral total knee arthroplasty: Are both joints created equal?

BackgroundA notable portion of unilateral total knee arthroplasty (TKA) patients undergo arthroplasty of the contralateral knee. The aims of this study were to describe the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) in staged bilateral TKAs (BTKAs) and identify factors associated with these outcomes. MethodsPatients with staged BTKA were retrospectively reviewed. Demographics, surgery details, and Patient-Reported Outcome Measurement Information System Physical Function Short Form 10a (PROMIS PF10a) were collected. MCID-I and MCID-W were defined for PROMIS PF10a. Patients were stratified into nine groups based on the MCID achievement of the first and second TKA: (A) MCID-I, MCID- I, (B) MCID-I, Neutral, (C) MCID-I, MCID-W, (D) Neutral, MCID-I, (E) Neutral, Neutral, (F) Neutral, MCID-W, (G) MCID- W, MCID-I, (H) MCID-W, Neutral, (I) MCID-W, MCID-W. Neutral patients did not achieve either MCID-I or MCID-W. ResultsThe final cohort consisted of 59 staged BTKA patients. In patients who achieved MCID-I in the first TKA, 39.1% achieved MCID-I again in the second TKA (A), 39.1% were neutral (B), and 21.7% achieved MCID-W (C) in the second TKA. However, 77.8% of those who achieved MCID-W in the first joint (n = 9) went on to achieve MCID-I (G) in the second TKA. Those who achieved MCID-I after both TKAs (A) had a longer staged interval than those who achieved first MCID-I, then MCID-W (C) (15 months vs 8 months, P = 0.0113). ConclusionIn staged BTKA, MCID achievement of the first TKA may not be associated with the outcome of the second TKA.

Relationship between patellar resurfacing and postoperative anterior knee pain in total knee arthroplasty

Aims: To retrospectively demonstrate the effect of patellar resurfacing (PR) on the clinical and functional outcomes of total knee arthroplasty (TKA). Methods: The files of 257 patients who presented to our clinic between 2013 and 2022 and underwent TKA due to the diagnosis of grade IV gonarthrosis were screened retrospectively. Thirty-two patients were excluded due to not attending regular follow-up, receiving steroid treatment, or being morbidly obese. The sample consisted of 225 patients, of whom 123 underwent PR (Group A) and 102 did not undergo PR (Group B). The Sperner classification was used to evaluate the level of patellar arthrosis. The effect of PR on postoperative clinical and functional outcomes in patients undergoing TKA was investigated using the WOMAC knee functional scoring and Visual Analog Scale (VAS) for clinical and functional evaluation at six, 12, and 24 months postoperatively. Results: The presence of anterior knee pain wasstatistically significantly lower in Group A than in Group B (p=0.0001). There was no statistically significant difference between the comorbidity distributions of the groups. The preoperative-to-postoperative changes in the mean VAS and WOMAC scores were statistically significantly higher in Group A compared to Group B (p=0.0001 for both). Conclusion: The implementation of PR in TKA may vary depending on countries, clinics, and even surgeons. In the current study, PR was found to contribute positively to the clinical and functional outcomes of patients by preventing complications such as anterior knee pain that may develop due to patellar arthrosis in the postoperative period.

Early Outcome of Simultaneous Bilateral Total Knee Arthroplasty Through the Oxford Knee Score in a Developing Country: A Prospective Cohort.

Introduction The most common degenerative joint disease in adults is osteoarthritis. The gold standard treatment option for this aging society with greater functional demands is total knee arthroplasty. The Oxford Knee Score (OKS) assesses factors such as stiffness, pain, function, satisfaction, and quality of life, allowing you to quantify treatment success after surgery. According to published research, there isn't a perfect postoperative timepoint to use the OKS to obtain TKA outcomes. Therefore, at the time of evaluation, the OKS shouldreflect the best possible outcome for the patient group. This study was conducted to see the OKS in patients who underwent simultaneous bilateral knee replacement at six weeks and six months postoperatively and to see if there was a clinically significant difference in the mean OKS. Methods This prospective cross-sectional study was conducted at the Section of Orthopedic Surgery at Aga Khan University Hospital, a tertiary care center in Karachi, Pakistan. Patients who underwent simultaneous bilateral total knee replacement from October 2023 till December 2023 were included; exclusion criteria included patients who had a recent knee infection and extensor mechanism disruption. OKS was calculated at six weeks and six months postoperatively. Results The total number of patients included in the study was 49 with a mean age of 61.9 +/- 6.1. There were 42 (85.7%) females and 7 (14.3%) males. The mean BMI of our patients was 33.3 +/- 3.8. The radiographic Kellgren Lawrence Grading (KLG) was used and 38 (77.6%) patients were placed in Grade IV KLG, and 11 (22.4%) were placed in Grade III KLG. The mean OKS preoperatively was 12.6 +/- 3.5. At six weeks, the OKS showed improvement, with the mean being 20.6 +/- 3.0. At six months postoperatively, there was a significant improvement in the OKS, with the mean now being 42.7 +/- 2.4. At six weeks post-surgery, the mean improvement in the OKS score was 7.9 +/- 2.71, whereas at six months post-surgery, the mean improvement in the OKS score was 30.1 +/- 3.6. This difference was significant (p-value=0.03). Conclusion Our study showed a clinically significant difference between the mean OKS at the six-week and six-month timeline, with a significant increase in the mean improvement OKS score at six months. OKS should be utilized six months postoperatively to assess the outcome of simultaneous bilateral knee arthroplasty patients.

Does previous total hip arthroplasty affect the outcomes of total knee arthroplasty? A one- and five-year follow-up registry study in a monocentric hospital

BackgroundOsteoarthritis in the lower extremities becomes more common as people age. In addition to conservative treatments, hip or knee arthroplasty is often needed. The aim of this study was to evaluate total knee arthroplasty (later TKA) in patients, comparing those who had previously undergone THA (later THA/TKA), with those who had not undergone such procedure. Pain, walking ability and functional capacity were assessed.MethodsPatients who underwent primary TKA between 1987 and 2017 at a single orthopaedic hospital was included in this study. The patients participated in clinical preoperative and postoperative examinations by an orthopaedic surgeon after one- and five- years. The final study group consisted of 418 patients who had undergone 502 knee arthroplasties. Of these 502 TKA cases, 462 had not undergone previous THA and 40 had undergone previous THA. To evaluate the patients’ physical function and walking ability, a structure form for knee arthroplasty based on the Hungerford score was used. The registry data from the Finnish National Institute of Health and Welfare was used. The data included TKA revision(s) and mortality events.ResultsAt the baseline and after one- and five- years primary TKA, no statistical differences were found in the total Hungerford score between TKA patients and THA/TKA patients. In both groups, the total score increased per surgery year. However, when analysing the relationship between the year of operation and the total score, no statistical differences were found between the groups (TKA and THA/TKA) at five years (p = 0.61). The only statistical difference found between the groups was in walking distance points after one year; THA/TKA patients (mean 83 [SD 17]) could walk remarkably shorter distances than TKA patients (91 [14]) one year after arthroplasty (p < 0.001).ConclusionsIn conclusion, walking distance improved more rapidly in TKA patients than in THA/TKA patients. However, patients who underwent more than one arthroplasty in their lower extremities managed their lives, activities, and pain almost as well as those who underwent only one knee arthroplasty.

Clinical outcomes of total knee arthroplasty for valgus knees caused by hip diseases: Coxitis knees and long leg arthropathies

PurposeCoxitis knees and long leg arthropathies are similar pathological conditions; however, their clinical outcomes after total knee arthroplasty (TKA) have rarely been reported. The present study aimed to investigate clinical outcomes after TKA for these knee conditions, namely valgus knees caused by hip disease. MethodsThis retrospective cohort study included 19 TKAs performed on valgus knees caused by hip osteoarthritis (OA). Two years post-operatively, clinical outcomes, including range of motion and 2011 Knee Society Score (2011KSS), were assessed and were compared with pre-operative values. Pre-operative knee phenotypes, including lateral distal femoral angle and medial proximal tibial angle, were assessed, and their associations with clinical outcomes were investigated. ResultsAll subscales of the 2011KSS improved significantly post-operatively (P ​< ​0.05). There was also a significant improvement in extension post-operatively (P ​< ​0.05). The mean femorotibial angle improved post-operatively from 157.7° to 175.2°(P ​< ​0.05). There were five coxitis knee patients who had knee OA on the ipsilateral side of the hip, and five long leg arthropathy patients who had knee OA on the contralateral side of the hip. ConclusionsSatisfactory clinical outcomes were observed after TKA for valgus knees caused by hip OA, such as coxitis knees and long leg arthropathies.