Total Knee Prosthesis Research Articles

Increased prevalence of gastric pathologies in patients with total hip and total knee prostheses: a retrospective endoscopic study

Aims: The objective of this retrospective study was to evaluate the prevalence of Helicobacter pylori (H. pylori) positivity, gastric atrophy, and intestinal metaplasia in patients with dyspeptic complaints who had undergone total hip and knee replacement surgeries, compared to a control group without prosthesis.
 Methods: The study group consisted of 51 patients with dyspeptic complaints and total knee and hip prosthesis, while the control group comprised 75 patients with similar complaints but without prosthesis. Endoscopic gastric biopsies were obtained from all participants, and the presence of H. pylori, gastric atrophy, and intestinal metaplasia were evaluated.
 Results: The prevalence of H. pylori positivity, gastric atrophy, and intestinal metaplasia were significantly higher in patients who underwent total knee and hip replacement compared to the control group without prosthesis.
 Conclusion: The results of this study suggest that patients who undergo total hip and knee replacement surgeries may be at higher risk for developing gastric pathologies, such as H. pylori infection, gastric atrophy, and intestinal metaplasia. Therefore, it is recommended that physicians who care for these patients monitor them closely for these conditions and consider endoscopic surveillance as part of their management plan.

Clinical Importance of Proximal Tibia in Total Knee Arthroplasty

The tibia is a thick and strong bone located medial to the leg. It is the longest bone in the bodyafter the os femoris, supporting the body weight and transferring this weight to the talus via the ankle jointvia the os femoris. It has two ends and a body. It articulates with the femur, fibula and talus. Total kneearthroplasty is used as an important treatment option in cases where conservative treatment options are noteffective or in advanced degenerative disorders. The need for total knee arthroplasty surgery is increasingwith advancing age. The general aim of total knee arthroplasty is to correct deformities, restore the functionof the knee joint and relieve long-term pain. Thus, it helps both psychological and physical recovery byimproving the patient's quality of life. Success of surgical intervention depends on the surgeon's experienceand knowledge of the anatomy of the proximal tibia. Appropriate tibial implants will ensure the longevityof the knee prosthesis and rapid movement of the patient. Anthropometric data must be accurate and reliablein order to use the implant in a healthy way for many years. Differences between age, gender and race areclinically important in determining the dimensions of inserted prosthetic components. Defining themorphologic and morphometric properties of the proximal tibia will be useful in improving prosthesis fit,manufacturing and application. Morphometric studies on the proximal tibia in the Turkish population arescarce and these studies will significantly contribute to the design of the tibial component of the total kneeprosthesis.

Gallstone Ileus of the Sigmoid Colon: Rare cause of Bowl Obstruction in a Case Report

This study aims to analyze the effectiveness of femoral block in postoperative analgesia for total knee prostheses and evaluate the immediate functional outcomes in patients who received this type of analgesia. Methods: A retrospective study was conducted on 35 cases of total knee replacement between January 2017 and December 2020. Epidemiological, clinical, and preoperative radiological data were collected. The femoral block was performed using ultrasound guidance, and the anaesthetic product used was diluted bupivacaine. Different analgesia protocols were used, and postoperative follow-up was conducted to assess clinical and radiological outcomes. Results: The study included 35 patients with a mean age of 64 years, predominantly female (77.7%). Most patients were in good health without specific medical history. Knee osteoarthritis with genu varum was the most common indication for total knee replacement. The femoral block was successfully performed in all cases. The average postoperative stay was 8 days, and the immediate functional outcomes were satisfactory, with an average flexion of 90° and walking assistance within 6 days. Conclusion: The study demonstrates the effectiveness of femoral block in providing postoperative analgesia for total knee replacement. The immediate functional outcomes were favorable, with patients achieving satisfactory flexion and early mobility. The multimodal approach to analgesia, including the femoral block, proved beneficial in optimizing pain management and facilitating rapid recovery after surgery.

Benefits of the Femoral Nerve Block in Total Knee Replacements: Analytical and Descriptive Study of a Series of 35 Cases

This study aims to analyze the effectiveness of femoral block in postoperative analgesia for total knee prostheses and evaluate the immediate functional outcomes in patients who received this type of analgesia. Methods: A retrospective study was conducted on 35 cases of total knee replacement between January 2017 and December 2020. Epidemiological, clinical, and preoperative radiological data were collected. The femoral block was performed using ultrasound guidance, and the anaesthetic product used was diluted bupivacaine. Different analgesia protocols were used, and postoperative follow-up was conducted to assess clinical and radiological outcomes. Results: The study included 35 patients with a mean age of 64 years, predominantly female (77.7%). Most patients were in good health without specific medical history. Knee osteoarthritis with genu varum was the most common indication for total knee replacement. The femoral block was successfully performed in all cases. The average postoperative stay was 8 days, and the immediate functional outcomes were satisfactory, with an average flexion of 90° and walking assistance within 6 days. Conclusion: The study demonstrates the effectiveness of femoral block in providing postoperative analgesia for total knee replacement. The immediate functional outcomes were favorable, with patients achieving satisfactory flexion and early mobility. The multimodal approach to analgesia, including the femoral block, proved beneficial in optimizing pain management and facilitating rapid recovery after surgery.

Long-term clinical results of alumina ceramic medial pivot total knee arthroplasty: a 10-year follow-up study

BackgroundThe newly-designed alumina ceramic medial pivot total knee prosthesis was introduced to reduce polyethylene wear and better fit the anatomical morphology of the Asian population. This study aimed to clarify the long-term clinical results of alumina medial pivot total knee arthroplasty over a minimum follow-up period of 10 years.MethodsThe data of 135 consecutive patients who underwent primary alumina medial pivot total knee arthroplasty were analyzed in this retrospective cohort study. Patients were examined over a minimum 10-year follow-up period. The knee range of motion, Knee Society Score (KSS) knee score, Knee Society Score function score, and radiological parameters were assessed. The survival rate was also evaluated by using reoperation and revision as endpoints.ResultsThe mean follow-up period lasted 11.8 ± 1.4 years. Patients who were not followed accounted for 7.4% of the total cohort. Knee and function scores of KSS improved significantly following total knee arthroplasty (P < 0.001). In 27 individuals (28.1%), a radiolucent line was observed. Aseptic loosening occurred in three cases (3.1%). The survival rates for reoperation and revision were 94.8% and 95.8% 10 years after the operation, respectively.ConclusionsDuring a minimum 10-year follow-up period, the present model of alumina medial pivot total knee arthroplasty showed good clinical outcomes and survival rates.

A Case of Prosthetic Infection with Candida Growth in the Knee Joınt

Introduction: Fungal prosthetic joint infections, constitute a small portion of all prosthetic infection cases and candida species are the causative agent in the majority of these cases. Most fungal prosthetic joint infections occur after revision arthroplasty. Case: A 72-year-old male patient, underwent total knee prosthesis operation for the right knee due to gonarthrosis. About 5 months later, he was hospitalized and treated due to bacterial prosthesis infection. 8 days after discharge, he applied again with the complaints of swelling, pain, temperature increase and redness in the right knee. He was hospitalized again due to prosthesis infection. Antifungal treatment was started for the patient due to the growth of Candida albicans in the knee joint. A total of 2.5 months of antifungal therapy was given. The patient, who recovered without any problems, continues to follow up in the outpatient clinic. Discussion: In this case report, we wanted to emphasize that in the presence of risk factors in prosthesis infection, we should not forget that the cause may also be fungus, that culture should be taken during the operation and that effective and long-term antifungal treatment should be given in fungal-related prosthesis infections.

Efficacy of high flexion total knee prosthesis replacement in the treatment of osteoarthrosis of the middle-aged and elderly knee

To study the clinical efficacy of high-flexion total knee prosthesis replacement in the treatment of middle-aged and elderly knee osteoarthropathy. Methods: Sixty middle-aged and elderly patients with osteoarthrosis of the knee admitted to the hospital between January 2020 and December 2022 were selected and randomly grouped to compare the various treatment effects of the two groups of patients. Results: The various treatment effects of patients in the observation group were better than those in the control group (P &lt; 0.05). Conclusion: Treatment of middle-aged and elderly patients with knee osteoarthropathy by high-flexion total knee prosthesis can improve the clinical effect and is worth promoting.

Medial pivot total knee arthroplasty: Mid-term results.

This study aims to evaluate the mid-term results of patients who underwent medial pivot total knee arthroplasty at a single center. A total of 304 knees of 236 patients (40 males, 196 females; mean operation age and standard deviation : 66,64 ±7,09 years; range, 45 to 82 years) treated with medial pivot total knee prosthesis in our center between January 2010 and December 2014 were retrospectively analyzed. The American Knee Society Score, Oxford Knee Score, and especially flexion angles were recorded during pre- and postoperative follow-up. Of the operated knees, 71.2% were unilateral and 28.8% were bilateral. The mean follow-up was 79.30±14.76 months. The postoperative results with the Functional Score, Knee Score, Oxford Score, Total Knee Society Score, and flexion angles were significantly higher compared to baseline (p<0.01). All postoperative scores were significantly lower inpatients aged ≥65years, compared to those aged <65 years (p<0.01). In patients who underwent resection of anterior and posterior the cruciate ligaments, only the mean flexion angles were found to increase (p<0.01). Our study results suggest that medial pivot knee prostheses are reliable in the mid-term and provide favorable results in terms of function and patient satisfaction. Level of Evidence: Level IV retrospective study.

Limb alignment changes with knee flexion: A study based on CAS data

BackgroundRecent evidence has questioned the value of standing limb alignment for predicting the adduction moment and forces exerted on healthy and prosthetic knees. The purpose of this study was to assess the lower limb alignment of OA knee patients at various knee flexion angles.The main hypothesis was that lower limb alignment measured throughout knee flexion does not significantly differ between patients displaying different extension alignment (neutral, varus or valgus). Methods206 arthritic knee patients undergoing computer-assisted total (CAS) knee prosthesis were included. Frontal limb alignment was assessed in a systematic manner by CAS at three knee positions: extension, 90 degrees of flexion and maximal flexion. The HKA angle at each knee position and the change in HKA angle between two knee positions (delta value) were reported and compared. ResultsA large proportion of OA patients had significant variation in their lower limb alignment (32% with Δ HKA > 5°). The extended limb deformity tended to reduce with knee flexion: mean of 5° and 6° deformity reduction for varus and valgus patients, 40% and 66% of varus and valgus patients progressed to neutral alignment with 90° knee flexion. Forty percent of neutral extended lower limb did not maintain their neutral alignment but rather progressed to either varus or valgus at 90° knee flexion. ConclusionsLimb alignment in extension is a poor predictor of limb alignment in flexion in OA patients.Only considering the traditional frontal alignment of an extended lower limb for planning knee arthroplasty or osteotomy is likely insufficient.

No higher tibial post fracture rate with highly cross-linked polyethylene inserts in total knee arthroplasty at a minimum 10-year follow-up.

The purpose of this study was to assess tibial post fracture between highly cross-linked polyethylene (HXPE) and conventional polyethylene inserts in consecutive posterior-stabilized (PS) total knee arthroplasty (TKA) over a minimum 10-years follow-up period. Between July 2008 and December 2011, a consecutive series of 3264 primary TKAs was performed in 2098 patients using a PS total knee prosthesis at a single institution. The final cohort was classified into the HXPE group (792 cases) and the conventional group (2113 cases) according to insert material used during the procedure. The mean follow-up period was 11.4years in the HXPE group and 11.8years in the conventional group. Both cases of tibial post fracture occurred in the HXPE group, a complication rate of 0.25%. These two cases required replacement with a thicker tibial insert with retention of the femoral and tibial components. There were no cases of tibial post fracture in the conventional group. There was no difference in tibial post fracture rate between the HXPE group and the conventional group in PS TKA on long-term follow-up. IV.

Reappraisal of the proximal tibia anatomy in Turkish population.

Total knee arthroplasty has been popular in recent years. Morphometry of proximal tibia is important for surgeons to perform successful total knee arthroplasty. Aim of this study was to reappraise the proximal tibia morphometry. In this study, 57 human dry tibia were evaluated. Anteroposterior and mediolateral dimensions of tibial condyles, maximum width of superior articular surface and length of tibia were measured. Furthermore, morphometric measurements of the intercondylar area and Gerdy's tubercle (infracondylar tibial tubercle) were done. All measurements were performed by two observers using a digital caliper. Mean anteroposterior and mediolateral dimensions of medial tibial condyle were found 39.76 and 23.27mm, respectively. Mean anteroposterior and mediolateral dimensions of lateral tibial condyle were measured 34.72 and 21.83mm, respectively. Mean anteroposterior dimension of intercondylar area was 41.62mm. Shape of the Gerdy's tubercle was oval in 76.8%, irregular in 12.5%, and triangular in 10.7%. Texture of the tubercle was smooth in 85.7% and rough in 14.3%. Mean superoinferior and mediolateral dimensions of Gerdy's tubercle were 12.28 and 10.27mm, respectively. Anteroposterior and mediolateral dimensions of tibial condyles were significantly higher (p < 0.05) for the medial condyle. Positive and statistically significant correlations were found between the tibial length and the other parameters (p < 0.05, r > 0.40). The morphometric data of tibial plateau are important for surgeons during total knee arthroplasty. The superoinferior and mediolateral dimensions of the Gerdy's tubercle, the distance between Gerdy's tubercle and tibial tuberosity, the distance between Gerdy's tubercle and lateral tibial plateau were measured for the first time in our study. The data obtained from this study can be used as a guideline in designing tibial component of the total knee prosthesis in Turkish population. In arthroplasty, patient-specific prosthetic implants may eradicate implant mismatch in the near future.

Long-term effectiveness of different patellar treatments in primary total knee arthroplasty

To compare the long-term effectiveness of patellar denervation by electrotomy combined with patellar replacement and patellar denervation by electrotomy alone in primary total knee arthroplasty (TKA). A retrospective analysis was conducted on the clinical data of 30 patients treated with primary TKA of both knees between July 2013 and March 2015 who met the selection criteria. There were 11 males and 19 females, aged 56-79 years, with an average age of 67.6 years. One knee was randomly selected for patellar denervation by electrotomy combined with patellar replacement during TKA (combined group), while the other knee was treated with patellar denervation by electrotomy alone (control group). All patients adopted the same type of total knee prosthesis. After surgery, the patients were followed up regularly, and the occurrence of complications was recorded. The functions of the knee and patella were evaluated using the Knee Society Score (KSS) and Feller score, respectively. The position of the prosthesis, patella trajectory, and prosthesis loosening and wear were observed by imaging examination. All 30 patients were followed up 81.4-103.5 months, with an average of 90.4 months. The patellar thickness of the combined group ranged from 21 to 26 mm, with an average of 23.0 mm. The position of the prosthesis and patella trajectory in the combined group and the control group were good, without obvious loosening or wear. After operation, 2 sides (6.7%) in the combined group and 3 sides (10.0%) in the control group presented joint adhesion and poor activities. No complication such as lower limb deep vein thrombosis, aseptic fractures, and infections around the prosthesis occurred in both groups. At last follow-up, the KSS clinical score, KSS function score, and Feller score showed no significant difference between the two groups ( P>0.05). According to the KSS score, 24 patients (80.0%) had no obvious preference for patellar denervation combined with patellar replacement, 3 patients (10.0%) preferred patellar replacement combined with patellar denervation, and 3 patients (10.0%) preferred no patellar replacement. Anterior knee pain occurred in 6 sides (20.0%) of both groups. There is no significant difference in the long-term effectiveness between patellar denervation combined with patellar replacement and patellar denervation alone conducted in patients with knee osteoarthritis undergoing primary TKA.

Mid-term clinical outcomes of a posterior stabilized total knee prosthesis for Japanese patients: A minimum follow-up of 5 years

BackgroundA high–flexion posterior-stabilized total knee prosthesis has been developed for the Asian population. The component design was based on computed tomography images of Japanese osteoarthritic knees. The femoral component is composed of zirconia ceramics, which exhibit low friction and high durability. The present study aimed to evaluate the mid-term clinical outcomes of this implant. MethodsThis study included 334 knees of 210 patients who underwent primary total knee arthroplasty with this implant at our hospital between October 2010 and December 2014. The patients comprised 28 men and 172 women with an average age of 73 years. The average follow-up period was 5.9 years, and the follow-up rate was 71.1%. Clinical outcomes were assessed using the Knee Society scoring system, 2011 Knee Society questionnaire, and Knee Injury and Osteoarthritis Outcome Score. Kaplan–Meier survivorship analysis was performed to determine the cumulative prosthesis survival rate. ResultsIn terms of clinical outcomes at the final follow-up, the average ranges of motion were −2.0 in extension and 126.7 in flexion. The Knee Society knee and function scores were 94.2% and 72.6%, respectively. With revision surgery or radiographic failure for any reason as the endpoint, the survival rates at 5 and 9 years were 98.2% and 95.5%, respectively. The most common reason for revision surgery or radiological failure was aseptic loosening. ConclusionsDespite several revision cases mainly due to aseptic loosening, the present study found that this new high-flexion posterior-stabilized total knee arthroplasty prosthesis design showed comparable results for Asian populations with other PS prosthesis. Levels of evidenceLevel Ⅱ (Prospective cohort study).

Biomechanical effects of the tibial slope angle change on total knee prosthesis: 3D finite elements analysis

: In total knee arthroplasty, finding the correct tibial slope angle while placing the prosthesis affects the joint load. In our study; the load on the tibial insert and the notch of the insert as a result of flexion of the knee joint 0-30-60-90 degrees at each inclination in prostheses applied with posterior inclination angles of 0,3,5 and 7 degrees was examined in the three-dimensional right knee finite element structural model. In this way, it was aimed to reveal at which slope the resulting load is the lowest. The finite element structural model was created using the 3D 2.5 number right knee solid model. Two types of analysis were performed to examine the effect of angle change of the PE Insert on tibia component; static structural analysis with static loads at certain fixed flexion angles, and transient analysis with time for varying loadings at dynamically changing flexion angles with rotation of the knee between 0-90 degrees. In the 0 and 30 degree models, the least load on the tibial insert was found at 7 degree tibial slop angle (11.6 and 9.87 mpa, respectively), in 60 and 90 degree models at 5 degree tibial slop angle (9.07 and 11.4 mpa respectively). In the models of 0 and 30 degrees, no pressure occured on the tibial insert notch at 3,5,7 degrees of tibial slop angles, while in the 60 degree model, a pressure of 0,153 MPa occured at all 0,3,5,7 degrees at 0 degrees tibial insert slop angle and this pressure was centered at the junction with the tibial insert. The higher the load on the tibial insert, the greater wear of the tibial insert in the knee prosthesis. For this reason, it is important with which slop angle the tibial insert should be placed during surgery.

Ten-year follow-up of a total knee prosthesis combining multi-radius, ultra-congruency, posterior-stabilization and mobile-bearing insert shows long-lasting clinically relevant improvements in pain, stiffness, function and stability

PurposeThere is a paucity of data available on total knee prostheses combining dual-radius, ultra-congruency, posterior-stabilization and mobile-bearing insert. This prospective cohort study aimed to assess the clinical evolution of the FIRST® prosthesis (Symbios Orthopédie, Yverdon, CH), the earliest prosthesis with this particular design. It was hypothesized that the primary outcomes, evaluating pain, stiffness, function and stability, would improve following arthroplasty and remain improved during the follow-up period of 10 years.MethodsAll patients programmed for a total knee arthroplasty using a FIRST® prosthesis at our university hospital between 2006 and 2008 were invited to participate. Study knees were evaluated pre-operatively as well as one, five and ten years post-operatively. Patients filled out questionnaires at each evaluation point and had a radiographic assessment at the five-year and ten-year follow-ups. Primary outcomes were the total, pain, stiffness and function measures of the Western Ontario and McMaster Universities Osteoarthritis questionnaire (WOMAC) and the knee and function measures of the Knee Society Score (KSS). Friedman and Wilcoxon’s rank-sum tests were used to compare measures across time points.ResultsHundred and twenty four prostheses were included (baseline demographics: 69.9 ± 8.3 years old, 28.1 ± 4.3 kg/m2, 54% male) and 68 could be followed during ten years. Five prostheses underwent a revision. All other prostheses lost at follow-up were lost for reasons unrelated to the prosthesis. All primary measures reported statistically and clinically significant improvements between baseline and the three follow-up evaluations. Statistically significant improvements at the three follow-up evaluations were also observed for most secondary measures. There was no implant loosening. At ten-year follow-up, radiolucent lines were observed in 2.9% femoral implants and 1.5% tibial implants.ConclusionThe positive results observed in all domains of assessment and the small revision rate demonstrated an effective functioning of the FIRST® prosthesis during the ten-year follow-up period. The results, globally similar to those previously published for other prosthesis designs, encourage the development of assistive methods to select the most appropriate designs on an individual basis.Level of evidenceIV, prospective cohort study.

Ultrasonic bone cement removal efficiency in total joint arthroplasty revision: A computer tomographic-based cadaver study.

Polymethylmethacrylate (PMMA) removal during septic total joint arthroplasty revision is associated with a high fracture and perforation risk. Ultrasonic cement removal is considered a bone-preserving technique. Currently, there is still a lack of sound data on efficacy as it is difficult to detect smaller residues with reasonable technical effort. However, incomplete removal is associated with the risk of biofilm coverage of the residue. Therefore, the study aimed to investigate the efficiency of ultrasonic-based PMMA removal in a human cadaver model.The femoral components of a total hip and a total knee prosthesis were implanted in two cadaver femoral canals by 3rd generation cement fixation technique. Implants were then removed. Cement mantle extraction was performed with the OSCAR-3-System ultrasonic system (Orthofix®). Quantitative analysis of cement residues was carried out with dual-energy and microcomputer tomography.With a 20 µm resolution, in vitro microcomputer tomography visualized tiniest PMMA residues. For clinical use, dual-energy computer tomography tissue decomposition with 0.75 mm resolution is suitable. With ultrasound, more than 99% of PMMA was removed. Seven hundred thirty-fourresidues with a mean volume of 0.40 ± 4.95 mm3 were identified with only 4 exceeding 1 cm in length in at least one axis.Ultrasonic cement removal of PMMA was almost complete and can therefore be considered a highly effective technique. For the first time, PMMA residues in the sub-millimetre range were detected by computer tomography. Clinical implications of the small remaining PMMA fraction on the eradication rate of periprosthetic joint infection warrants further investigations.

Musculoskeletal multibody dynamics investigation of posterior-stabilized total knee prosthesis

Posterior-stabilized total knee prostheses have been widely used in orthopedic clinical treatment of knee osteoarthritis, but the patients and surgeons are still troubled by the complications, for example severe wear and fracture of the post, as well as prosthetic loosening. Understanding the in vivo biomechanics of knee prostheses will aid in the decrease of postoperative prosthetic revision and patient dissatisfaction. Therefore, six different designs of posterior-stabilized total knee prostheses were used to establish the musculoskeletal multibody dynamics models of total knee arthroplasty respectively, and the biomechanical differences of six posterior-stabilized total knee prostheses were investigated under three simulated physiological activities: walking, right turn and squatting. The results showed that the post contact forces of PFC Sigma and Scorpio NGR prostheses were larger during walking, turning right, and squatting, which may increase the risk of the fracture and wear as well as the early loosening. The post design of Gemini SL prosthesis was more conductive to the knee internal-external rotation and avoided the edge contact and wear. The lower conformity design in sagittal plane and the later post-cam engagement resulted in the larger anterior-posterior translation. This study provides a theoretical support for guiding surgeon selection, improving posterior-stabilized prosthetic design and reducing the prosthetic failure.

A novel way of quantifying bone defect in primary total knee replacements using plain radiographs.

Bone defect assessment in primary advanced knee arthritis can present a challenge for the surgeon and lead to unfavourable outcomes if not adequately determined during preoperative planning. The aim of this study was to introduce a new, simple and quick way to assess and quantify bone defect using short film radiographs and utilising it to choose the total knee prosthesis. This is a prospective case series of patients who underwent TKA (Total Knee Arthroplasty) using various types of prostheses. Three different angles - Tibiofemoral angle, MPTA (medial proximal tibial angle), and JLCA (joint line convergence angle) - were measured preoperatively to evaluate limb alignment, placement of the tibial, and femoral components of total knee prosthesis. Postoperatively roentgenographic index introduced by Lotke et al was used to assess our preoperative methodology. The American knee society score was used pre- and postoperatively up to one year. A total of eight knees of six patients were analysed (four males, two females). The mean age of the patients was 57.75±5.701 years. All the knees were in varying degrees of varus deformity preoperatively. The accuracy of the preoperatively used radiological angles was analysed by postoperative measurement of tibiofemoral angle (d), tibial anatomical axis (b) and femoral anatomical axis (a), and Roentgenographic index as suggested by Lotke et al. Postoperatively, all the knees were in valgus with tibiofemoral angle (d) 6.50±0.926, tibial component alignment (b) mean was 89±1.195, and femoral component alignment (a) mean was 5.13±0.991 valgus. Mean roentgenographic index was 89.38±3.292. American knee society score improved at one-year follow-up postoperatively and was statistically significant with p<0.001. In this study, a new classification for bone defects in primary arthritic knees by utilising simple plain radiograph short films and as a guide for implant selection is proposed.

Do obese patients benefit from a kinematic, appropriately designed total knee prosthesis?

IntroductionModern total knee arthroplasty (TKA) using the Journey 2 implant utilizes a bicruciate stabilized (BCS) technique. However, whether bicruciate stabilized TKA is equally effective across weight classes is unknown. MethodsWe identified patients who underwent primary bicruciate stabilized TKA during 2016 and 2017, at a single institution. All included patients had, at minimum, 2-year follow-up. Patients were categorized into body-mass index (BMI) groups as follows: underweight, normal, or overweight (<30 kg/m2), obese (≥30 to <35 kg/m2), and severely obese (≥35 kg/m2). Patient reported outcome measures (PROMs) were measured at baseline. Both KSS and KOOS JR, along with the Visual Analogue Scale (VAS), were also recorded at follow-up. Pre-operative, post-operative, and pre-to post-operative changes in PROMs were analyzed using analysis of variance (ANOVA) and linear regression. ResultsThe 292 patients had a mean age of 64.8 years and mean BMI of 32.3 kg/m2. There were 116 (39.7%) patients in the underweight, normal, or overweight group, 88 (30.1%) in the obese category, and 88 (30.1%) in the severely obese group. There were no differences between PROMs at baseline or at follow-up (p > 0.10 for all comparisons). There were also no differences in the improvement from pre-to post-operative KSS (p = 0.21) and KOOS JR (p = 0.62). ConclusionsBicruciate stabilized TKA has similar effects on PROMs across BMI groups. These results suggest that bicruciate stabilized TKA is a viable treatment option both for low-weight and high-weight patients.

Safety and Efficacy of Single Condylar Knee Prosthesis When Treating Knee Single Compartment Osteoarthritis: A Prospective, Case-Randomized Controlled Study.

Objective The aim of this study is to explore the safety and efficacy of single condylar knee prosthesis when treating knee single compartment osteoarthritis by measuring the decrease of hemoglobin, total postoperative blood loss, maximum reduction of HCT, and knee joint activity. Methods A total of 80 patients with knee joint single compartment osteoarthritis treated in our hospital from January 2020 to December 2021 were studied. They were randomly assigned to a study group (n = 40) and a control group (n = 40). The study group was treated with total knee prosthesis, while the control group was treated with simple knee prosthesis. The decrease rate of hemoglobin, the amount of bleeding, and the maximum decrease of hematocrit were compared after treatment. The range of motion of knee joint was evaluated by the Fugl-Meyer motor function scale (FM-B) and Berg balance scale (BBS). Results The decrease of hemoglobin in the study group at 24 hours, 36 hours, and 48 hours after treatment was remarkably lower (P < 0.05). The total blood loss and the maximum reduction of hematocrit(HCT) in the study group were lower (P < 0.05). The range of motion (ROM) of the knee joint in the study group at 6 and 12 months after treatment was remarkably higher than that before treatment and remarkably higher compared to the control group (P < 0.05). The FM-B scale and BBS scale of the studied cohort at 6 and 12 months after treatment were remarkably higher than those before treatment and were remarkably higher compared to the control's (P < 0.05). Conclusion The unicondylar knee prosthesis is safer and more effective in the treatment of noncompartmental osteoarthritis of the knee, facilitating less trauma and perioperative blood loss and enhancing the patient's motion and balance.