Total Knee Arthroplasty Surgery Research Articles

The efficacy and safety of patient-specific instrumentation in primary total knee replacement: a systematic review and meta-analysis

ABSTRACT Introduction Patient-specific instrumentation (PSI) for primary total knee arthroplasty (TKA) surgery has been shown to increase accuracy of component positioning. However, it is unclear whether this also translates to actual benefits for patients in terms of better outcomes (efficacy) or less complications such as revisions (safety). We therefore systematically reviewed the literature to determine the efficacy and safety of PSI in primary TKA. Methods Randomized controlled trials comparing PSI to non-PSI in primary TKA were included. A random effects model was used with meta-regression in case of heterogeneity. Results Forty-three studies were included with a total of 1816 TKA in the PSI group and 1887 TKA in the control group. There were no clinically relevant differences between the PSI-group and non-PSI group regarding all outcomes. There was considerable heterogeneity: meta-regression analyses showed that the year the study was published was an important effect modifier. Early publications tended to show a positive effect for PSI compared to non-PSI TKA, whereas later studies found the opposite. Conclusion Based on evidence of moderate certainty, our study suggested that there were no clinically relevant differences in efficacy and safety between patients treated with PSI TKA and patients treated with non-PSI TKA.

Enhanced recovery after surgery (ERAS) protocol in geriatric patients underwent unicompartmental knee arthroplasty: A retrospective cohort study.

The enhanced recovery after surgery (ERAS) pathway was formulated with the aim to reduce surgical stress response, alleviate pain and guarantee the best-fit experience of patients' perioperative period. However, the application of ERAS in geriatric patients who underwent unicompartmental knee arthroplasty (UKA) was relatively lacking. We hypothesize that UKA patients can benefit from the ERAS protocol. A total of 238 patients were recruited in this retrospective study from August 2018 to December 2021, and Oxford phase III UKA was applied to all patients. ERAS pathway included nutrition support, anesthesia mode, interoperative temperature, and blood pressure control, application of tranexamic acid, early initiation of oral intake and mobilization, and pain management. Demographic data, operation-relative variables, and postoperative complications were analyzed. Forgotten Joint Scores, Oxford Knee Score, Lysholm score, numerical rating scale, and knee range of motion were introduced to estimate the activity function and pain of surgical knee, and these variables were compared between the 2 groups. There were 117 patients in the ERAS group and 121 patients in the traditional group, respectively. The ERAS group had a shorter length of surgical incision and less intraoperative blood loss. Postoperative hemoglobin and albumin of patients in the ERAS group were better than those in the traditional group (P < .05), after 17.0 ± 10.8 months follow-up, the numerical rating scale, Lysholm, Oxford Knee Score, Forgotten Joint Scores, and knee range of motion of patients in the ERAS group were significantly better than the traditional group. The length of hospital stay for patients who underwent ERAS was 11.7 ± 3.8 days and the postoperative complication rate was lower for the ERAS group patients (P = .000 and 0.031). ERAS can reduce the length of hospital stay, and patients can achieve excellent postoperative knee function. The formulation and implementation of the ERAS protocol require good collaboration across multiple disciplines, as well as a deep understanding of the existing clinical evidence and the concept of the ERAS program.

Association of Anterior Knee Pain (AKP) in Different Age Groups after Total Knee Replacement (TKR)

Objective: The purpose of this research is to assess and to determine the frequency of Anterior Knee Pain after Total Knee Arthroplasty. Study Design: Cross sectional study. Place and Duration:This Cross sectional study was conducted at Department of Orthopedic s, Khyber Teaching Hospital, KTH Peshawar in the period of eight months from june 2020 to january 2022. Introduction: Anterior Knee Pain (AKP) is one of the most commonest causes of persistent problems after knee replacement. Total Knee Arthroplasty (TKA) is a surgical procedure in which artificial joint or prosthesis replace the damage knee. A significant proportion of the patients experience AKP after TKA surgery. Methods: After recording complete history, physical examination and routine baseline investigations were performed . Post-operatively, patients were kept under observations for 5 days in ward and were discharged if indicated. Patients were followed at regular intervals and finally at the end of third month to measure the intensity of pain on VAS. Results:Out of 205 patients, 69.3% were males and 30.7% were females. Means ± SD calculated for age was 48.62±7.98 years, for BMI was 24.63±3.07 and for Pain on VAS was 1.31±1.39. Most patients (51.7%) were recorded in 51-60 years age group. Rheumatoid Arthritis (RA) in 18% while Osteoarthritis (OA) (OA) was found in 82% patients. 21.5% patients were diabetic while 31.7% patients were hypertensive. AKP at third month was found in 8.8% patients. Conclusion: It is evident that anterior knee pain (AKP) after the total knee arthroplasty (TKA), or total knee replacement (TKR) is prevalent and clinically relevant. There is an absolute need for further investigations to find out ways to reduce or eliminate the AKP after TKA in order to improve the quality of life after this surgery. Keywords: Anterior knee pain, Arthroplasty, Total knee replacement.

Clinical three-dimensional anatomy of the femur considering navigation-aided surgery of total knee arthroplasty in Japanese patients

PurposeFew studies exist regarding sagittal alignment describing femur morphology in navigation-aided surgery. This study investigated the three-dimensional (3D) sagittal femoral alignment of the whole femur. MethodsSeventy-three consecutive patients (59 females, 14 males, mean age: 76.1 years), yielding 140 femurs, were included in this study. A computed-tomography-based patient-specific 3D femur model was used to define a mechanical axis-based reference plane. Proximal and distal femoral axis angles (PFA, DFA) to the reference plane were measured in 3D using custom software. PFA and DFA represent the proximal and distal inclination of the femoral anatomical axis in sagittal plane, respectively. ResultsPFA (10.6 ± 1.5°) was greater than DFA (2.6 ± 1.6°; P < 0.0001). DFA in females (2.3 ± 1.4°) was smaller than in males (3.9 ± 1.7°; P < 0.0001). ConclusionThis is the first report of measurement of femoral sagittal alignment related to both 3D anatomy and decision making of femoral flexion angle using navigation surgery for total knee arthroplasty. This report shows a robust DFA measurement that could be used as a template for femoral implants flexion angle when performing both conventional and navigated total knee arthroplasty.

Does stature of female affect Knee Injury and Osteoarthritis Outcome Score following knee arthroplasty surgery: an observational pilot study

BackgroundKnee osteoarthritis (OA) occurs frequently in females. So far, no study has evaluated postoperative outcome measures in females based on body height. We aimed to evaluate postoperative pain relief and Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6 months in women following total knee arthroplasty (TKA).In this prospective, observational pilot study, 20 women, 50–70 years, American Society of Anesthesiologist (ASA) physical status I and II, undergoing TKA surgery were enrolled. The patients were allocated to Group I (n = 10), women with a height less than 153 cm, and Group II (n= 10), women with a height greater than 153 cm. All patients received paracetamol, diclofenac, and epidural analgesia postoperatively for up to 72 h. The primary outcome was a comparison of KOOS scores from preoperative baseline value to 6 months following TKA.ResultsThe baseline demographics, KOOS, waist-hip ratio, and knee range of motion were similar. The height mean ± standard deviation (SD) (range) in Group I was 149.85 ± 3.28 (142.5–152.5) cm versus 157.25 ± 2.99 (155–165) cm in Group II, p = 0.001. KOOS score improved in patients of both Groups I and II as compared to the respective baseline. At 6 months, the KOOS pain score improved to 96.50 ± 3.14 [94.26–98.74 (89–100)] in Group I as compared to 89.40 ± 6.45 [84.79–94.01 (81–100)] in Group II, p value = 0.02.ConclusionsPostoperative KOOS pain score at 6 months was superior in short stature versus normal stature women following TKA surgery.

Trends in Computer-Assisted Surgery for Total Knee Arthroplasty in Germany: An Analysis Based on the Operative Procedure Classification System between 2010 to 2021.

Alignment strategies for primary total knee arthroplasty (TKA) have changed significantly over time with a shift towards a more individualized alignment goal. At the same time, computer-assisted surgery (CAS) has gained interest for intraoperative control and accuracy in implant positioning and limb alignment. Despite the often discussed benefits and drawbacks of robotics and navigation for TKA, the routine use of these new devices on a day-to-day basis remains obscure. Therefore, nationwide hospital billing data based on the Operation Procedure Classification System (OPS) were retrieved from the Federal Statistical Office of Germany for the period from 2010 to 2021. OPS codes for primary total knee arthroplasty (OPS code: 5-822*) were further analyzed regarding the usage of computer navigation (additional OPS code: 5-988) or robotic devices (additional OPS code: 5-987). Gender and age at the time of surgery were also assessed. The results show a total of 2,226,559 primary TKAs were implanted between 2010 and 2021, of which 2,044,914 were performed conventionally (91.84% of all TKAs). A total of 170,276 TKAs were performed using navigation technique (7.65% of all TKAs) and another 11,369 TKAs were performed using robotics (0.51% of all TKAs). For the period from 2018 to 2021, a substantial increase in robot-assisted TKA (R-TKA) was observed, with an average increase rate of 84.74% per year, while the number of navigated TKAs declined (-3.67% per year). Computer-assisted surgery, and particularly robotics for TKA, are seeing growing popularity and stepwise translation into routine clinical use in Germany, with a steep increase rate of more than 80% per year since 2018. Nevertheless, the majority of TKAs are still performed using manual instrumentation, rendering conventional TKA the currently unchanged gold standard.

Comparison of the effects of preoperative celecoxib and gabapentin on pain, functional recovery, and quality of life after total knee arthroplasty: A randomized controlled clinical trial.

Acute pain is one of the main complaints of patients after total knee arthroplasty (TKA), which causes delayed mobility, increased morphine consumption, and subsequently increased costs. Therefore, the present study was performed to evaluate the preventive effect of preoperative celecoxib and gabapentin on reducing patient pain as a primary outcome after TKA surgery. This randomized, double-blind controlled clinical trial was performed on 270 patients with osteoarthritis that were candidates for TKA surgery allocated into three groups. In the first group, 900 mg of gabapentin was administered orally on a daily basis for 3 days before surgery. In the second group, 200 mg of oral celecoxib was administered twice daily for 3 days before surgery. In the third group, oral placebo was administered twice daily for 3 days before the surgery. The patients' pain score and knee and its functional score were recoded. The mean of reduction pain in gabapentin and celecoxib groups was significantly lower than that of the control group at 12, 24, and 48 h after surgery (P < 0.001); however, two groups were not significantly different from each other (P > 0.05). Furthermore, the two medication groups were not significantly different in this regard (P > 0.05). In addition, the knee score in the gabapentin group with the means of 85.40 ± 5.47 and the celecoxib group with the means of 87.03 ± 3.97 were significantly higher than those of the control group with the means of 78.90 ± 4.39 in the 1st month after the surgery (P < 0.001). According to the results of the present study, the preventive administration of gabapentin and celecoxib showed a significant and similar effectiveness on reducing patient pain after TKA surgery and on improving the KSS and quality of life scores.

Comparison of Combined Intraarticular and Intravenous Administration of Tranexamic Acid with Intraarticular and Intravenous Alone in Patients Undergoing Total Knee Arthroplasty without Drainage Catheter: A Clinical Trial Study.

We aimed to assess the most effective route for Tranexamic acid (TXA) administration among Intraarticular (IA), Intravenous (IV), and combined IA/IV for Total Knee Arthroplasty (TKA) surgeries. A double-blinded clinical trial was run on 147 TKA candidates. Blood loss and hemoglobin (Hb) drop were evaluated using the Gross and Nadler formula in three matched case groups administered TXA during the TKA through IV, IA, or combined IA/IV route. Tourniquet was used on all operations for controlling intraoperative blood loss. No drainage catheter was used for the cases. The combined group showed an average blood loss of 630±252 ml, which was significantly lower than that in the IV group (878±268 ml, P<0.01) and the IA group (774±288 ml, P=0.03). Furthermore, the mean Hb and hematocrit drop were significantly lower in the combined group, compared to the other two groups, 48 and 72 h postoperatively (P<0.05). The combined IA/IV route had a 28% and 19% reduction of blood loss, compared to the IV or IA methods, respectively. Therefore, using TXA via the combined IA/IV route may be more effective for reducing perioperative blood loss following TKA surgery using a tourniquet without drain placement.

Delayed Recovery of Idiopathic Common Peroneal Nerve Palsy After Total Knee Arthroplasty: A Rare Case Report

Introduction: Common peroneal nerve palsy (CPNP) is a rare complication post total knee arthroplasty (TKA). Even though it is diagnosed acutely, the recovery potential is just over 50%. The average period for complete recovery in such cases is 5 months; however, the management remains controversial. Through this report, we present one such case of complete CPNP after bilateral TKA who was conserved with various modalities. Even though the recovery was delayed, the patient made full recovery. Case Report: A 70-year-old female patient was diagnosed to have bilateral tricompartmental knee osteoarthritis with varus deformity, both clinically and radiologically (Kellgren–Lawrence grade 4). She underwent bilateral TKA in a single sitting as per the standard protocols practiced by the primary author. On post-operative day 1, she had left-sided foot drop with a complete sensory deficit. The patient underwent routine rehabilitation with an ankle foot orthosis splint in the immediate post-operative period, with simultaneous faradic current stimulation for the left lower limb. Periodic electromyography and nerve conduction study was done at the end of 4-week and 3-month post-TKA. At 6.5-month post-surgery, she made a full clinical recovery. Conclusion: The surgical maneuvers and full neurovascular examination before and after every TKA surgery should be carefully performed. Despite this, if a patient presents with CPNP, the surgeon need not take an aggressive approach, unlike fracture fixation cases. These patients can be managed conservatively using appropriate orthosis, physical therapy, and faradic current stimulation. Through this case, we attempt to report that CPNP patient can recover even after 6 months of surgery when there is no tangible cause for the palsy. Keywords: Common peroneal nerve palsy, total knee arthroplasty, EMG, NCV, faradic stimulator.

Sevoflurane Preconditioning and Total Knee Arthroplasty Bleeding: Randomized Controlled Trial

Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular overload, increased costs, and mortality. As the tourniquet reduces intraoperative bleeding, it may be associated with postoperative bleeding, venous thrombosis, and distal ischemia. The reperfusion may trigger a local and systemic inflammatory response. Anesthetic preconditioning (APC) with sevoflurane minimizes ischemia-reperfusion syndrome (IRS). This study evaluated the effects of APC with sevoflurane on perioperative bleeding in TKA. Methods: We allocated 30 patients into two groups: a sevo group (sevoflurane 2% for 15 minutes before the tourniquet) and a control group (propofol infusion). Laboratory tests were collected right before the tourniquet (LAB PRE, in the operating room) and after its release at four moments: LAB POST (immediately after), LAB 2 (two hours after), LAB 12 (12 hours after), and LAB 24 (24 hours after). The volume of the suction drain was measured at one, two, 12, and 24 hours after the end of the surgery. Antifibrinolytics were not administered. Results: There was no statistically significant difference in bleeding-related variables, such as drained volume and hemoglobin and hematocrit measurements. Drainage volume was higher in the first two hours after the procedure, while hematocrit decreased pre- to postoperatively and between two and 12 hours post-procedure. Conclusion: Sevoflurane as an anesthetic preconditioning did not reduce postoperative bleeding in TKA surgery.

Isokinetic knee muscle strength comparison after enhanced recovery after surgery (ERAS) versus conventional setup in total knee arthroplasty (TKA): a single blinded prospective randomized study

PurposeTotal knee arthroplasty (TKA) combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate isokinetic knee muscle strength after cemented TKA in combination with an enhanced recovery after surgery (ERAS) compared to a conventional setup.MethodsIn the single blinded prospective randomized study, 52 patients underwent navigated primary cemented TKA within an ERAS (n = 30) or a conventional setup (n = 22). Preoperatively, five days and four weeks after surgery isokinetic knee muscle strength with BIODEX-type measuring device (peak torque in Nm, work in Joules and power in Watt) and subjective patient-related outcome measures (PROMs) were investigated.ResultsThe ERAS group showed significantly better outcomes in knee flexion at 180°/s (peak torque (Nm) p = 0.047, work (J) p = 0.040 and power (W) p = 0.016) 5 days postoperatively. The isokinetic measuring at knee extension 60°/s and 180°/s demonstrated no significant difference. The PROMs showed that patients were satisfied with the postoperative results in both groups. After 4 weeks, there was no longer a significant difference in isokinetic measuring at knee extension and flexion between the ERAS and conventional group.ConclusionsTKA with the concept of ERAS improves excellent isokinetic outcome and patient satisfaction. The isokinetic muscle strength measurement can help patients and surgeons to modify expectations and improve patient satisfaction.

Newer Coronal Alignment Philosophies in Total Knee Arthroplasty: A Brief Review

Total Knee Arthroplasty (TKA) surgeries have been one of the most successful surgeries over the past half a decade. However a substantial proportion of patients undergoing TKA have the feeling of their replaced knee being an ‘unnatural one’. Also the conventional TKA requires the surgeon to maintain a coronal plane Hip Knee Angle (HKA) of 180 deg with the joint line being parallel to the horizontal and this requires a significant soft tissue release. Recently there are many different pre arthritic knee phenotypes been described with varying joint line obliquities and HKA angles. It is this difference of coronal HKA axis and joint line obliquity in the non replaced and the replaced knee that is believed to be the cause of dissatisfaction after TKA. Many coronal plane alignment philosophies have been reported to bridge this gap as mentioned earlier which replicate the pre arthritic knee anatomy with minimal soft tissue release. The only concern of the different philosophies is the long term implant survival when fixed in a non mechanically aligned position. However robotics have added a significant safety with calibrated execution to prevent outliers and improve implant survivorship. This is a brief review of the different coronal plane alignment philosophies in TKA. Keywords: Coronal, alignment, dissatisfaction, HKA, joint line obliquity

Effects of adductor canal block combined with infiltration between the popliteal artery and capsule of the knee on pain management and early rehabilitation compared with epidural analgesia for patients undergoing total knee arthroplasty: a prospective randomised controlled trial

Total knee arthroplasty (TKA) is often regarded as one of the most painful orthopedic operations. Variety of regional anesthetic procedures are used to reduce this pain. Infiltration between the popliteal artery and capsule of the posterior knee (IPACK) is increasingly being utilized in conjunction with adductor canal block (ACB) to provide adequate analgesia for TKA. The aim of study is to assess the analgesic effectiveness of ACB + IPACK block and epidural analgesia (EA) after TKA during the early stages of physical therapy. This prospective study included 58 patients who underwent unilateral TKA surgery. Patients were randomized into two groups as EA group (n = 30) and ACB + IPACK group (n = 28). The visual analogue scale (VAS) scores of the patients at the postoperative 8th (PO8th) hour, 1st postoperative day (POD1), and postoperative 2nd day (POD2) during the active and passive physical therapy movements, VAS scores during the ambulation, and active and passive range of movement values in POD1 were recorded. In addition, ambulation rates of the patients at the PO8th hour, 25 meters ambulation times in POD1, and completion times of 10 assisted squats in POD1 were recorded. The ACB + IPACK group had a substantially higher PO8th hour VAS score (p = 0.038). However, there was no significant difference in POD1, POD2 VAS scores. The analgesics consumption and VAS scores during ambulation were comparable among groups. Ambulation rate (22 (78.5%) vs. 16 (53.3%), p = 0.043) and speed (139.65 ± 57.12 sec. vs. 188.66 ± 77.95 sec., p = 0.023) were significantly better in the ACB + IPACK group. The strength of quadriceps contractions was similar in both groups. The use of a combination of ACB + IPACK block for postoperative analgesia in TKA patients is not only successful in reducing postoperative pain, but also a promising treatment with favourable effects on early ambulation and rehabilitation.

Tourniquet use during primary total knee arthroplasty-a survey of Irish orthopaedic surgeons in 2022.

Tourniquet use during primary total knee arthroplasty is a debated topic in the literature with no consensus on its optimal use. To analyse current tourniquet practice amongst Irish orthopaedic surgeons performing primary total knee arthroplasty surgery. To evaluate if there has been a shift in practice in recent years and to explore potential reasons behind this. An eleven-question online survey was developed using the online platform SurveyMonkey. This was distributed by email to Irish orthopaedic surgeons via the Irish Institute of Trauma and Orthopaedic Surgery. Fifty responses were included in the final analysis of this study. Eighteen (36%) respondents reported changing their tourniquet use in the past 5years. Thirty-one (62%) respondents reported inflating the tourniquet for the entire case, with the remaining never applying a tourniquet (n = 6, 12%), applying a tourniquet but not routinely inflating it (n = 3, 6%), or inflating the tourniquet only during cementation (n = 5, 10%). The number of years of experience as a consultant appeared to impact tourniquet use in a bimodal pattern. While the majority of Irish orthopaedic surgeons in this survey inflate a tourniquet for the entire surgical procedure, there is a definite shift towards reduced tourniquet use compared to previous Irish, UK, and American surveys.

DO PREOPERATIVE IL-1BETA, IL-6 AND TNF-ALPHA LEVELS OF PATIENTS WHO UNDERWENT TOTAL KNEE ARTHROPLASTY SURGERY AFFECT THE POSTOPERATIVE FUNCTIONAL AND STRUCTURAL RESULTS?

Purpose: Serum cytokines were associated with symptoms and progression of osteoarthritis. It is unknown whether these cytokines have a predictive role on the severity of symptoms after total knee arthroplasty (TKA) or not. This study was performed to investigate the effect of preoperative Serum Cytokine Levels (SCL) on length of stay in hospital (LOS), postoperative pain intensity, functional status, joint position sense, and change in X-ray.&#x0D; Methods: Twenty-nine patients with Grade 4 osteoarthritis degeneration level were included in the study. SCL (IL-6, TNF-alpha, IL-1beta) were assessed before surgery. Pain intensity at rest/activity and lower limb alignment were evaluated preoperative, postoperative 72nd hour and 6th week. Functional status and joint position sense were assessed before surgery and 6 weeks after surgery. Length of stay in hospital was also recorded.&#x0D; Results: The mean age of the participants was 67.55±6.55 years. The length of stay in the hospital mean was 6.48±3.06 day (min:3, max:16 days). Preoperative IL-6 and TNF-alpha level negatively correlated with functional status in the 6th week after surgery (r=0.46; p=0.01, r=0.39; p=0.03). Also, there was a positive correlation between preoperative TNF-alpha and the lower limb alignment at the 6th week after surgery (r=0.39; p=0.04).&#x0D; Conclusion: Patients with osteoarthritis who had lower preoperative IL-6 and TNF-alpha levels had better functional status and better lower limb alignment in the postoperative period. So in order to decide TKA surgery timing, primarily decreasing SCL might be caused better biomechanical development after surgery. Preoperative SCL was not directly related to the length of stay in the hospital.

Efficacy of Local Infiltration of Analgesics via Intra-articular Epidural Catheter vs Adductor Canal Block in Primary Total Knee Arthroplasty Surgery.

Pain is believed to be a poorly understood phenomenon, which is mostly regulated by neural, cellular, hormonal &amp; emotional components. Epidural analgesia is used for pain relief in patients undergoing primary total knee arthroplasty, though provides good pain control, many a time is associated with side effects such as hypotension, urinary retention and impaired mobility. The purpose of the current study is to compare the efficacy of ACB to local infiltration of analgesics by Intraarticular Epidural Catheter for primary total knee arthroplasty by comparing visual analog scale, knee flexion, and active SLRT on the day of surgery (POD-0), POD1-3, day of discharge, and 4 weeks after surgery. This study is prospectively randomized, the cases undergoing primary knee replacement were divided into two groups, which includes a minimum of 36 cases in each group.Group-1(36) patients received local infiltration of analgesics via IAECand Group-2(36) patients received single shot ACB. As far as age, sex, BMI(kg/m2), pre-op VAS, mean pre-op flexion, mean pre-operative varus, mean preop KSS(Knee society score), duration of surgery and hospital stay is concerned no significant difference was noticed between the two groups.Group-1(LIA via IAEC) had significantly lower VAS on a postoperative day (POD) 1-3, lower tramadol consumption, better ROM (atPOD1-3), superior quadriceps recovery(active SLRT), earlier mobilization day, better KSS (at 4weeks) postoperatively, compared to Group-2(single shot ACB).LIAby IAEC for patients undergoing primary TKA is a better option compared to single shot ACB concerning to pain levels, narcotic usage, range of motion, quadriceps recovery and KSS (Knee society score).

Tibial Stems in Primary Total Knee Arthroplasty: A literature Review

Abstract: This article displays a review of the specialty literature regarding the surgery of primary total knee arthroplasty (TKA), and more specifically refers to the complicated cases of primary total knee replacement where due to some preexisting pathologic circumstances, the orthopaedic surgeon must anticipate the risks and enhance the stability of the implant to obtain a long lifespan without revision surgeries. We collected the findings throught literature and compared them to our own surgical experience to create a rationale for the selection of the best knee prosthesis in surgical practice. Keywords: total knee arthroplasty; primary total knee arthroplasty; implant; prosthesis; tibial stem extension;

Acute postoperative pain and dorsal root ganglia transcriptomic signatures following total knee arthroplasty (TKA) in rats: An experimental study.

Total knee arthroplasty (TKA) is the final treatment option for patients with advanced knee osteoarthritis (OA). Unfortunately, TKA surgery is accompanied by acute postoperative pain that is more severe than arthroplasty performed in other joints. Elucidating the molecular mechanisms specific to post-TKA pain necessitates an animal model that replicates clinical TKA procedures, induces acute postoperative pain, and leads to complete functional recovery. Here, we present a new preclinical TKA model in rats and report on functional and behavioral outcomes indicative of pain, analgesic efficacy, serum cytokine levels, and dorsal root ganglia (DRG) transcriptomes during the acute postoperative period. Following TKA, rats exhibited marked deficits in weight bearing that persisted for 28 days. Home cage locomotion, rearing, and gait were similarly impacted and recovered by day 14. Cytokine levels were elevated on postoperative days one and/or two. Treatment with morphine, ketorolac, or their combination improved weight bearing while gabapentin lacked efficacy. When TKA was performed in rats with OA, similar functional deficits and comparable recovery time courses were observed. Analysis of DRG transcriptomes revealed upregulation of transcripts linked to multiple molecular pathways including inflammation, MAPK signaling, and cytokine signaling and production. In summary, we developed a clinically relevant rat TKA model characterized by resolution of pain and functional recovery within five weeks and with pain-associated behavioral deficits that are partially alleviated by clinically administered analgesics, mirroring the postoperative experience of TKA patients.

Extensor mechanism reconstruction with allograft following total knee arthroplasty: a systematic review and meta-analysis of achilles tendon versus extensor mechanism allografts for isolated chronic patellar tendon ruptures.

Extensor mechanism rupture is a severe complication with an incidence of 0.1-2.5% after total knee arthroplasty (TKA). Achilles tendon allograft (ATA) and extensor mechanism allograft (EMA) in TKA surgery have yielded mixed clinical results. Our systematic review aims to identify the proportion of failure in extensor mechanism reconstruction after TKA using allograft and evaluate clinical and functional outcomes and the most common complications. Furthermore, we performed a meta-analysis among studies dealing with isolated patellar tendon ruptures to assess the failure rate, surgical complications, and clinical findings (extensor lag and knee range of motion) of extensor mechanism reconstruction using either ATA or EMA grafts. A systematic review of the literature was performed following the PRISMA guidelines, including the studies dealing with the use of EMA and ATA for extensor mechanism rupture following TKA. Coleman Methodology Score and the MINORS score were used to assess the quality of the studies. A meta-analysis was performed to evaluate the failure rate, complications, and clinical findings (extensor lag and knee range of motion) of the ATA and EMA treatments in isolated patellar tendon ruptures. A total of 238 patients (245 knees), with a mean age ranging from 54 to 74years, who underwent extensor mechanism reconstruction with an allograft were identified in the 18 included studies. We analysed 166 patellar tendon ruptures, 29 quadriceps tendon ruptures, and 29 patellar fractures in the analysis. A chronic injury was described in the majority of included cases. ATA and whole EMA were used in 89 patients (92 knees) and 149 patients (153 knees), respectively. The overall failure percentage was 23%, while EMA and ATA were 23 and 24%. The most common complication was extensor lag (≥ 20°). The overall incidence of postoperative infection was 7%. Eleven of 14 included papers reported more than 100° of the mean postoperative knee flexion. The percentage of patients requiring walking aids is 55 and 34.5% in ATA and EMA, respectively. The failure outcome after extensor mechanism reconstruction in isolated patellar tendon ruptures was 27%, with no statistical difference between EMA and ATA in terms of failure rate and clinical outcomes. Extensor mechanism reconstruction with allograft represents a valid treatment option in patients with acute or chronic rupture following total knee arthroplasty. Persistent extensor lag represents the most common complication. EMA is associated with a lower frequency of patients requiring walking aids at last follow-up, although it has similar clinical and functional outcomes to ATA. In patellar tendon ruptures, ATA has a comparable success rate with EMA. Level IV, therapeutic study. PROSPERO 2019 CRD42019141574.

How does kinesiophobia affect short- and long-term gait parameters in individuals with total knee arthroplasty surgery?

Delays in weight transfer due to various fears after Total knee arthroplasty (TKA) surgery negatively affect recovery. Therefore, the presence of kinesiophobia is essential for the success of the treatment. This study was planned to investigate the effects of kinesiophobia on Spatio-temporal parameters in patients who underwent unilateral TKA surgery. This study was a prospective and cross-sectional study. Seventy patients with TKA were assessed preoperatively in the 1st week (Pre1W) and post- operatively in the 3rd month (Post3M) and 12th month (Post12M). Spatiotemporal parameters were assessed using the Win-Track platform (Medicapteurs Technology, France). The Tampa kinesiophobia scale and Lequesne index were evaluated in all individuals. A significant relationship was found between the Pre1W, Post3M, and Post12M periods and Lequesne Index scores (p<0.01), and this relationship was in favor of improvement. In the Post3M period, kinesiophobia increased compared to the Pre1W period, and kinesiophobia decreased effectively in the Post12M period (p<0.01). The effect of kine-siophobia was evident in the first postoperative period. In the correlation analyses between spatiotemporal para- meters and kinesiophobia, significant negative correlations were observed (p<0.01) in the early postoperative period (Post3M). Evaluating the effectiveness of kinesiophobia on Spatio-temporal parameters at different time intervals before and after TKA surgery may be necessary for the treatment process.