Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty

BACKGROUND Total knee arthroplasty(TKA)is a mature procedure recommended for correcting knee osteoarthritis deformity,relieving pain,and restoring normal biomechanics.Although TKA is a successful and cost-effective procedure,patient dissatisfaction is as high as 50%.Knee pain after TKA is a significant cause of patient dissatisfaction;the most common location for residual pain is the anterior region.Between 4%and 40%of patients have anterior knee pain(AKP).AIM To investigate the effect of various TKA procedures on postoperative AKP.METHODS We searched PubMed,EMBASE,and Cochrane from January 2000 to September 2022.Randomized controlled trials with one intervention in the experimental group and no corresponding intervention(or other interventions)in the control group were collected.Two researchers independently read the title and abstract of the studies,preliminarily screened the articles,and read the full text in detail according to the selection criteria.Conflicts were resolved by consultation with a third researcher.And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software.RESULTS There were 25 randomized controlled trials;13 were comparative studies with or without patellar resurfacing.The meta-analysis showed no significant difference between the experimental and control groups(P=0.61).Six studies were comparative studies of circumpatellar denervation vs non-denervation,divided into three subgroups for meta-analysis.The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups(P=0.31,P=0.50).One subgroup meta-analysis showed a significant difference between the experimental and control groups(P=0.001).Two studies compared fixed-bearing TKA and mobile-bearing TKA;the results meta-analysis showed no significant difference between the experimental and control groups(P=0.630).Two studies compared lateral retinacular release vs non-release;the meta-analysis showed a significant difference between the experimental and control groups(P=0.002);two other studies compared other factors.CONCLUSION Patellar resurfacing,mobile-bearing TKA,and fixed-bearing TKA do not reduce the incidence of AKP.Lateral retinacular release can reduce AKP;however,whether circumpatellar denervation can reduce AKP is controversial.

全膝关节置换中BrainlabKnee3导航辅助间隙平衡技术的应用优势

背景:近年来,计算机导航技术辅助关节置换逐渐受到医疗领域的关注。文献报道计算机导航在全膝关节置换中的应用临床效果不一。为了探索新一代Brainlab Knee 3导航系统的临床效果,进行了此项研究。目的:分析计算机导航系统(Brainlab Knee 3)结合间隙平衡技术在全膝关节置换中的应用效果。方法:2020年11月至2021年5月大连市第二人民医院关节外科收治71例行全膝关节置换患者,导航组35例,术中采用计算机导航结合间隙平衡技术行全膝关节置换;传统组36例,术中采用传统手术器械定位截骨。比较两组患者术中内、外侧关节间隙差;膝关节活动度、KSS评分;髋膝踝角;冠状面股骨组件角、冠状面胫骨组件角和矢状面胫骨组件角偏差值。结果与结论:①导航组伸直位内外侧间隙差0,1,2 mm的患者分别为19,14,2例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为18,15,2例。传统组伸直位内外侧间隙差0,1,2 mm的患者分别为10,20,6例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为10,15,8例。②导航组手术时间长于传统组(P<0.05),导航组有2例患者术后形成下肢肌间静脉血栓,传统组患者均无并发症。③置换后6,12个月两组患者膝关节活动度均明显增加,导航组膝关节活动度高于传统组(P<0.05)。④置换后12个月两组患者KSS评分均明显增加,导航组KSS评分高于传统组(P<0.05)。⑤置换后6个月髋膝踝角、冠状面股骨组件角、冠状面胫骨组件角、矢状面胫骨组件角偏差值均显著小于传统组(P<0.05)。⑥结果表明,采用计算机导航结合间隙平衡技术辅助全膝关节置换对关节活动度、下肢力线、胫骨假体组件位置的准确性方面具有优势,置换后关节功能恢复良好。

Analysis of the causes of primary revision after unicompartmental knee arthroplasty: A case series

BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.

Single-center experience with Knee+^(TM) augmented reality navigation system in primary total knee arthroplasty

BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years,as they enhance precision compared to conventional hardware.The expansion of computer assistance is evolving with the employment of augmented reality.Yet,the accuracy of augmented reality navigation systems has not been determined.AIM To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty(TKA),utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon.METHODS From May 2021 to December 2021,30 patients,25 women and five men,under-went a primary unilateral TKA.Revision cases were excluded.A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment.All patients were operated on by the same team,without a tourniquet,utilizing three distinct prostheses with the assistance of the Knee+™augmented reality navigation system in every operation.Postoperatively,the same radiographic exam protocol was executed to evaluate the implants’position,orientation and coronal plane alignment.We recorded measurements in 3 stages regarding femoral varus and flexion,tibial varus and posterior slope.Firstly,the expected values from the Augmented Reality system were documented.Then we calculated the same values after each cut and finally,the same measurements were recorded radiolo-gically after the operations.Concerning statistical analysis,Lin’s concordance correlation coefficient was estimated,while Wilcoxon Signed Rank Test was performed when needed.RESULTS A statistically significant difference was observed regarding mean expected values and radiographic mea-surements for femoral flexion measurements only(Z score=2.67,P value=0.01).Nonetheless,this difference was statistically significantly lower than 1 degree(Z score=-4.21,P value<0.01).In terms of discrepancies in the calculations of expected values and controlled measurements,a statistically significant difference between tibial varus values was detected(Z score=-2.33,P value=0.02),which was also statistically significantly lower than 1 degree(Z score=-4.99,P value<0.01).CONCLUSION The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized.Augmented reality navigation systems can bolster orthopaedic surgeons’accuracy in achieving precise axial alignment.However,further research is required to further evaluate their efficacy and potential.

Patellar reconstruction in primary total knee arthroplasty using bone chips from routine cuts:A case report and review of literature

BACKGROUND Total patellectomy is currently reserved for exceptional cases,such as recalcitrant patellofemoral instability and comminuted fractures,due to its demonstrated negative impact on knee biomechanics.Therefore,managing patellectomy is crucial to mitigate its inherent deleterious effects.Various techniques have been described,including autologous or allogeneic bone grafts for reconstruction and soft tissue realignment to enhance the extensor mechanism.CASE SUMMARY A 73-year-old male underwent a patellectomy due to a comminuted fracture,subsequently developing osteoarthritis and experiencing a decline in functional status.Concurrent with total knee replacement,we conducted a patellar reconstruction,incorporating routine bone cuts and utilizing bone chips to fashion a new patella.This intervention resulted in the restoration of full extension and improvement of knee function.CONCLUSION Patellar reconstruction demonstrates benefits on knee mechanics and stabilization,contributing to enhanced outcomes and satisfaction following knee replacement.We present an affordable technique for managing patellectomized patients undergoing total knee replacement.

Assessment of the effectiveness of weight-adjusted antibiotic administration,for reduced duration,in surgical prophylaxis of primary hip and knee arthroplasty

BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic surgery.The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed,for the duration of the operation,the minimum inhibitory concentration of the likely organisms that are encountered.Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4%and 8%to between 1%and 3%.Controversy,however,still surrounds the optimal frequency and dosing of antibiotic administration.AIM To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime,combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty METHODS Following ethical approval,patients undergoing primary total hip arthroplasty(THA)/total knee arthroplasty(TKA)with the old regime(OR)of a preoperative dose[cefazolin 2 g intravenously(IV)],and two subsequent doses(2 h and 8 h),were compared to those after a change to a new regime(NR)of a weight-adjusted preoperative dose(cefazolin 2 g IV for patients<120 kg;cefazolin 3g IV for patients>120 kg)and a post-operative dose at 2 h.The primary outcome in both groups was SSI rates during the 2 years post-operatively.RESULTS A total of n=1273 operations(THA n=534,TKA n=739)were performed in n=1264 patients.There was no statistically significant difference in the rate of deep(OR 0.74%(5/675)vs NR 0.50%(3/598);fishers exact test P=0.72),nor superficial SSIs(OR 2.07%(14/675)vs NR 1.50%(9/598);chi-squared test P=0.44)at 2 years postoperatively.With propensity score weighting and an interrupted time series analysis,there was also no difference in SSI rates between both groups[RR 0.88(95%CI 0.61 to 1.30)P=0.46].CONCLUSION A weight-adjusted regime,with a reduction in number of post-operative doses had no adverse impact on SSI incidence in this population.

Commentary on“The deterministic condition for the ground reaction force acting point on the combined knee valgus and tibial internal rotation moments in the early phase of cutting maneuvers in female athletes”

1.Introduction For decades,substantial disagreement has persisted as to whether dynamic knee valgus is the cause of the majority of anterior cruciate ligament(ACL)injuries or rather the result of the ACL rupture.1 Consequently,great effort and expense has gone into capturing 3-dimensional kinetics and kinematics from live athletes to drive in vitro and in silico models of ACL injury in order to elucidate the actual mechanism of injury,as these factors have been demonstrated to be surrogates of intraarticular structural loading on the ACL.2,3 The elucidation of injury mechanisms for non-contact ACL injuries is of great medical value as such knowledge consequently permits quantified examination and validation of interventions and their respective effectiveness in both prevention and rehabilitation of these traumatic knee injuries.

Multidisciplinary approach toward enhanced recovery after surgery for total knee arthroplasty improves outcomes

Knee osteoarthritis is a degenerative disorder of the knee,which leads to joint pain,stiffness,and inactivity and significantly affects the quality of life.With an increased prevalence of obesity and greater life expectancies,total knee arthroplasty(TKA)is now one of the major arthroplasty surgeries performed for knee osteoarthritis.When enhanced recovery after surgery(ERAS)was introduced in TKA,clinical outcomes were enhanced and the economic burden on the healthcare system was reduced.ERAS is an evidence-based scientific protocol aimed at ameliorating the surgical stress response.ERAS aims to enhance the recovery phase,which encompasses multidisciplinary strategies at every step of perioperative care,including the rehabilitation phase.Implementation of ERAS in TKA aids in reducing the length of hospital stay,improving pain management,reducing perioperative complications,and enhancing patient satisfaction.Multidisciplinary collaboration,integrating the expertise of anesthesiologists,orthopedic surgeons,nursing personnel,and other healthcare professionals,is the cornerstone of ERAS in patients undergoing TKA.

Adipose-derived regenerative therapies for the treatment of knee osteoarthritis

Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying therapy.Definitive treatment ultimately requires joint replacement.Therapies capable of regenerating cartilage could significantly reduce financial and clinical costs.The regenerative potential of mesenchymal stromal cells(MSCs)has been extensively studied in the context of knee osteoarthritis.This has yielded promising results in human studies,and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to inflammation.Adipose-derived MSCs(ASCs)are becoming increasingly popular owing to their relative ease of isolation and high proliferative capacity.Stromal vascular fraction(SVF)and micro-fragmented adipose tissue(MFAT)are produced by the enzymatic and mechanical disruption of adipose tissue,respectively.This avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations,including immune cells,may potentiate the reparative function of ASCs.In this editorial,we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee osteoarthritis.We discuss the study’s findings in the context of emerging evidence regarding adipose-derived regenerative therapies.An underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs,SVF,and MFAT.

Addressing metallosis in knee arthroplasty:From diagnostic challenges to innovative treatments

In this editorial,we comment on the article by Toro et al published in the recent issue of World Journal of Orthopedics.This editorial review provides a comprehensive exploration of the landscape surrounding knee arthroplasty metallosis,focusing on key aspects ranging from the mechanisms influencing susceptibility to clinical implications and advanced treatment strategies.We elucidate the complex interplay of implant design,patient-specific variables,and wear-related processes contributing to metallosis.Furthermore,we seek to shed light on diagnostic challenges,the necessity of a multidisciplinary approach,and the imperative for vigilant implant surveillance.Uni-on-uni revision,as a targeted treatment modality,is discussed,highlighting its potential to address metallosis in unicompartmental knee arthroplasty(UKA).There is a need for heightened awareness among clinicians regarding the subtle presentations of metallosis,coupled with the limitations of traditional imaging techniques.Addressing metallosis requires a collaborative,multidisciplinary approach to effectively navigate the complexities associated with this complication.Furthermore,the review emphasizes the evolving paradigm of personalized care,with uni-on-uni revision emerging as a promising surgical solution.In conclusion,the editorial outlines the dynamic nature of knee arthroplasty metallosis and its multifaceted impact on clinical practice.It calls for ongoing collaboration,education,and integration of innovative solutions to enhance diagnostic accuracy,proactive management,and overall patient outcomes in the realm of UKA.

Rehabilitation care for pain in elderly knee replacement patients

BACKGROUND Total knee arthroplasty(TKA)is recognized as the most effective surgical intervention for relieving pain and improving joint mobility and deformity in patients with knee osteoarthritis and other synovial diseases.The application of accelerated postoperative rehabilitation(enhanced recovery after surgery)has demonstrated its efficacy in improving patient outcomes,and early postoperative joint function exercise has become a key prognostic factor in knee replacement.The unexpected appearance of limb pain and swelling hindered the patient’s tendency for early mobilization,leading in prolonged hospitalization,delayed functional recovery and negative psychological responses.A retrospective analysis was conducted on a cohort of 116 patients who under-went TKA at our hospital between July 2019 and July 2021.The patients were divided into two groups:A control group(n=58)receiving programmatic nur-sing,and an observed group(n=58)receiving programmed nursing combined with a collaborative nursing model.A pain management team consisting of attending physicians,head nurses,and responsible nurses was established.Outcome measures included visual analogue scale(VAS)scores,activities of daily living(ADL)scale scores,and functional scores.The ADL scores of patients in both groups exhibited a continuous increase.However,there was no statistically significant difference in the ADL scores between the two groups at 48 h and the 7th d post-surgery(P>0.05).Upon reexamination at the 3rd mo,the observation group demonstrated higher ADL scores compared to the control group(67.48±14.69 vs 59.40±16.06,P<0.05).The VAS scores of both groups significantly decreased,with no significant difference observed between the groups at each time point(P>0.05).The functional status of patients in both groups exhibited a gradual increase prior to intervention and at the 1st,2nd,and 3rd month following discharge(P<0.05).There was no statistically significant difference in knee joint function scores between the two groups at the 1st month after discharge(47.52 vs 45.81,P>0.05).However,the knee joint function scores of patients in the observation group were significantly higher than those in the control group at the 2nd(59.38 vs 53.19,P<0.05)and 3rd month(71.92 vs 64.34,P<0.05)following discharge.CONCLUSION The utilization of programmed pain nursing in conjunction with collaborative nursing for out-of-hospital care of TKA patients has demonstrated favorable outcomes,encompassing pain reduction,enhanced prognosis,and improved nursing quality for patients.

Robotics in total knee replacement:Current use and future implications

Robotic total knee replacement(TKR)surgery has evolved over the years with the aim of improving the overall 80% satisfaction rate associated with TKR surgery.Proponents claim higher precision in executing the pre-operative plan which results in improved alignment and possibly better clinical outcomes.Opponents suggest longer operative times with potentially higher complications and no superiority in clinical outcomes alongside increased costs.This editorial will summarize where we currently stand and the future implications of using robotics in knee replacement surgery.

Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis:A comparison of clinical and radiological outcomes

BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.

Mortality rate after total knee arthroplasty or total hip arthroplasty in patients with a history of liver transplant

In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a total hip arthroplasty(THA)or total knee arthroplasty(TKA)implanted.Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population.However,there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population(individuals without LT).Therefore,in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population.Therefore,future research should attempt to resolve this controversy.

Optimizing pain management in elderly patients post-knee surgery:A novel collaborative strategy

Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of such surgeries,the article highlights the critical need for effective postoperative care strategies.This editorial provides an overview of rehabilitation care for pain in elderly knee replacement patients,emphasizing the importance of a multimodal approach to postoperative recovery.Furthermore,the article advocates for a patient-centered,comprehensive rehabilitation regimen that enhances recovery and quality of life in elderly patients undergoing knee replacement surgery.

Efficacy of stromal vascular fraction for knee osteoarthritis:A prospective,single-centre,non-randomized study with 2 years follow-up

BACKGROUND Current osteoarthritis(OA)treatments focus on symptom relief without addressing the underlying disease process.In regenerative medicine,current treatments have limitations.In regenerative medicine,more research is needed for intra-articular stromal vascular fraction(SVF)injections in OA,including dosage optimization,long-term efficacy,safety,comparisons with other treatments,and mechanism exploration.AIM To compare the efficacy of intra-articular SVF with corticosteroid(ICS)injections in patients with primary knee OA.METHODS The study included 50 patients with Kellgren-Lawrence grades II and III OA.Patients were randomly assigned(1:1)to receive either a single intra-articular SVF injection(group A)or a single intra-articular ICS(triamcinolone)(group B)injection.Patients were followed up at 1,3,6,12,and 24 months.Visual analog score(VAS)and International Knee Documentation Committee(IKDC)scores were administered before the procedure and at all followups.The safety of SVF in terms of adverse and severe adverse events was recorded.Statistical analysis was performed with SPSS Version 26.0,IBM Corp,Chicago,IL,United States.RESULTS Both groups had similar demographics and baseline clinical characteristics.Follow-up showed minor patient loss,resulting in 23 and 24 in groups A and B respectively.Group A experienced a notable reduction in pain,with VAS scores decreasing from 7.7 to 2.4 over 24 months,compared to a minor reduction from 7.8 to 6.2 in Group B.This difference in pain reduction in group A was statistically significant from the third month onwards.Additionally,Group A showed significant improvements in knee functionality,with IKDC scores rising from 33.4 to 83.10,whereas Group B saw a modest increase from 36.7 to 45.16.The improvement in Group A was statistically significant from 6 months and maintained through 24 months.CONCLUSION Our study demonstrated that intra-articular administration of SVF can lead to reduced pain and improved knee function in patients with primary knee OA.More adequately powered,multi-center,double-blinded,randomised clinical trials with longer follow-ups are needed to further establish safety and justify its clinical use.

Mid-term outcomes of a kinematically designed cruciate retaining total knee arthroplasty

BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.

Is there sufficient evidence to support the use of antibiotic holiday just before the second stage of an infected total hip or knee arthroplasty revision surgery?

The practice of implementing an antibiotic holiday before the second stage of hip or knee arthroplasty is currently controversial due to limited evidence for this approach,as per the International Consensus Meeting 2018 on Musculoskeletal Infection.A greater understanding of this issue could augment the quality of Alrayes and Sukeik’s mini-review(2023)on diagnosing,managing,and treating periprosthetic knee infections.However,a significant lack of literature exists concerning the optimal duration for the antibiotic holiday,calling for more research before establishing any clinical guidelines.

Knee Osteoarthritis Progression after Distal Femur Closing Wedge Osteotomy

Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to identify the factors associated with the progression of knee osteoarthritis after a medial closing-wedge distal femoral osteotomy. Methods: Hospital-based observational study on 20 patients who underwent a medial closing-wedge distal femoral osteotomy evaluating the progression of osteoarthritis using the Kellgren and Laurence classification. The Wilcoxon test was used to compare the variation in the progressive stage of the Kellgren and Laurence classification of knee osteoarthritis preoperatively and at the final follow up. Univariate analysis made it possible to determine the factors associated with progression. The final significance threshold for statistical tests was set at 5% (p Results: Overall, the mean follow-up of 46 months ± 6.6 months, with a mean age of 43 years (range: 27 - 69 years) and a female predominance (M: F = 3/7). The progression of tibiofemoral osteoarthritis following a medial closing-wedge distal femoral osteotomy is associated with valgus or varum malalignment been a moderate valgus (OR 6.2 [1.5 - 42.7] at 95% CI;p-value = 0.02), a correction of the mechanical deviation angle with a valgus alignment (OR 2.7 [0.9 - 8.3] at 95% CI), and loss of correction (OR 3.8 [1.3 - 11.6] at 95% CI;p -value) for the lateral compartment while varus alignment (OR 1.7 [0.9 - 8.3] 95% CI, p-value = 0.05) and with rupture of the lateral cortex (OR 2.8 [1.7 - 11.5] 95% CI, p-value = 0.02) were those of the medial compartment. Conclusion: Distal femur closing wedge osteotomy does not definitively interrupt the progression of valgus knee osteoarthritis. The factors associated with the progression of this pathology are modifiable. Taking them into account when performing this surgical technique could improve the osteotomy survival curve.

Autologous peripheral blood-derived orthobiologics:Different types and their effectiveness in managing knee osteoarthritis

Knees are the most commonly impacted weight-bearing joints in osteoarthritis(OA),affecting millions of people worldwide.With increasing life spans and obesity rates,the incidence of knee OA will further increase,leading to a significant increase in the economic burden.Conventional treatment modalities utilized to manage knee OA have limitations.Over the last decade,the role of various autologous peripheral blood-derived orthobiologics(APBOs)for the treatment of knee OA has been extensively investigated.This editorial provided an overview and focused on defining and shedding light on the current state of evidence based on the most recent published clinical studies concerning the use of APBO for the management of knee OA.While numerous studies have demonstrated promising results for these preparations,a notable gap exists in the comparative analysis of these diverse formulations.This absence of head-to-head studies poses a considerable challenge for physicians/surgeons in determining the optimal preparation for managing knee OA and achieving sustained longterm results.Thus,more adequately powered,multicenter,prospective,doubleblind,randomized controlled trials with longer follow-ups are needed to establish the long-term efficacy and to aid physicians/surgeons in determining the optimal APBO for the management of knee OA.