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Knee Arthroplasty: Recent Advances and Future Challenges

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A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Orthopedics".

Deadline for manuscript submissions: 25 April 2027 | Viewed by 1928

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Editor

Dr. Matteo Marullo

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Guest Editor

Department of Joint Replacement, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
Interests: knee replacement; partial knee replacement; mininvasive surgery; fast-track surgery; robotic surgery

Special Issue Information

Dear Colleagues,

Knee arthroplasty has undergone remarkable evolution over the past decades, becoming one of the most successful procedures in modern orthopedics. Advances in implant design, biomaterials, surgical techniques, perioperative management, and digital technologies have significantly improved functional outcomes and patient satisfaction. At the same time, new challenges are emerging—ranging from the management of younger, more active patients to the prevention of complications, personalization of care, and long-term survivorship of implants.

We are pleased to invite you to contribute to this Special Issue, which aims to provide a comprehensive and updated overview of current innovations and future directions in knee arthroplasty.

This Special Issue aligns closely with the journal’s scope by focusing on clinical and technological advancements that may improve patient outcomes, optimize surgical practice, and enhance understanding of implant performance. Our objective is to gather high-quality contributions that reflect the multidisciplinary nature of knee arthroplasty and encourage discussion on emerging trends and unmet needs in the field.

In this Special Issue, original research articles and reviews are welcome. Research areas may include, but are not limited to, the following:

Innovations in implant design and biomaterials;
Robotic-assisted knee arthroplasty;
Patient-specific instrumentation;
Alignment strategies;
Enhanced recovery protocols and perioperative optimization;
Management of complications and revision knee arthroplasty;
Long-term clinical outcomes and survivorship analyses;
Biomechanics and kinematic assessment of knee implants, including gait analysis;
Digital health, AI, and data-driven approaches in arthroplasty;
Treatment strategies for younger and high-demand patients.

We look forward to receiving your valuable contributions.

Dr. Matteo Marullo
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

knee arthroplasty
implant design
robotic surgery
revision surgery
biomechanics
clinical outcomes
perioperative care
fast-track surgery
digital orthopedics
partial knee replacement

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Published Papers (3 papers)

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Research

11 pages, 493 KB

Open AccessArticle

Long-Term Clinical and Radiological Outcomes of Cementless Total Knee Arthroplasty in Patients with Rheumatoid Arthritis

by Filippo Calanna, Silvia De Martinis, Leonardo Clausetti, Alessia Invernizzi, Luca Tanel, Roberto Viganò, Alessandra Menon, Alessio Maione, Riccardo Compagnoni, Paolo Ferrua and Pietro S. Randelli

J. Clin. Med. 2026, 15(18), 7091; https://doi.org/10.3390/jcm15187091 - 12 Sep 2026

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Abstract

Background: Total knee arthroplasty (TKA) is an established treatment for end-stage rheumatoid arthritis (RA). Although cemented fixation has traditionally been preferred because of concerns regarding poor bone quality, advances in implant design and osseointegration have renewed interest in cementless fixation. This study evaluated the long-term clinical and radiological outcomes of cementless TKA in patients with RA. Methods: A retrospective single-center study included adult patients with RA who underwent primary cementless TKA between 2004 and 2021 using the same cruciate retaining implant. Clinical outcomes were assessed using range of motion (ROM), Visual Analog Scale (VAS), Oxford Knee Score (OKS), and patient satisfaction. Radiographic evaluation assessed implant fixation, while implant survivorship was analyzed using bilateral clustering via a Marginal Cox model analysis. Results: Seventy-five cementless TKAs performed in 52 patients were analyzed after a mean clinical follow-up of 10.8 ± 3.8 years. Mean ROM was 101° ± 26.5°, mean VAS score was 0.88 ± 1.84, and mean OKS was 40.3 ± 7.1. Overall, patients were satisfied or very satisfied in 89.6% of implants. Radiographic assessment showed no evidence of progressive radiolucent lines, osteolysis, implant subsidence, aseptic loosening, or malalignment. Only one revision was required because of periprosthetic joint infection, resulting in an implant survivorship of 98.3% at long-term follow-up. Conclusions: Cementless TKA demonstrated excellent long-term implant survival, durable radiographic fixation, and favorable clinical and functional outcomes in patients with rheumatoid arthritis. These findings support modern cementless fixation as a reliable and effective alternative to cemented TKA in carefully selected RA patients. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Recent Advances and Future Challenges)

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14 pages, 1784 KB

Open AccessArticle

Accuracy of ROSA^® Partial Knee System in Tibial Alignment During Medial Unicompartmental Knee Arthroplasty: An Observational Study

by Stefano Petrillo, Damiano Ardiri, Paolo Perazzo, Sergio Romagnoli and Matteo Marullo

J. Clin. Med. 2026, 15(10), 3566; https://doi.org/10.3390/jcm15103566 - 7 May 2026

Cited by 1 | Viewed by 647

Abstract

Background/Objectives: The ROSA^® Partial Knee System (Zimmer Biomet, Warsaw, IN, USA) is an imageless robotic platform developed to improve the reproducibility of tibial resection and implant positioning in unicompartmental knee arthroplasty (UKA). Evidence on imageless ROSA-assisted medial UKA remains limited. This preliminary single-center study evaluated the early radiographic accuracy of the system in reproducing planned tibial coronal alignment and tibial slope during robotic-assisted medial UKA, while perioperative and short-term clinical findings were assessed as secondary exploratory observations. Methods: A retrospective analysis of a prospectively maintained database was performed on 23 consecutive patients who underwent robotic-assisted medial UKA using the ROSA^® Partial Knee System and Persona^® Partial Knee implant between December 2025 and March 2026. Planned and robot-validated values were compared with postoperative radiographic measurements, which were used as the achieved alignment reference. Deviations >2° and >3° from target were defined as outliers. Paired clinical analyses were restricted to patients with data available at both time points. Results: Mean age was 68.4 ± 8.5 years and mean BMI was 28.2 ± 4.1 kg/m². Preoperative HKA was 5.4 ± 3.4° varus, while final robot-validated and postoperative radiographic HKA values were 2.3 ± 0.7° and 2.6 ± 0.9° varus, respectively (p = 0.08). Robot-validated and postoperative radiographic MPTA values were 2.0 ± 0.5° and 2.1 ± 0.7°, respectively (p = 0.41). Planned, robot-validated, and postoperative radiographic tibial slope values were 4.5 ± 0.6°, 4.6 ± 0.6°, and 4.8 ± 0.8°, respectively (p = 0.27). Mean absolute postoperative deviation from target was 0.42 ± 0.38° for HKA, 0.34 ± 0.29° for MPTA, and 0.46 ± 0.39° for tibial slope. Within 2° of target, accuracy ranged from 91.3% to 95.7%, and all cases were within 3°. Short-term clinical outcomes improved in the available paired subsets (n = 14 for VAS and KSS, n = 12 for ROM, and n = 9 for UCLA activity score). Conclusions: In this preliminary single-center observational series, the ROSA^® Partial Knee System showed high early radiographic accuracy in reproducing planned tibial coronal alignment and tibial slope during robotic-assisted medial UKA, with low outlier rates. Short-term clinical findings were favorable in the available paired subsets but should be interpreted as exploratory. Larger comparative studies with longer follow-up are needed to determine the clinical relevance of this technical accuracy. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Recent Advances and Future Challenges)

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11 pages, 1597 KB

Open AccessArticle

Accuracy and Precision of Femoral and Tibial Bone Resections Using Manual Unrestricted Kinematic Alignment in Total Knee Arthroplasty: A Retrospective Digital Caliper Study

by Charles Riviere and Loic Villet

J. Clin. Med. 2026, 15(9), 3506; https://doi.org/10.3390/jcm15093506 - 3 May 2026

Cited by 1 | Viewed by 419

Abstract

Purpose: To evaluate the accuracy and precision of both femoral and tibial bone resections in unrestricted kinematic alignment total knee arthroplasty (uKA TKA) performed with manual instrumentation, using postoperative digital caliper measurements. Methods: A retrospective study analyzing prospectively collected data on femoral and tibial resection thickness in 73 patients undergoing primary uKA TKA. Femoral cuts were performed with manual KA-optimized instrumentation in all cases. Tibial cuts were performed manually in 58 cases and with patient-specific instrumentation (PSI) in 15; PSI tibial resections were excluded from tibial analyses. Postoperatively, resection thickness was measured using a digital vernier caliper (0.2 mm resolution) at predefined sites: distal medial femur (DMF), distal lateral femur (DLF), posterior medial femur (PMF), posterior lateral femur (PLF), medial tibial plateau (MTP), and lateral tibial plateau (LTP). Resection error was defined as measured minus target thickness (mm). Accuracy was reported as mean signed error; precision as SD of signed error; absolute errors and error class distributions were also reported. Postoperative measurements reflect the accuracy and precision of the initial manual tibial resections, excluding any subsequent corrective cuts. Results: A total of 408 measurements were analyzed (292 femoral, 116 tibial). Mean signed error across resections was low and consistently negative (−0.15 to −0.31 mm), with infra-millimetric precision (SD 0.45 to 0.73 mm). Mean absolute errors remained low across sites (0.35 to 0.62 mm). The proportion of errors outside ±0.5 mm ranged from 21.1% (PLF) to 44.4% (LTP) and those outside ±1.0 mm from 1.4% (DMF) to 18.5% (LTP). No errors exceeded ±2.0 mm. Conclusions: Manual caliper-verified unrestricted KA TKA achieved high accuracy and precision for both femoral and tibial resections. However, these findings do not establish superiority over other techniques and do not account for final implant position, soft-tissue balance, or clinical outcomes. This study provides quantitative data on tibial resection accuracy in uKA TKA and may serve as a benchmark for evaluating the performance of technology-assisted techniques. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Recent Advances and Future Challenges)

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