Knee Arthroplasty—Advancements in Techniques and Arising Complications

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 7560

Special Issue Editors


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Guest Editor
Orthopaedic and Rehabilitation Department, Medical University of Warsaw, 02-091 Warsaw, Poland
Interests: orthopaedic surgery; knee surgery; total knee arthroplasty; unicompartmental knee arthroplasty; periprosthetic joint infection; robotic surgery; navigation; mechanical tensioner

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Guest Editor
1. Department of Physiotherapy, Faculty of Health Sciences, Medical College Krakow, Jagiellonian University, Krakow, Poland
2. Oleksy Medical & Sports Sciences, Łańcut, Poland
Interests: rehabilitation medicine; sports medicine; exercise science; return to sport; injury risk; biomechanics; bioengineering
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Special Issue Information

Dear Colleagues,

Knee arthroplasty is known as the most successful medical procedure. It is well-regarded for its cost effectiveness, pain relief, and improvement in mobility for an end-stage osteoarthritis. The aim of further advancements in techniques and prioritising certain parameters is to further improve patient satisfaction and functional outcomes. So far, despite good survival rates, up to 20% of patients remain dissatisfied after total knee arthroplasty. Promising new technologies are constantly developing with an aim to enhance surgical accuracy and use optimal alignment for patients’ individual anatomy and morphology. The literature suggests directions for future research in order to address current fears in the techniques. We believe that individualized planning and patient-specific implant positioning will yield excellent results. Hence, patient-specific instruments, custom-made implants, fast-track knee arthroplasty, navigations and robotics have been utilised to minimize surgical stress and to improve post-operative outcomes. At the same time, acute and chronic pain control after surgery and early rehabilitation care remain a query that has received unproportionally little attention. Finally, new and modern implants have been introduced for knee arthroplasty, and the criteria for unicompartmental knee surgery have been stretched in recent years.

With this Special Issue, we want to provide an update about current advancements and their contribution in knee arthroplasty techniques and fighting the complications.

The topics of interest for this Special Issue are as follows: current concepts, advancements, novelties, approaches, qualifications, and limitations in total and unicompartmental knee arthroplasty; minimally invasive surgery in knee arthroplasty; patient-specific instrumentations and customized implants; patient-specific alignment (PSA); implant positioning and limb alignment; robotic-assisted surgery; navigation technology; implant geometries and knee morphologies; and concepts for approaching complications.

I look forward to receiving your contributions.

Dr. Artur Stolarczyk
Dr. Łukasz Oleksy
Guest Editors

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Keywords

  • total knee arthroplasty
  • TKA
  • TKA novelties
  • patient-specific approach
  • robotics
  • robotic-assisted surgery
  • patient-specific alignment
  • custom-made implants
  • limb alignment
  • navigation
  • new technology TKA
  • treatment of TKA complications

Published Papers (3 papers)

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Research

10 pages, 928 KiB  
Article
No Blood Loss Increase in Cementless vs. Cemented Fixation Following Bilateral Total Knee Arthroplasty: A Propensity Score Matching Study
by Sueen Sohn, Nicole Cho, Hyunjoo Oh, Yong Deok Kim, Hoon Jo and In Jun Koh
Medicina 2023, 59(8), 1458; https://doi.org/10.3390/medicina59081458 - 12 Aug 2023
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Abstract
Background and Objectives: Recent advancements in three-dimensional printing technology have enhanced the biologic fixation of cementless total knee arthroplasty (TKA), therefore increasing the utilization of newer-generation cementless implants. However, the lack of sealing and tamponade effect of cement on the resected bone [...] Read more.
Background and Objectives: Recent advancements in three-dimensional printing technology have enhanced the biologic fixation of cementless total knee arthroplasty (TKA), therefore increasing the utilization of newer-generation cementless implants. However, the lack of sealing and tamponade effect of cement on the resected bone surface after cementless TKA raises concerns regarding the potential for greater blood loss compared to cemented TKA. The aim of this study was to (1) compare blood loss and transfusion rates between cementless and cemented TKAs and (2) identify the risk factor for higher blood loss in patients who underwent 1-week-interval staggered bilateral (SB) TKA. Materials and Methods: This retrospective, propensity-matched study included 54 cementless and 53 cemented SB TKAs performed by a single surgeon from 2019 to 2023 with a single implant that has similar design features in both cementless and cemented implants. All patients underwent 1-week-interval SB TKA and received the same patient blood management (PBM) and rehabilitation protocol. The estimated total blood loss (TBL), transfusion rate, and total hemoglobin drop were assessed. Patients were categorized according to TBL into average TBL and higher TBL groups. Univariate and multiple logistic regression analyses were performed to identify risk factors for higher blood loss. Results: There was no difference in TBL between cementless and cemented TKA groups (1233 ± 299 and 1282 ± 309 mL, respectively; p > 0.05). In addition, no between-group differences in the transfusion rate and mean total hemoglobin drop were observed. The logistic regression analyses revealed that whether TKA was cementless or cemented was not associated with higher blood loss; rather, the only identified risk factor was the pre-TKA patient blood volume (odd ratio 1.001, 95% confidence interval 1.000–1002, p = 0.026). Conclusions: Contemporary cementless fixation does not increase blood loss or transfusion rates compared to cemented fixation in patients undergoing 1-week-interval staggered bilateral TKA. Full article
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10 pages, 932 KiB  
Article
Failed Attempt to Recommend Noise Cancelling Headphones for Knee Arthroplasty Surgeons—Results of a Pilot Study
by Christian Stadler, Matthias Luger, Bernhard Schauer, Stella Stevoska, Tobias Gotterbarm and Antonio Klasan
Medicina 2023, 59(2), 320; https://doi.org/10.3390/medicina59020320 - 9 Feb 2023
Cited by 1 | Viewed by 1798
Abstract
Background and Objectives: Noise exposure during total knee arthroplasty (TKA) has been demonstrated to exceed thresholds that are deemed as over-exposure by industry noise level standards. With orthopedic surgeons being at risk of suffering from Noise Induced Hearing Loss, the purpose of [...] Read more.
Background and Objectives: Noise exposure during total knee arthroplasty (TKA) has been demonstrated to exceed thresholds that are deemed as over-exposure by industry noise level standards. With orthopedic surgeons being at risk of suffering from Noise Induced Hearing Loss, the purpose of this pilot study was to evaluate the viability of the use of industry grade active noise cancelling headphones (ANCH) during TKA. Material and Methods: In this prospective pilot study, 10 TKA were performed. In five of these cases, surgeon, assistant, scrub nurse and anesthetist wore ANCH with automatic noise level dependent noise attenuation above 82 dB. A validated 14-item questionnaire was used after each case to evaluate the quality of communication, performance, teamwork and mental load. In seven cases a calibrated sound level meter was used to measure the operating theatre noise. Peak sound level (LApeak), A-weighted continuous sound level (LAeq) and A-weighted noise exposure averaged for an 8-h time-period (LEPd) were calculated. Results: There was no perceived benefit of ANCH for the surgeons (p = 0.648), assistants (p = 0.908) and scrub nurses (p = 0.251). There was an overall improvement observed by anesthetists (p = 0.001). A worse communication while wearing ANCH was reported by surgeons but not by the rest of the team. Average LApeak was 90.6 ± 3.2 dB(C), LAeq was 61.9 ± 1.0 dB(A) and LEPd was 53.2 ± 1.2 dB(A). Conclusions: Industry grade ANCH seem to provide no benefit for surgeons, assistants and scrub nurses during TKA, while anesthesiologists seem to benefit from the use of ANCH during TKA. Due to the limitations of this pilot study, further studies with larger study populations are necessary to adequately investigate the use of ANCH during TKA. Full article
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18 pages, 1913 KiB  
Article
Robotic-Assisted Total Knee Arthroplasty Utilizing NAVIO, CORI Imageless Systems and Manual TKA Accurately Restore Femoral Rotational Alignment and Yield Satisfactory Clinical Outcomes: A Randomized Controlled Trial
by Olga Adamska, Krzysztof Modzelewski, Jakub Szymczak, Jakub Świderek, Bartosz Maciąg, Paweł Czuchaj, Małgorzata Poniatowska and Artur Wnuk
Medicina 2023, 59(2), 236; https://doi.org/10.3390/medicina59020236 - 27 Jan 2023
Cited by 8 | Viewed by 4428
Abstract
Background and objectives: The introduction of novel techniques in total knee arthroplasty (TKA) aiming to enhance outcomes and satisfaction of the procedure is constantly ongoing. In order to evidence a priority of one, we have conducted a randomized controlled trial with the [...] Read more.
Background and objectives: The introduction of novel techniques in total knee arthroplasty (TKA) aiming to enhance outcomes and satisfaction of the procedure is constantly ongoing. In order to evidence a priority of one, we have conducted a randomized controlled trial with the aim of comparing patient-reported functional outcomes, radiographic outcomes and intraoperative measures between imageless (NAVIO and CORI), robotic-assisted (ra)- TKA (ra-TKA) and manual TKA (mTKA) for primary knee osteoarthritis (KOA). Materials and Methods: A total of 215 patients with the diagnosis of KOA of the knee were randomly assigned to one of the three groups: NAVIO (76 patients) or CORI (71 patients) robotic-assisted TKA, or manual technique (68 patients) TKA. The primary outcome (Knee Injury and Osteoarthritis Outcome Study [KOOS]), Visual Analogue Scale (VAS), Range of motion (ROM), femoral component rotational alignment and the secondary outcomes (surgery time, blood loss, complications, and revision at 12 months after surgery) were compared between three groups. KOOS and VAS were collected at particular follow up visits from each patient individually and ROM in flexion and extension was assessed during the physical examination. Femoral component rotational alignment was measured on the CT scan performed postoperatively utilizing the Berger’s method. Statistical significance was set at p < 0.05. Results: Both the ra-TKA groups and mTKA group displayed significant improvements in the majority of the functional outcome scores at 12 months. Despite having more prominent surgery time (NAVIO: mean +44.5 min in comparison to mTKA and CORI: mean +38.5 min in comparison to mTKA), both NAVIO and CORI tend to achieve highly accurate femoral component rotational alignment with mean radiographic scores in NAVIO vs. CORI vs. mTKA of 1.48° vs. 1.33° vs. 3.15° and lower blood loss (NAVIO: 1.74; CORI: 1.51; mTKA: 2.32. Furthermore, the investigation revealed the significant difference in femoral component rotational alignment between mTKA—NAVIO and mTKA—CORI and significantly different KOOS scores in NAVIO vs. CORI vs. mTKA of 87.05 vs. 85.59 vs. 81.76. Furthermore, the KOOS analysis showed between group significant statistical differences, but did not reach minimal clinically significant difference. There were no differences in postoperative ROM and VAS. There were no differences in complications between groups. Conclusions: To achieve a successful TKA, the precise tool and individualised objective is of great importance. The results suggest satisfactory results after both ra-TKA methods and mTKA. Ra-TKA and mTKA stand for a safe and reliable treatment method for OA. Patients reported excellent alleviation in functional outcomes and the radiological results revealed that the better precision does not necessarily lead to a better outcome. Therefore, ra-TKA does not imply strong enough advantages in comparison to the manual method, especially in terms of cost-efficiency and surgical time. Full article
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