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Hip and Knee Arthroplasty: Update on Clinical Management

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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: 20 October 2026 | Viewed by 1789

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Dr. Maximilian F. Kasparek

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Guest Editor

Department of Orthopedic Surgery and Traumatology, Evangelisches Krankenhaus, 1180 Vienna, Austria
Interests: hip arthroplasty; knee arthroplasty; orthopedic surgery

Special Issue Information

Dear Colleagues,

Total hip and knee arthroplasties are among the most successful surgical interventions in modern medicine, providing substantial improvements in pain relief, function, and quality of life. Nevertheless, increasing procedure volumes, evolving patient demographics, and the adoption of new care models underscore the need for continuous refinement of clinical management strategies.

This Special Issue, "Hip and Knee Arthroplasty: Update on Clinical Management", offers a comprehensive, evidence-based overview of contemporary practices and emerging innovations in both primary and revision arthroplasty. The scope spans the entire perioperative pathway, covering advances in surgical techniques, perioperative optimization, infection prevention, multimodal analgesia, thromboprophylaxis, and enhanced recovery protocols.

Modern alignment philosophies in total knee arthroplasty (TKA)—ranging from traditional mechanical alignment to patient-specific functional approaches—are highlighted, alongside the evolving role of robotic-assisted surgery. Furthermore, this Special Issue explores recent developments for complex reconstructions and personalized implant solutions.

Collectively, these contributions provide an up-to-date, clinically relevant, and concise resource to support evidence-based decision-making in contemporary hip and knee arthroplasty practice.

Dr. Maximilian F. Kasparek
Guest Editor

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Keywords

total hip arthroplasty (THA)
total knee arthroplasty (TKA)
revision arthroplasty
implant fixation
cemented
cementless
hybrid
alignment in TKA
mechanical alignment
kinematic alignment
restricted kinematic alignment
functional alignment
navigation
robotic-assisted surgery
patient-specific instrumentation
additive manufacturing
3D printing
personalized implant

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Research

11 pages, 1364 KB

Open AccessArticle

Postoperative Changes in Femoral Rotation Angle and Their Influencing Factors Following Total Hip Arthroplasty via Single Approach: A Retrospective CT-Based Study

by Hiroaki Kurishima, Yasutake Tomata, Norikazu Yamada, Atsushi Noro, Yasuaki Kuriyama, Hidetatsu Tanaka, Yu Mori and Toshimi Aizawa

J. Clin. Med. 2026, 15(7), 2729; https://doi.org/10.3390/jcm15072729 - 4 Apr 2026

Viewed by 383

Abstract

Background/Objectives: This study aimed to evaluate the femoral rotation angle (FRA) before and after THA using a single approach and to identify its influencing factors through three-dimensional measurements. Methods: This retrospective study analyzed patients undergoing 108 primary unilateral THA via the anterolateral-supine approach (ALSA) from May to October 2023. Patients with hip contractures, femoral deformities, or other specific conditions were excluded for precise FRA measurements. Preoperative and postoperative CT scans were used for measurements of the FRA, anteversion, leg lengthening, and global offset. FRA was defined as the angle between the posterior condylar line and the line connecting the bilateral anterosuperior iliac spines, with external rotation as positive. Multiple linear regression, adjusted for age, sex, body mass index, and stem design, assessed the influence of anteversion change, leg lengthening, global offset change, and soft tissue release on the difference in FRA. Results: The mean FRA changed significantly from −2.8° preoperatively to −11.8° postoperatively (p < 0.001), demonstrating an average internal rotation of 9.0° after THA. Anteversion increased by a mean of 9.0° (p < 0.001), leg length increased by 9.0 mm (p < 0.001), and global offset decreased by 1.7 mm (p < 0.001). Multivariate analysis revealed that anteversion change (β = −0.41, p < 0.001) and global offset change (β = 0.40, p = 0.022) were significantly associated with FRA differences. Leg lengthening and ischiofemoral ligament or conjoint tendon resection were not significant (p = 0.089, p = 0.917, and p = 0.750, respectively). Conclusions: ALSA THA significantly rotates the femur internally, associated with an increase in anteversion and a decrease in global offset. Full article

(This article belongs to the Special Issue Hip and Knee Arthroplasty: Update on Clinical Management)

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11 pages, 581 KB

Open AccessEditor’s ChoiceArticle

How Likely Do Patients After Total Knee Arthroplasty with a Posterior-Stabilized Knee System Meet Their Desired Sport Activity Level?

by Tobias Scheidl, Oliver Haider, Martin Faschingbauer, Christian Manuel Sterneder, Friedrich Boettner and Maximilian F. Kasparek

J. Clin. Med. 2026, 15(3), 1255; https://doi.org/10.3390/jcm15031255 - 4 Feb 2026

Cited by 1 | Viewed by 482

Abstract

Background/Objectives: While most patients resume sports within one year after total knee arthroplasty (TKA), data on whether patients achieve their desired level of sports activity remain limited. This study aimed to evaluate the relationship between desired sports activity levels and postoperative outcomes after TKA and to identify factors associated with achieving the desired activity level. Methods: This retrospective cohort study included 280 patients (63.9% female; mean age, 65.7 years) who underwent primary TKA with a mean follow-up of 28.2 months. The University of California and Los Angeles (UCLA) activity score was used pre- and postoperatively to assess the desired and the achieved activity level. Results: The mean UCLA activity score improved significantly after surgery (from 4.6 to 5.6; p < 0.001). However, the mean preoperative desired UCLA score was significantly higher than the mean postoperative achieved UCLA score (7.1 vs. 5.6; p < 0.001). Overall, 34.6% of patients reached their desired activity level. These patients demonstrated a significantly lower preoperative desired UCLA score (6.1 vs. 7.6; p < 0.001) and a higher postoperative achieved UCLA score (6.7 vs. 5.0; p < 0.001) compared with patients who did not. Male sex, higher preoperative UCLA scores, and lower preoperative desired UCLA scores were identified as independent predictors of achieving the desired activity level. Conclusions: The present study demonstrated that despite excellent Knee Society function and WOMAC scores only 1/3 of patients reach their sport-related desired activity level. Surgeons must ensure that they communicate realistic expectations to patients prior to surgery, in order to avoid dissatisfaction that may arise from unmet expectations. Full article

(This article belongs to the Special Issue Hip and Knee Arthroplasty: Update on Clinical Management)

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11 pages, 1914 KB

Open AccessArticle

Synovial Periprosthetic Infection Markers Show High Variability in Different Clinical and Microbiological Settings

by Joachim Ortmayr, Jennifer Straub, Klemens Vertesich, Irene Katharina Sigmund, Christoph Böhler, Reinhard Windhager and Kevin Staats

J. Clin. Med. 2026, 15(1), 52; https://doi.org/10.3390/jcm15010052 - 21 Dec 2025

Viewed by 560

Abstract

Background/Objectives: Accurately diagnosing a periprosthetic joint infection (PJI) represents a challenging and complex task. Especially in the case of low-grade infections, important diagnostic modalities may be inconclusive and synovial markers such as white blood cell count (WBC) and polymorphonuclear percentage (PMN) gain relevance. We therefore aim to assess WBC and PMN in different clinical and microbiological settings. Methods: We performed a retrospective analysis of 115 patients with a diagnosed PJI. WBC and PMN were compared between patients with low- and high-virulent infections, negative and positive histology, symptom duration ≤ 4 weeks and >4 weeks, and positive and negative pathogen detection. Results: Synovial WBC was significantly higher in patients with successful pathogen detection (42.44 [87.0] G/L vs. 16.35 [32.0] G/L; p < 0.01), as was PMN (86.0 [60.0]% vs. 91.0 [89.0]%; p < 0.01). PJIs with high-virulent pathogens showed higher WBC compared to low-virulent pathogens (58.27 [102.0] G/L vs. 27.27 [46.0] G/L; p < 0.01). Patients with onset of symptoms ≤ 4 weeks demonstrated higher WBC (58.27 [112.0] G/L vs. 16.42 [46.0] G/L]; p < 0.01) as well as higher PMN (91.5 [9.0]% vs. 88.0 [20.0]%); p = 0.042). Cases with negative histology showed significantly lower WBC (16.73 [44.0] G/L vs. 42.86 [87.0] G/L; p < 0.01) and lower PMN (86.0 [67.0]% vs. 91.0 [9.0]%; p = 0.036). Conclusions: WBC and PMN show high variability and appear to be influenced by virulence, histology, onset of symptoms, and pathogen detection. Full article

(This article belongs to the Special Issue Hip and Knee Arthroplasty: Update on Clinical Management)

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