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Knee Replacement Surgery: Latest Advances and Prospects

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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 (20 April 2024) | Viewed by 7169

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Special Issue Editors

Dr. Tilman Walker

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Guest Editor

Department of Orthopedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
Interests: unicompartmental knee arthroplasty; minimal invasive surgery; treatment of periprosthetic infections; complex primary and revision arthroplasty

Prof. Dr. Tobias Gotterbarm

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Guest Editor

Department for Orthopedics and Traumatology, Kepler University Hospital, Krankenhausstrasse 9, 4020 Linz, Austria
Interests: total knee arthroplasty; total hip arthroplasty; unicompartmental knee arthroplasty; minimal invasive surgery; robotic assisted surgery

Prof. Dr. Babak Moradi

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Guest Editor

Clinic for Orthopedics and Trauma Surgery, University Hospital Kiel, 24105 Kiel, Germany
Interests: osteoarthritis; total knee arthroplasty; total hip arthroplasty; unicompartmental knee arthroplasty; minimal invasive surgery

Special Issue Information

Dear Colleagues,

Knee arthroplasty is known as one of the most successful procedures in orthopaedic surgery, with the aim of pain relief and improvement of mobility in patients with severe osteoarthritis. Despite good long-term survival rates, up to 20% of patients following knee arthroplasty remain dissatisfied with the persistency of their pain and functional limitations. New technologies are constantly being developed to enhance surgical accuracy and use optimal alignment for patients’ individual anatomy and morphology. At the same time, acute and chronic pain control after surgery and early rehabilitation care remain challenging. Finally, new and modern implants have been introduced for knee arthroplasty, and indications for unicompartmental knee surgery have been broadened in recent years.

With this Special Issue, we want to provide an update about latest advances and prospects in knee arthroplasty techniques as one of the most frequently performed surgical procedures in orthopaedic surgery worldwide.

Topics of interest to this Special Issue include (but are not limited to): current concepts, their advantages, and limitations in total and unicompartmental knee arthroplasty; personalized approaches in knee arthroplasty; fast-track and ultra-fast-track in total and/or unicompartmental knee arthroplasty; the role of minimally invasive surgery in knee arthroplasty; patient-specific instrumentations and customized implants; patient specific alignment (PSA); implant positioning and limb alignment; robotic-assisted systems, smart tools and/or navigation technology for knee arthroplasty; and new insights into unicompartmental knee arthroplasty as well as treatment concepts for periprosthetic infection.

I look forward to receiving your contributions.

Dr. Tilman Walker
Prof. Dr. Tobias Gotterbarm
Prof. Dr. Babak Moradi
Guest Editors

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Keywords

total knee arthroplasty
unicompartmental knee arthroplasty
minimally invasive surgery
robotic-assisted surgery
periprosthetic infection

Published Papers (9 papers)

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15 pages, 847 KiB

Open AccessArticle

Compare the Quadriceps Activity between Mini-Midvastus and Mini-Medial Parapatellar Approach in Total Knee Arthroplasty with Electromyography

by Ying-Chun Wang, Sheng-Hua Wu, Chi-An Chen, Jing-Min Liang, Chia-Chi Yang, Chung-Hwan Chen, Wan-Rong Chung, Paul Pei-Hsi Chou and Hsuan-Ti Huang

J. Clin. Med. 2024, 13(10), 2736; https://doi.org/10.3390/jcm13102736 - 7 May 2024

Viewed by 268

Abstract

Background: The comparison between the mini-midvastus (mini-MV) and mini-parapatellar (mini-MPP) approach in total knee arthroplasty (TKA) remains a subject of debate. The present study compared quadriceps activation, pain levels, and clinical outcomes between the two approaches; quadricep activation was assessed using surface electromyography (sEMG). Methods: This retrospective cross-sectional study comprised a total of 78 patients aged between 50 and 85 years with primary osteoarthritis. Patients were divided into a mini-MV (n = 38) group and a mini-MPP (n = 40) group according to the surgical approach. Results: The two groups exhibited no significant differences in sEMG for the vastus medialis (VM) or rectus femoris (RF) at the follow-up time points, with the exception that the mini-MV group exhibited superior strength of RF during extensions at the 2-week follow-up. However, the mini-MPP group had superior Western Ontario and McMaster Universities Index (WOMAC) total and function scores at the 2- and 6-week follow-ups. The mini-MPP group also had superior WOMAC stiffness scores at the 2-week follow-up. The two groups did not differ significantly in terms of pain levels or morphine consumption. Conclusions: The sEMG data of quadriceps muscle would not differ significantly between the mini-MV and mini-MPP approaches for TKA. Moreover, the mini-MPP approach may yield superior WOMAC scores when compared with the mini-MV approach. Full article

(This article belongs to the Special Issue Knee Replacement Surgery: Latest Advances and Prospects)

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13 pages, 1053 KiB

Open AccessArticle

First Italian Experience with the Oxinium Metal-Backed Fixed-Bearing Medial Journey II Unicompartmental Knee System: Promising Short-Term Outcomes of 145 Cases

by Federico D’Amario, Luca De Berardinis, Giacomo Zanon, Fjorela Qordja, Umberto Vitale and Antonio Pompilio Gigante

J. Clin. Med. 2024, 13(5), 1303; https://doi.org/10.3390/jcm13051303 - 25 Feb 2024

Cited by 1 | Viewed by 601

Abstract

(1) Background: Unicompartmental knee arthroplasty (UKA) provides a viable alternative to total knee arthroplasty (TKA) in patients with isolated medial osteoarthritis (OA). From 2007 to 2021, 23% of all primary knee arthroplasties in Italy were UKAs. We retrospectively evaluated clinical outcomes and satisfaction in patients implanted with a new oxinium metal-backed fixed-bearing medial unicompartmental prosthesis at a 24-month follow-up. (2) Methods: From December 2020 to December 2021, 145 patients were treated by a single surgeon at a single institution using the hypoallergenic Journey II prosthesis. Clinical outcome measures included the Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), Oxford Knee Society (OKS) score, University of California Los Angeles Activity Score (UCLA), the Physical Component Summary (PCS), and the Mental Component Summary (MCS), and were calculated preoperatively and at 12 and 24 months. The Forgotten Joint Score-12 (FJS-12) was calculated at 12 and 24 months. Patient satisfaction was collected at 24 months. The scores were compared using the Friedman test. (3) Results: All clinical scores improved significantly from baseline to 24 months (p < 0.0001), except for the FJS-12, which from 12 to 24 months did not improve significantly (p = 0.041). Patient satisfaction was 9.32 ± 0.74 out of 10. No patient experienced complications or required revision surgery. (4) Conclusions: The Journey II unicompartmental prosthesis is a valuable treatment option for end-stage medial OA, improving knee function, providing pain relief, and ensuring high patient satisfaction at 24 months. Full article

(This article belongs to the Special Issue Knee Replacement Surgery: Latest Advances and Prospects)

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11 pages, 1342 KiB

Open AccessArticle

Validating a Novel 2D to 3D Knee Reconstruction Method on Preoperative Total Knee Arthroplasty Patient Anatomies

by Shai Factor, Ron Gurel, Dor Dan, Guy Benkovich, Amit Sagi, Artsiom Abialevich and Vadim Benkovich

J. Clin. Med. 2024, 13(5), 1255; https://doi.org/10.3390/jcm13051255 - 22 Feb 2024

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Abstract

Background: As advanced technology continues to evolve, incorporating robotics into surgical procedures has become imperative for precision and accuracy in preoperative planning. Nevertheless, the integration of three-dimensional (3D) imaging into these processes presents both financial considerations and potential patient safety concerns. This study aims to assess the accuracy of a novel 2D-to-3D knee reconstruction solution, RSIP XPlan.ai™ (RSIP Vision, Jerusalem, Israel), on preoperative total knee arthroplasty (TKA) patient anatomies. Methods: Accuracy was calculated by measuring the Root Mean Square Error (RMSE) between X-ray-based 3D bone models generated by the algorithm and corresponding CT bone segmentations (distances of each mesh vertex to the closest vertex in the second mesh). The RMSE was computed globally for each bone, locally for eight clinically relevant bony landmark regions, and along simulated bone cut contours. In addition, the accuracies of three anatomical axes were assessed by comparing angular deviations to inter- and intra-observer baseline values. Results: The global RMSE was 0.93 ± 0.25 mm for the femur and 0.88 ± 0.14 mm for the tibia. Local RMSE values for bony landmark regions were 0.51 ± 0.33 mm for the five femoral landmarks and 0.47 ± 0.17 mm for the three tibial landmarks. The RMSE along simulated cut contours was 0.75 ± 0.35 mm for the distal femur cut and 0.63 ± 0.27 mm for the proximal tibial cut. Anatomical axial average angular deviations were 1.89° for the trans epicondylar axis (with an inter- and intra-observer baseline of 1.43°), 1.78° for the posterior condylar axis (with a baseline of 1.71°), and 2.82° (with a baseline of 2.56°) for the medial–lateral transverse axis. Conclusions: The study findings demonstrate promising results regarding the accuracy of XPlan.ai™ in reconstructing 3D bone models from plain-film X-rays. The observed accuracy on real-world TKA patient anatomies in anatomically relevant regions, including bony landmarks, cut contours, and axes, suggests the potential utility of this method in various clinical scenarios. Further validation studies on larger cohorts are warranted to fully assess the reliability and generalizability of our results. Nonetheless, our findings lay the groundwork for potential advancements in future robotic arthroplasty technologies, with XPlan.ai™ offering a promising alternative to conventional CT scans in certain clinical contexts. Full article

(This article belongs to the Special Issue Knee Replacement Surgery: Latest Advances and Prospects)

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21 pages, 2270 KiB

Open AccessArticle

Time-Dependent Prediction Models for Individual Prognosis of Chronic Postsurgical Pain following Knee Replacement Based on an Extensive Multivariable Data Set

by Ulrich Betz, Michael Clarius, Manfred Krieger, Jürgen Konradi, Robert Kuchen, Lukas Schollenberger, Jörg Wiltink and Philipp Drees

J. Clin. Med. 2024, 13(3), 862; https://doi.org/10.3390/jcm13030862 - 1 Feb 2024

Viewed by 594

Abstract

(1) Background: Clinically useful prediction models for chronic postsurgical pain (CPSP) in knee replacement (TKA) are lacking. (2) Methods: In our prospective, multicenter study, a wide-ranging set of 91 variables was collected from 933 TKA patients at eight time points up to one year after surgery. Based on this extensive data pool, simple and complex prediction models were calculated for the preoperative time point and for 6 months after surgery, using least absolute shrinkage and selection operator (LASSO) 1se and LASSO min, respectively. (3) Results: Using preoperative data only, LASSO 1se selected age, the Revised Life Orientation Test on pessimism, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)—subscore pain and the Timed “Up and Go” Test for prediction, resulting in an area under the curve (AUC) of 0.617 and a Brier score of 0.201, expressing low predictive power only. Using data up to 6 months after surgery, LASSO 1se included preoperative Patient Health Questionnaire-4, Knee Injury and Osteoarthritis Outcome Score (KOOS)—subscore pain (pain) 3 months after surgery (month), WOMAC pain 3 and 6 months, KOOS subscore symptoms 6 months, KOOS subscore sport 6 months and KOOS subscore Quality of Life 6 months. This improved the predictive power to an intermediate one (AUC 0.755, Brier score 0.168). More complex models computed using LASSO min did little to further improve the strength of prediction. (4) Conclusions: Even using multiple variables and complex calculation methods, the possibility of individual prediction of CPSP after TKA remains limited. Full article

(This article belongs to the Special Issue Knee Replacement Surgery: Latest Advances and Prospects)

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9 pages, 692 KiB

Open AccessArticle

Survival and Clinical Outcomes after Unconstrained Total Knee Arthroplasty for Tibial Plateau Fractures–A Retrospective Study with Minimum 4-Year Follow-Up

by Philip-C. Nolte, Kim Schlentrich, Philipp Raisch, Matthias K. Jung, Paul A. Grützner and Oliver Bischel

J. Clin. Med. 2023, 12(23), 7303; https://doi.org/10.3390/jcm12237303 - 25 Nov 2023

Viewed by 799

Abstract

This study investigated survival, complications, revisions, and patient-reported outcomes (PROs) for unconstrained total knee arthroplasty (TKA) in posttraumatic osteoarthritis (PTO) caused by intraarticular tibial plateau fractures with minimum four years follow-up. Forty-nine patients (71.4% male; 58.7 years) were included. Kaplan–Meier analysis was performed with failure defined as TKA removal. Patients without failure underwent pre- and postoperative evaluation (range of motion (ROM), Oxford Knee Score (OKS), Knee Society Score (KSS), anatomical femorotibial angle (aFTA), proximal tibial slope (PTS)) and Short Form-12 (SF-12) Physical (PCS) and Mental Component Summary (MCS) assessment at final follow-up. Fifteen (30.6%) patients had a complication, and eight (16.3%) patients underwent prosthesis removal at median 2.5 years. Cumulative survival rate of TKA was 79.6% at 20 years. A total of 32 patients with a mean follow-up of 11.8 years underwent further analyses. ROM (p = 0.028), aFTA (p = 0.044), pPS (p = 0.009), OKS (p < 0.001) and KSS (p < 0.001) improved significantly. SF-12 PCS was 42.3 and MCS was 54.4 at final follow-up. In general, one third of patients suffer a complication, and one in six patients has their prosthesis removed after TKA for PTO due to tibial plateau fractures. In patients who do not fail, TKA significantly improves clinical and radiographic outcomes at long-term follow-up. Full article

(This article belongs to the Special Issue Knee Replacement Surgery: Latest Advances and Prospects)

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10 pages, 758 KiB

Open AccessArticle

Good Mid-Term Implant Survival of a Novel Single-Design Rotating-Hinge Total Knee Arthroplasty

by Matthias Schlechter, Christoph Theil, Georg Gosheger, Burkhard Moellenbeck, Jan Schwarze, Jan Puetzler and Sebastian Bockholt

J. Clin. Med. 2023, 12(19), 6113; https://doi.org/10.3390/jcm12196113 - 22 Sep 2023

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Abstract

Background: Rotating-hinge knee (RHK) implants are an option for knee arthroplasty in cases of instability or severe bone loss. However, the revision rate can be increased compared to unconstrained implants which mandate improvements in implant design. This study investigates a novel RHK design for total knee arthroplasty (TKA). Methods: Retrospective analysis of a single design RHK TKA (GenuX MK, Implantcast) implanted between 2015 and 2019 including 133 patients (21 primary TKA, 112 revisions). The main indication for revision TKA was second-stage reimplantation following infection. The median follow-up amounted to 30 months (IQR 22–47). Results: In total, 13% (18/133) of patients underwent revision surgery after a mean time of 1 month (IQR 0–6). The main reason for the revision was (re-) infection in 8% of patients. All revisions were performed following revision TKA and none following primary TKA. There were no revision surgeries for loosening or instability. The revision-free implant survival of 83% was (95% CI 75–91%) after five years. A higher number of previous surgeries was associated with a greater revision risk (p = 0.05). Conclusion: Revision and complex primary TKA using a single-design RHK implant results in good implant survival at mid-term follow-up although infection remains a major concern. Full article

(This article belongs to the Special Issue Knee Replacement Surgery: Latest Advances and Prospects)

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15 pages, 1491 KiB

Open AccessArticle

Impact of Comorbidities and Previous Surgery on Mid-Term Results of Revision Total Knee Arthroplasty for Periprosthetic Joint Infection

by Kevin-Arno Koch, David M. Spranz, Fabian Westhauser, Tom Bruckner, Burkhard Lehner, Abtin Alvand, Christian Merle and Tilman Walker

J. Clin. Med. 2023, 12(17), 5542; https://doi.org/10.3390/jcm12175542 - 25 Aug 2023

Viewed by 599

Abstract

(1) Background: In the treatment of periprosthetic joint infection (PJI), the individual host status and previous surgical procedures appear to have a relevant influence on success rates and clinical outcome of knee revision surgery. Current data about the predictive value are limited in this subgroup of patients. (2) Methods: Retrospectively, 107 patients (109 knees) undergoing two-stage exchange knee arthroplasty for PJI using a rotating-hinge design with at least two years follow-up. The cumulative incidence (CI) for different endpoints was estimated with death as competing risk. Univariate and multivariate analyses for potential predictive factors were performed. Patient-related outcome measures (PROMs) for clinical outcome were evaluated. (3) Results: At 8 years, the CI of any revision was 29.6%, and of any reoperation was 38.9%. Significant predictors for risk of re-revision were the Charlson Comorbidity Index (CCI) and the number of previous surgical procedures prior to explanation of the infected implant. The functional and clinical outcome demonstrated acceptable results in the present cohort with a high comorbidity level. (4) Conclusions: A compromised host status and multiple previous surgical procedures were identified as negative predictors for re-revision knee surgery in the treatment of PJI. Reinfection remained the major reason for re-revision. Overall mortality was high. Full article

(This article belongs to the Special Issue Knee Replacement Surgery: Latest Advances and Prospects)

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11 pages, 1142 KiB

Open AccessArticle

What Is the Correlation between Clinical and Radiographic Findings in Patients with Advanced Osteoarthritis of the Knee?

by Moritz M. Innmann, Andre Lunz, Larissa Fröhlich, Thomas Bruckner, Christian Merle, Tobias Reiner and Marcus Schiltenwolf

J. Clin. Med. 2023, 12(16), 5420; https://doi.org/10.3390/jcm12165420 - 21 Aug 2023

Cited by 1 | Viewed by 1213

Abstract

Knee range of motion and patient-reported outcome measures (PROMs) are often used as screening tools to assess the severity of knee osteoarthritis and guide the decision to refer patients to an arthroplasty clinic. However, there is little understanding regarding the correlation between these factors. Thus, the purpose of this study was to determine the correlation between patient-reported clinical function measured with the Oxford Knee Score (OKS), pain assessed using the visual analog scale (VAS), knee range of motion (ROM), and characteristic radiographic features in patients with advanced osteoarthritis of the knee. A prospective analysis of a consecutive series of 138 patients with advanced unilateral osteoarthritis (OA) of the knee was performed. The severity of radiographic OA was classified according to the most commonly used Kellgren and Lawrence classification (K&L). Spearman’s rank correlation analysis and multiple linear regression analysis were performed. The OKS was used as a dependent variable and was adjusted for pain, ROM, and nine standardized radiographic parameters on multiple views of the tibiofemoral and patellofemoral joint. OKS and pain correlated weakly with the K&L grade (r = −0.289; p = 0.001; r = 0.258; p = 0.002). K&L grade and the degree of patellofemoral joint space narrowing were identified as independent factors being associated with a poorer OKS (coefficient −4.528, p = 0.021; coefficient −2.211, p = 0.038). Slightly worse results were identified for OKS and pain in patients with K&L grade 4 osteoarthritis compared to patients with K&L grade 3 osteoarthritis (∆OKS 5.5 points, p < 0.001; ∆VAS 1.7 points, p = 0.003). There was no significant difference for passive range of motion between patients with K&L grade 3 or 4. When counseling patients with advanced knee osteoarthritis who may be eligible for knee arthroplasty, it is essential to give primary consideration to pain levels and self-reported limitations experienced during daily activities. Relying solely on knee ROM and PROMs is not an effective screening method for guiding the decision to refer patients to an arthroplasty clinic. Full article

(This article belongs to the Special Issue Knee Replacement Surgery: Latest Advances and Prospects)

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11 pages, 833 KiB

Open AccessPerspective

Arterial Stiffness, Assessed Using the Cardio–Ankle Vascular Index, before and 2 Years after Total Knee Arthroplasty in Patients with Knee Osteoarthritis

by Yoshinori Ishii, Hideo Noguchi, Junko Sato, Ikuko Takahashi, Hana Ishii, Ryo Ishii, Kei Ishii, Kai Ishii and Shin-ichi Toyabe

J. Clin. Med. 2023, 12(24), 7734; https://doi.org/10.3390/jcm12247734 - 17 Dec 2023

Viewed by 686

Abstract

Purpose: Cardiovascular disease (CVD) is a major risk factor for mortality in patients with osteoarthritis, and such comorbidities increase the risk of postoperative complications following total knee arthroplasty (TKA). Arteriosclerosis plays a major role in hemodynamic dysfunction and CVD; however, the postoperative changes in arteriosclerosis following TKA have not been evaluated. Therefore, we assessed the postoperative changes in arteriosclerosis using the cardio–ankle vascular index (CAVI) in patients undergoing TKA, and its relationships with preoperative patient characteristics. Methods: Arteriosclerosis was prospectively evaluated in 119 consecutive patients (140 knees) (15 males (17), 104 females (123); median age 73 years) with knee osteoarthritis who underwent TKA. CAVI was measured before and 2 years after TKA, and the relationships between CAVI and preoperative age, sex, BMI, physical activity status, comorbidities, clinical score, triglyceride concentration, cholesterol concentration, and smoking history were analyzed. Results: CAVI remained stable or improved in 54 joints (39%) and worsened in 86 joints (61%) 2 years post-operation. The median difference between pre- and postoperative CAVI was 0.2 (−0.3, 0.8), and the only preoperative factor associated with this change was preoperative CAVI (r = −0.469, p < 0.001). No other preoperative factor had a significant effect on postoperative arteriosclerosis. Conclusions: The results suggest that patients who undergo TKA subsequently show less severe arteriosclerosis, and the protective effect of TKA on arterial stiffness is greater in those with a higher preoperative CAVI. TKA may be an effective means of reducing the deterioration of arteriosclerosis associated with knee osteoarthritis, at least in the relatively short term. Full article

(This article belongs to the Special Issue Knee Replacement Surgery: Latest Advances and Prospects)

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