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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: closed (25 February 2026) | Viewed by 14847

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Special Issue Editor

Dr. Carlo Biz

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Guest Editor

Associate Professor of Orthopedics, Department of Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Via Giustiniani 3, 35128 Padua, Italy
Interests: foot and ankle surgery; arthroscopic surgery; diabetic foot; anatomy of the foot and ankles; trauma surgery; fracture; muscle precursor cells of human skeletal muscle
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Special Issue Information

Dear Colleagues,

This Special Issue is dedicated to the clinical, radiological, and biochemical evaluations in the orthopedic field of knee replacements, which have undergone significant advancements in recent years. Innovations such as robotics-assisted surgeries, 3D-printed implants, smart wearable technology, artificial intelligence, and various cutting-edge devices are revolutionizing knee surgery.

Knee osteoarthritis (OA) is the primary condition necessitating knee replacement surgery. Increasing life expectancies and the global obesity epidemic are driving a rapid rise in the prevalence of knee OA, consequently leading to a higher demand for knee replacement surgeries. Acute and persistent pain (often nocturnal), severe functional disability, and the failure of non-surgical treatments are key factors that lead to the decision for surgical intervention. The two main surgical options for late-stage medial compartment OA of the knee are total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). There is often disagreement among surgeons about the best surgical choice for these patients, who frequently present with similar pathologies. This has led to variations in implants and treatment approaches.

Given the diverse clinical and radiographic presentations of knee OA and the new directions and improvements in replacement surgical procedures, it is essential to evaluate the clinical, radiological, and biomechanical outcomes of treated patients. Additionally, studies focusing on knee prostheses for benign or malignant bone tumors, as well as biochemical evaluations, are welcome. The analysis of different biomarkers in conjunction with radiological assessments can be valuable for diagnosing and managing chronic painful knee arthroplasty cases, which may appear unsolvable, or they could serve as disease predictors and prognostic factors for early implant mobilization. With this premise, we aim to establish this Special Issue to gather original articles and reviews on these topics.

Prof. Dr. Carlo Biz
Guest Editor

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Keywords

artificial intelligence
bone tumors
knee joint
knee pain
knee replacement
knee surgery
orthopedic surgery
osteoarthritis
prognostic markers
radiological evaluation

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Published Papers (6 papers)

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Research

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14 pages, 2176 KB

Open AccessArticle

Early Outcomes of Cruciate-Retaining Versus Posterior-Stabilized Total Knee Arthroplasty in Younger Patients: A Prospective Eastern European Cohort Study

by Lorand Vitalis, Andrei Marian Feier, Sandor György Zuh, Octav Marius Russu and Tudor Sorin Pop

J. Clin. Med. 2025, 14(24), 8893; https://doi.org/10.3390/jcm14248893 - 16 Dec 2025

Viewed by 1022

Abstract

Background/Objectives: Cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) are both widely used in primary knee osteoarthritis (KOA), but evidence in younger patients remains limited. This study compared functional outcomes, pain, range of motion, quality of life, and psychological status between CR and PS implants in an Eastern European cohort. Methods: A prospective comparative cohort study was conducted in patients aged 40–64 years undergoing primary cemented TKA. The primary outcome was change in the Lower-Extremity Functional Scale (LEFS) at 12 months. Secondary outcomes included the Lysholm Knee Scoring Scale, EQ5D5L index, visual analogue scale (VAS) for pain, PROMIS Depression score, active knee flexion, and patient satisfaction. Outcomes were evaluated at baseline, 6 weeks, 3 months, 6 months, and 12 months. Between-group comparisons used Welch t-tests and results are reported as mean differences with 95% confidence intervals. Results: A total of 147 patients were included (CR n = 71; PS n = 76). The prespecified primary endpoint, 12-month change in LEFS, was very similar between groups (mean difference 0.14 points, 95% CI −3.80 to 4.08; p = 0.94). LEFS improved from 49.1 ± 14.8 to 66.8 ± 11.6 in the CR group and from 47.9 ± 14.6 to 65.8 ± 12.4 in the PS group at 12 months. Lysholm scores increased to 88.5 ± 11.4 (CR) and 86.2 ± 10.6 (PS) (p = 0.21). EQ-5D-5L improved in both groups, with a non-significant difference at 12 months (p = 0.077). VAS pain decreased from 7.39 ± 1.19 to 1.59 ± 0.84 (CR) and from 7.55 ± 1.46 to 1.75 ± 0.90 (PS) (p = 0.27). Active flexion increased to 117.5 ± 10.5° (CR) and 115.0 ± 11.3° (PS) (p = 0.15). PROMIS Depression improved similarly in both groups, and satisfaction levels at 12 months were comparable. Conclusions: Both CR and PS TKA produced comparable improvements in pain, function, quality of life, mental health, and knee flexion in KOA patients aged 40–64 at one year. Implant design did not influence clinical benefit or PROMs in this cohort. Full article

(This article belongs to the Special Issue New Advances in Total Knee Arthroplasty)

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13 pages, 570 KB

Open AccessArticle

Long-Term Outcomes of Combined Medial Unicompartmental Knee Replacement and Anterior Cruciate Ligament Reconstruction in Middle-Aged Patients with ACL-Deficient Knees

by Matteo Marullo, Stefano Petrillo, Antonio Russo, Fabrizio Bertelle and Sergio Romagnoli

J. Clin. Med. 2025, 14(18), 6439; https://doi.org/10.3390/jcm14186439 - 12 Sep 2025

Viewed by 1555

Abstract

Background: Successful unicompartmental knee arthroplasty (UKA) requires complete ligamentous competence, including the anterior cruciate ligament (ACL). The present study evaluated the long-term outcomes, complications, survival, and osteoarthritis (OA) progression in patients with medial femorotibial OA and ACL lesions undergoing simultaneous combined UKA and ACL reconstruction (ACLR). Methods: Patients who underwent simultaneous medial UKA and ACLR or revision ACLR from January 2004 to December 2021 were retrospectively reviewed. Inclusion criteria were a minimum follow-up period of 2 years and implantation of a cemented, fixed-bearing UKA. Outcomes were measured using the Knee Society Score (KSS), Tegner Activity Scale (TAS), University of California, Los Angeles (UCLA) Activity Score, and range of motion (ROM). Results: Thirty-four patients met the inclusion criteria. Mean follow-up was 11.7 years. Mean age was 52 years. Patients demonstrated significant improvements in KSS-C (from 52.8 ± 6.8 to 94.9 ± 7.9), KSS-F (from 58.3 ± 10.0 to 98.1 ± 4.2), TAS (from 0.7 ± 0.5 to 4.9 ± 1.1), UCLA (from 1.4 ± 0.6 to 6.6 ± 1.4), and ROM (from 109.1 ± 8.9 to 126.3 ± 6.1) (p < 0.01). Survival rate was 97.1% at 11.7 years. Lachman test results improved significantly (from 16 patients with grade II and 16 grade III to 13 grade 0 and 19 grade I, p < 0.01). No significant difference in functional outcomes was found between primary and revision ACLR groups; however, patients undergoing revision ACLR exhibited higher OA progression in the lateral compartment (p = 0.03). Conclusions: Simultaneous medial UKA and ACLR or revision ACLR led to excellent long-term outcomes, high survival rates, significant functional improvements, and minimal OA progression in the lateral compartment. Full article

(This article belongs to the Special Issue New Advances in Total Knee Arthroplasty)

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9 pages, 216 KB

Open AccessArticle

Risk Factors for Re-Tear of the Meniscus Following Meniscus Repair with Concomitant ACL Reconstruction

by Kyle R. Gronbeck, Stephen Nystrom, Bryan Perkins and Marc A. Tompkins

J. Clin. Med. 2025, 14(16), 5881; https://doi.org/10.3390/jcm14165881 - 20 Aug 2025

Cited by 2 | Viewed by 4011

Abstract

Objectives: To examine the rate of meniscal re-tear in patients with concomitant ACL reconstruction, with specific focus on surgical factors and patient demographic factors. Methods: A retrospective chart review was performed on all patients who underwent meniscal repair with concomitant ACL reconstruction at our institution over a seven-year period. Demographic and case variables were assessed, including sex, age, height, weight, BMI, medial versus lateral repairs, ACL graft type, ACL reconstruction technique, meniscus repair technique, and post-operative weight bearing status. Failure of repair was defined as need for repeat surgery on the same meniscus. Results: There were 191 patients included in the study; of those 118 did not need further surgery on the meniscus at a minimum of 2 years post operation while 73 did have a re-operation on the same meniscus (rate of failure 38.2%). There were significant differences between re-operation and non-re-operation groups based on ACL graft type (54% failure for allograft vs. 30/23% failure for both autograft cohorts) and meniscal repair side (46% re-tear rate for medial meniscus vs. 17% for lateral meniscus). The pediatric (under 18 years old) cohort included 57 patients; 28 patients required additional meniscal surgery and 29 did not (rate of re-operation 49%). Conclusions: The overall failure rate of meniscus repair was nearly 40%. Risk factors for re-tear of the meniscus were repair of the medial meniscus and allograft usage for ACL reconstruction. The rate of re-tear in patients under 18 was nearly 50%, which is higher than in the adult population. Full article

(This article belongs to the Special Issue New Advances in Total Knee Arthroplasty)

11 pages, 929 KB

Open AccessArticle

Long-Term Excellent Clinical Outcomes, High Survivorship, and Low Osteoarthritis Progression in Lateral Unicompartmental Knee Arthroplasty: A 10-Year Minimum Follow-Up

by Matteo Marullo, Stefano Petrillo, Antonio Russo and Sergio Romagnoli

J. Clin. Med. 2025, 14(7), 2492; https://doi.org/10.3390/jcm14072492 - 6 Apr 2025

Cited by 2 | Viewed by 3329

Abstract

Background: The literature on the long-term outcomes of lateral unicompartmental knee arthroplasty (UKA) remains limited due to the lower prevalence of lateral osteoarthritis (OA) and the technical challenges of the procedure. This study aimed to assess the long-term clinical outcomes, implant survivorship, and OA progression in patients undergoing lateral UKA with a minimum follow-up of 10 years. Methods: This retrospective study analyzed 96 lateral UKAs from 2001 to 2013 using a cemented, fixed-bearing implant. Patients with at least 10 years of follow-up were included. Clinical outcomes were measured using range of motion (ROM), a pain visual analog scale (VAS), Knee Society Scores (KSSs), and the Forgotten Joint Score (FJS). Implant survivorship was assessed using a Kaplan–Meier analysis, while OA progression in the medial compartment was evaluated radiographically. Results: At a mean follow-up of 14.5 years, implant survivorship was 94.7%, with five revisions primarily due to OA progression. Significant improvements were observed in ROM, VAS, and KSS (p < 0.01). An increase in the Kellgren–Lawrence grade in the medial compartment was reported in 47.9% of patients. Conclusions: Lateral UKA provides excellent long-term outcomes, demonstrating high survivorship, significant functional improvement, and high patient satisfaction. Full article

(This article belongs to the Special Issue New Advances in Total Knee Arthroplasty)

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Review

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14 pages, 355 KB

Open AccessReview

Is There a Body Mass Index Threshold for Patients Undergoing Primary Total Knee Replacement—A Literature Review

by Muhammad Kamran, Mahmoud Abumarzouq and Anant Mahapatra

J. Clin. Med. 2026, 15(1), 103; https://doi.org/10.3390/jcm15010103 - 23 Dec 2025

Cited by 1 | Viewed by 953

Abstract

Background: Osteoarthritis (OA) is a prevalent degenerative joint disease and a major cause of disability in the aging population. Total knee arthroplasty (TKA) is a common intervention for advanced OA, yet postoperative outcomes may vary, particularly among individuals with obesity. Elevated body mass index (BMI) is a recognized risk factor for the development and progression of OA and may influence perioperative and postoperative complication rates. Objective: This literature review evaluates whether a specific BMI threshold should guide eligibility for primary TKA, with particular emphasis on the impact of BMI on surgical risk, implant outcomes, and functional recovery. Methods: A systematic search was conducted across PubMed (MEDLINE), Cochrane Library, EMBASE, and Google Scholar to identify peer-reviewed studies from the past two decades examining the relationship between BMI and clinical outcomes following primary TKA. Findings: Higher BMI—especially ≥40 kg/m²—is consistently associated with increased perioperative and postoperative complications, including wound issues, infection, thromboembolic events, longer hospital stay, and higher revision risk. Despite these elevated risks, evidence demonstrates that obese and morbidly obese patients experience substantial improvements in pain, mobility, and function that are comparable in magnitude to those seen in non-obese individuals. The literature does not support a universally applicable BMI cutoff for determining surgical eligibility. Conclusions: BMI is an important modifier of surgical risk but should not be used as an absolute criterion for excluding patients from TKA. Instead, a personalized approach is recommended—one that considers BMI within the context of comorbidities, functional limitation, patient motivation, and opportunities for preoperative optimization. With appropriate patient selection and risk-mitigation strategies, TKA remains a clinically valuable and justified intervention across all BMI categories. Full article

(This article belongs to the Special Issue New Advances in Total Knee Arthroplasty)

Other

Jump to: Research, Review

19 pages, 863 KB

Open AccessSystematic Review

Single-Stage vs. Multi-Stage Reconstruction in Multi-Ligament Knee Injuries: A Systematic Review and Meta-Analysis of Outcomes and Complications

by Monketh Jaibaji, Omar Najim, Hamza Alali, Lisa Wood, Louw Van Niekerk, Tim Bonner and Andrea Volpin

J. Clin. Med. 2025, 14(19), 6897; https://doi.org/10.3390/jcm14196897 - 29 Sep 2025

Cited by 3 | Viewed by 2616

Abstract

Background/objectives: Multi-ligament knee injuries (MLKIs) present complex surgical challenges, and there remains no consensus on whether single-stage or staged reconstruction yields superior outcomes. This study aimed to assess differences in complications, functional outcomes, and return-to-sport rates between single-stage and staged surgical approaches. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines. Four databases (PubMed, Scopus, Embase, and the Cochrane Library) were searched for studies published between 2000 and 2025. Eligible studies reported surgical management of MLKIs and specified either single-stage or multi-stage reconstruction. Data on complications, functional scores (Lysholm), return to sport, rehabilitation protocols, and graft type were extracted and analyzed using descriptive statistics and study-level regression models. Results: A total of 43 studies encompassing 2086 patients were included (1900 single-stage; 186 multi-stage). Staged reconstruction was associated with a significantly lower rate of arthrofibrosis (1.95% vs. 7.29%; OR 3.96, p = 0.007), higher Lysholm scores (+4.7 points, p < 0.001), and higher return-to-sport rates (48% vs. 65%, p = 0.001) compared to single-stage. Use of synthetic grafts increased the risk of arthrofibrosis (OR 4.09, p = 0.031). Early mobilization and weightbearing were not associated with increased arthrofibrosis risk. Conclusions: Staged reconstruction may yield better functional outcomes and lower complication rates—particularly arthrofibrosis, compared to single-stage approaches. These findings support an individualized surgical strategy, guided by injury complexity, graft selection, rehabilitation goals, and patient-specific functional demands. Full article

(This article belongs to the Special Issue New Advances in Total Knee Arthroplasty)

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