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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 30 July 2025 | Viewed by 4341

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Special Issue Editor

Dr. Richard Lass

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Guest Editor

Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, 1090 Vienna, Austria
Interests: total hip arthroplasty; total knee arthroplasty; implant material and bearings; implant fixation techniques; robotic-assisted technology and navigation; alignment in TKA; spinopelvic alignment in THA

Special Issue Information

Dear Colleagues,

Total joint arthroplasty has been described as one of the most important and successful orthopedic interventions for patients with end-stage osteoarthritis of the joint.

The developments in hip and knee arthroplasty in recent years have aimed to improve outcomes, reduce complications, and improve implant survival. This Special Issue aims to summarize some of the most interesting trends and developments in this important and fast-moving field.

Notable developments have included modern ceramic materials, mini hip stems, and the wider use of the dual mobility articulation for hip arthroplasty, respecting the spinopelvic relationship and cementless knee replacement. Advances in additive manufacturing and the surface modification of joint replacements offer increasing options for more challenging arthroplasty cases.

Robotic-assisted surgery is one of the most interesting developments in hip and knee surgery in recent years, concentrating on technologies to improve patient outcomes through strategies to mimic more natural kinematics and optimised implant positioning. The recent growth of the use of this technology is providing data that will help determine whether this approach should become the standard of care for hip and knee arthroplasty in the future.

The purpose of this Special Issue is to present “New Insights into joint Arthroplasty”, concerning several of what we consider are the most significant technological developments with respect to implant design, fixation, and assistive technology in hip and knee arthroplasty.

Dr. Richard Lass
Guest Editor

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Keywords

total hip arthroplasty
total knee arthroplasty
robotic-assisted technology and navigation
modern implant materials
modern implant fixation techniques
alignment in TKA
spinopelvic alignment in THA

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Published Papers (7 papers)

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Research

12 pages, 2125 KiB

Open AccessArticle

Long-Term Outcomes of Cementless Versus Hybrid Cemented Total Knee Arthroplasty: A Minimum 10-Year Follow-Up

by Lukas Rabitsch, Klemens Vertesich, Alexander Giurea, Reinhard Windhager and Richard Lass

J. Clin. Med. 2025, 14(9), 3134; https://doi.org/10.3390/jcm14093134 - 30 Apr 2025

Viewed by 207

Abstract

Background: Although cemented total knee arthroplasty (TKA) is considered the standard fixation technique, the emerging trend toward cementless fixation has created the need for a detailed comparison. In a previous study, we reported the 5-year results comparing cementless and hybrid cemented TKAs using the same implant design. The purpose of this study was to assess the long-term follow-up at a minimum of 10 years. Methods: A retrospective analysis was performed on 120 TKAs (60 cementless, 60 hybrid cemented) conducted between 2003 and 2007 using the e.motion posterior cruciate-retaining knee prosthesis with a floating-platform mobile polyethylene bearing (Aesculap, Tuttlingen, Germany). Demographic and clinical data were collected; radiographic follow-up was performed with attention to signs of loosening, while complications and revision surgery were assessed using competing risk analysis. Operative time was recorded as an indicator of surgical efficiency. Results: At 10 years, 59 TKAs (54 patients) were available for long-term follow-up. Both fixation groups demonstrated significant improvement in Knee Society Scores (KSSs) compared to preoperative values (p < 0.001). However, there was no significant difference in KSSs between the two groups at 10 years follow-up (p = 0.480). The 10-year cumulative incidence of revision was 8.4% in both groups (p = 0.721), and that of aseptic loosening was identical at 3.4% (p = 0.967). Although radiolucent lines were noted in three tibial components of the cementless group, the difference was not statistically significant (p = 0.075). Notably, the cementless group demonstrated a significantly shorter operative time with a mean difference of 10 min (p = 0.017). Conclusions: At a minimum follow-up of 10 years, there were no significant differences between the hybrid cemented and cementless groups in revision rates, cumulative incidences, clinical scores, or radiological signs of loosening, confirming the long-term effectiveness of both fixation methods in clinical practice. Full article

(This article belongs to the Special Issue New Insights into Joint Arthroplasty)

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10 pages, 1965 KiB

Open AccessArticle

Does the Implantation of a Short-Stem Hip Prosthesis Change the Lower Limb Alignment?—Comparison of Two Modern Short-Stem Designs

by Robert Rus, Maximilian F. Kasparek, Valerie Ladstaetter, Tobias Scheidl, Oliver Haider, Maximilian Muellner, Anna Jungwirth-Weinberger and Thomas Muellner

J. Clin. Med. 2025, 14(7), 2240; https://doi.org/10.3390/jcm14072240 - 25 Mar 2025

Viewed by 314

Abstract

Background/Objectives: Limited data exist regarding the influence of total hip arthroplasty (THA) on the alignment of the lower limb. Therefore, the objective of this study was to investigate potential alterations in lower limb alignment (LLA) following total hip arthroplasty, with a focus on the comparison of two different short-stem implant designs. Methods: This retrospective study compares pre- and postoperative hip–knee–ankle angle (HKA), femoral offset, and leg length data of 115 consecutive hips with two different implant types (Mathys Optimys^® stem and Implantec Alpha proxy^® stem). Results: There was not a significant difference between the pre- and postoperative HKA angles regarding the entire study population (p = 0.293), nor after comparing the two short-stem implant designs (p = 0.433). Hip offset almost remained unchanged in the entire study cohort (p = 0.662), as well as when comparing the two short-stem implant designs (p = 0.206). Conclusions: Modern short-stem THA does not significantly affect overall LLA. Full article

(This article belongs to the Special Issue New Insights into Joint Arthroplasty)

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12 pages, 2636 KiB

Open AccessArticle

High Accuracy of Restoration of the Individual Hip Anatomy Using Custom-Made Prostheses in Total Hip Arthroplasty

by Maximilian F. Kasparek, Anna Jungwirth-Weinberger, Kirubakaran Pattabiraman, Marios Loucas, Devanand Hulmani, Maximilian Muellner, Tobias Scheidl, Oliver Haider and Thomas Muellner

J. Clin. Med. 2025, 14(6), 2115; https://doi.org/10.3390/jcm14062115 - 20 Mar 2025

Viewed by 413

Abstract

Background/Objectives: Femoral or acetabular deformities are important factors in development of early osteoarthritis. In particular, young patients benefit from individual anatomical restoration by decreasing the risk of early loosening and wear and achieving a good clinical outcome. Methods: This prospective study evaluates the use of a custom-made prosthesis in anterior approach total hip arthroplasty (THA). Pre- and postoperative imaging included conventional X-rays as well as computer tomography (CT) with a specialized protocol to analyze femoral diaphysis width, horizontal and vertical offset, caput-collum-diaphyseal (CCD) angle, leg length, femoral and acetabular anteversion angles, and the position of the center of rotation. Results: A total of 22 hips (11 female, 11 male) with a mean age of 55.8 years underwent THA with a custom-made prosthesis (Symbios^®). Accurate restoration has been shown for offset, leg length, and femoral anteversion. The custom stems showed a good fit within the femoral canal. Conclusions: This custom-made prosthesis has been shown to be a valuable option for the treatment of hip osteoarthritis in young patients, with adequate restoration of the preoperative anatomy. Full article

(This article belongs to the Special Issue New Insights into Joint Arthroplasty)

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9 pages, 1308 KiB

Open AccessArticle

Influence of Mechanical Deformity on Joint Line Reconstruction

by Anna Jungwirth-Weinberger, Maximilian F. Kasparek, Kirubakaran Pattabiraman, Arnab Sain, Maximilian Muellner, Tobias Scheidl, Oliver Haider and Thomas Muellner

J. Clin. Med. 2025, 14(4), 1264; https://doi.org/10.3390/jcm14041264 - 14 Feb 2025

Viewed by 617

Abstract

Background: Restoration of the joint line is important for an optimal outcome after total knee arthroplasty (TKA). The goal of this study was to analyze the accuracy of joint line reconstruction in conventionally performed TKA. The study evaluates the potential influences of mechanical deformity on joint line restoration. Methods: A total of 115 patients (58.3% female, mean age 72.4 years (52–89)) with 43 valgus and 72 varus knees were reviewed. A total of 36 patients underwent CR-TKA, and 79 underwent PS-TKA. The joint line was measured from the adductor tubercle to the joint line. Results: A total of 106 patients (92.2%) had the joint line restored within four millimeters. The distance increased significantly from preoperative (48.30 ± 6.35 mm) to postoperative 49.03 ± 6.29 mm (p = 0.003). Varus knees showed no significant change (p = 0.313), while valgus knees had a significant elevation (p = 0.0004). Conclusions: In conventional total knee arthroplasty (TKA), the distance from the adductor tubercle to the joint line slightly increased. However, in most patients, the joint line was restored within four millimeters. Valgus knees in particular are at risk for postoperative joint line elevation. Full article

(This article belongs to the Special Issue New Insights into Joint Arthroplasty)

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12 pages, 375 KiB

Open AccessArticle

Significance of Preoperative Multidisciplinary Assessment with 30-Second Sit-to-Stand and Timed Up-and-Go Tests in Predicting Postoperative Outcomes

by Mücahid Osman Yücel, Sönmez Sağlam, Raşit Emin Dalaslan, Mehmet Arıcan, Zekeriya Okan Karaduman, Bedrettin Akar, Mücahit Çelik and İsmail Sav

J. Clin. Med. 2025, 14(4), 1085; https://doi.org/10.3390/jcm14041085 - 8 Feb 2025

Viewed by 691

Abstract

Background/Objectives: Evaluating basic daily activities like sitting, standing, and walking is crucial for predicting preoperative risks and postoperative recovery. These functional abilities can be assessed through patient history or measured using objective tests. For this purpose, the 30-Second Sit-to-Stand (30STS) Test and Timed Up-and-Go (TUG) Test are frequently used in clinical settings. However, few studies have evaluated their effectiveness in anesthesia and orthopedics. In this study, we aimed to assess the applicability of these tests across clinical disciplines. Methods: A total of 43 patients who underwent total knee arthroplasty (TKA) surgery between January and December 2023 with American Society of Anesthesiologists (ASA) scores of 2–3 were retrospectively evaluated. The 30STS, TUG, and VAS scores were recorded preoperatively and on postoperative days 90–180. Results: The preoperative 30STS and TUG scores showed no statistically significant difference between the ASA 2–3 groups, but the ASA 2 group demonstrated a more pronounced performance improvement in both tests during the first 90 days postoperatively. The correlation tests revealed a strong positive relationship with the TUG Test and a moderate positive relationship with the 30STS and VAS scores. Conclusions: The correlation between the preoperative and postoperative results of the 30STS and TUG Tests suggests that preoperative tests can predict post-operative functional performance. However, the lack of a significant statistical relationship between the preoperative tests and ASA scores indicates that these tests may not be sufficiently useful for assessing the functional capacity. The better test outcomes in the ASA 2 patients indicate that combining these assessments with anesthetic evaluations may improve postoperative functional predictions, thereby promoting a multidisciplinary approach. Full article

(This article belongs to the Special Issue New Insights into Joint Arthroplasty)

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12 pages, 430 KiB

Open AccessArticle

The Etiology of Total Knee Arthroplasty Failure Influences on Improvement in Knee Function: A Follow-Up Study

by Sandy Weis, Lisa Seifert, Moritz Oltmanns, Farouk Khury, Ralf Bieger and Martin Faschingbauer

J. Clin. Med. 2024, 13(24), 7672; https://doi.org/10.3390/jcm13247672 - 16 Dec 2024

Viewed by 743

Abstract

Background: Outcomes following total knee arthroplasty (TKA) revisions are variable, and it is hypothesized that the underlying cause of primary TKA failure impacts postoperative outcomes. This study analyzes the results of TKA revisions seven years after surgery, in relation to the etiology of primary failure and other influencing factors. A previous study conducted in 2013 examined the same cohort of patients three months after revision surgery. Methods: From the original study, 97 patients were followed up, and 49 patients were eligible for inclusion. Patients were classified into four groups: “periprosthetic infection” (PPI), “aseptic loosening,” “instability,” and “arthrofibrosis.” Outcomes were analyzed using established scores (the Knee Society Score (KSS), New Knee Society Score (nKSS), and the Western Ontario and McMaster Universities (WOMAC) index) and considering factors such as age, gender, BMI, and ASA classification. The outcomes were analyzed using three time intervals: “Outcome Short” (preoperative to 3 months postoperative); “Outcome Long” (preoperative to 7 years postoperative); and “Delta PostOP” (3 months postoperative to 7 years postoperative). Results: Significant improvements were observed in all time intervals, especially in the “Outcome Short” (p < 0.001) and “Delta PostOP” (p < 0.001) periods. The “instability” and “aseptic loosening” groups showed better outcomes in terms of range of motion and knee scores than the “arthrofibrosis” and “infection” groups (p < 0.05). A lower BMI and an ASA status of II were associated with better outcomes (p < 0.05). Women also showed superior results in the nKSS (p < 0.05). Discussion: Patients with “aseptic loosening” and “instability” had the best long-term outcomes. Lower BMI and better ASA status also correlated with improved results. These findings can inform patients of the potential outcomes of revision surgery, thereby facilitating informed decision-making. Full article

(This article belongs to the Special Issue New Insights into Joint Arthroplasty)

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16 pages, 1286 KiB

Open AccessArticle

Early Learning Curve in Robotic-Assisted Total Knee Arthroplasty: A Single-Center Experience

by David Putzer, Lennart Schroeder, Georgi Wassilew, Michael Liebensteiner, Michael Nogler and Martin Thaler

J. Clin. Med. 2024, 13(23), 7253; https://doi.org/10.3390/jcm13237253 - 28 Nov 2024

Cited by 1 | Viewed by 834

Abstract

Background/Objectives: This study evaluated the learning curve for robotic-assisted total knee arthroplasty (RA TKA) performed by three experienced surgeons, focusing on procedure duration, surgeon satisfaction, and confidence. Methods: A prospective study was conducted with three senior arthroplasty surgeons, each performing 15 RA TKA procedures using the Triathlon Knee System with the Robotic Arm Interactive Orthopedic (RIO) System. Data on preparation, cut-to-suture, and breakdown times were collected. Surgeon anxiety levels were measured preoperatively using the STAI-6 scale, while postoperative satisfaction and confidence were assessed via a questionnaire. Statistical analysis was conducted using GraphPad Prism. Results: Of 50 scheduled surgeries, 45 were completed. The average cut-to-suture time was 1 h 38 min, with significant time reductions in robotic-specific steps as experience increased. Comparing the first five surgeries to the last five, the time for navigation hardware mounting, landmarks registration, femur and tibia registration, and bone preparation decreased by up to 30% (p < 0.001 to p = 0.025). General instrument preparation time decreased by 20% (p = 0.004). Surgeon anxiety levels dropped, indicating increased comfort with the system, while postoperative surveys showed increased satisfaction and confidence. Conclusions: The study demonstrated a substantial learning curve for RA TKA, with improved efficiency and surgeon confidence by the fifteenth procedure. These findings highlight the potential for streamlined workflows and guide training for new adopters of robotic knee arthroplasty. Full article

(This article belongs to the Special Issue New Insights into Joint Arthroplasty)

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