Search Results (41)

Background/Objectives: Total knee arthroplasty (TKA) is commonly associated with postoperative muscle atrophy and weakness, while traditional rehabilitation is often limited by pain and patient compliance. Passive blood flow restriction (pBFR) training may offer a safe, low-threshold method to attenuate muscle loss in this early phase. This pilot study examined the feasibility, safety, and early effects of pBFR initiated during hospitalization on muscle mass, swelling, and functional recovery after TKA. Methods: In a prospective, single-blinded trial, 26 patients undergoing primary or aseptic revision TKA were randomized to either a control group (CON: sham BFR at 20 mmHg) or intervention group (INT: pBFR at 80% limb occlusion pressure). Both groups received 50 min daily in-hospital rehabilitation sessions for five consecutive days. Outcomes, including lean muscle mass (DXA), thigh/knee circumference, 6 min walk test (6 MWT), handgrip strength, and patient-reported outcomes, were assessed preoperatively and at discharge, six weeks, and three months postoperatively. Linear mixed models with Bonferroni correction were applied. Results: The INT group showed significant preservation of thigh circumference (p = 0.002), reduced knee swelling (p < 0.001), and maintenance of lean muscle mass (p < 0.01), compared with CON, which exhibited significant declines. Functional performance improved faster in INT (e.g., 6 MWT increase at T3: +23.7%, p < 0.001; CON: −7.2%, n.s.). Quality of life improved in both groups, with greater gains in INT (p < 0.05). No adverse events were reported. Conclusions: Initiating pBFR training on the first postoperative day is feasible, safe, and effective in preserving muscle mass and reducing swelling after TKA. These findings extend prior BFR research by demonstrating its applicability in older, surgical populations. Further research is warranted to evaluate its integration with standard rehabilitation programs and long-term functional benefits. Full article

Background/Objectives: Periprosthetic joint infection (PJI) is a severe complication following both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). While the microbiological profile of TKA PJI has been well characterized, limited data exist regarding UKA PJIs. This study aimed to compare the causative microorganisms and surgical treatment outcomes in PJI cases following UKA and TKA. Methods: This retrospective cohort study included 82 patients (71 TKA and 11 UKA) who underwent surgical treatment for PJI between January 2017 and May 2024. PJI was diagnosed based on the Musculoskeletal Infection Society (MSIS) criteria. Treatment strategies included debridement, antibiotics, and implant retention (DAIR) or two-stage revision arthroplasty. Microbiological data were extracted from intraoperative cultures. Fisher’s exact test and the Mann–Whitney U test were used for statistical comparisons. Results: Gram-positive organisms, primarily Staphylococcus aureus and coagulase-negative staphylococci, were isolated in all UKA PJIs. In contrast, the TKA group demonstrated greater microbial diversity, including Gram-negative bacilli, polymicrobial infections, and a higher rate of culture-negative cases (33.8% vs. 18.2%). DAIR was performed more frequently in UKA cases (72.7% vs. 28.2%, p = 0.002). Recurrence rates following DAIR were similar in both groups (12.5% in UKA, 20.0% in TKA, p = 1.000). Two-stage revision resulted in no recurrence in UKA and a 9.8% recurrence rate in TKA patients. Conclusions: UKA PJIs appear to be microbiologically less complex than TKA PJI cases, with Gram-positive organisms predominating. Despite these differences, the outcomes of surgical treatment—both DAIR and two-stage revision—were comparable between groups. Standard PJI treatment principles may be applicable to both arthroplasty types; however, larger prospective studies are needed to confirm these findings. Full article

Background: Total knee arthroplasty (TKA) is one of the most frequently performed procedures for end-stage arthritis. Effective pain control is essential for recovery, and opioids are widely used. However, patients with opioid use disorder (OUD) may be at increased risk of complications. Methods: We analyzed 2,514,099 TKA cases from the Nationwide Inpatient Sample (2016–2019), identifying 11,785 patients with OUD. After 1:1 propensity score matching, clinical and economic outcomes were compared between OUD and non-OUD patients. Results: Patients with OUD had significantly higher odds of intraoperative fracture (OR: 6.1), DVT (OR: 5.0), pneumonia (OR: 2.5), pulmonary edema (OR: 1.6), and blood transfusion (OR: 1.5) (p < 0.001). Mean hospital charges were higher (USD 68,687 vs. USD 60,984), and LOS was longer (2.8 vs. 2.5 days, p < 0.001). OUD patients were more likely to undergo revision TKA at a younger age (59.6 vs. 65.4 years, p = 0.016), with higher infection rates and greater costs. Conclusions: Patients with OUD undergoing TKA experience more complications, higher costs, and require earlier revision. Underreporting of OUD highlights the need for improved preoperative screening. Full article

Background and Objectives: Central sensitization (CS) has been identified as a significant factor influencing persistent pain and dissatisfaction following total knee arthroplasty (TKA). However, its effect on unicompartmental knee arthroplasty (UKA) remains largely unexplored. Unlike TKA, UKA preserves most native knee structures, with less bone cut, leading to different postoperative pain mechanisms. Nevertheless, the revision rate for unexplained pain following UKA is higher than after TKA. This study investigates the influence of preoperative CS on pain and dissatisfaction after UKA. Materials and Methods: This retrospective cohort study included 121 patients who underwent primary UKA for medial compartment osteoarthritis of the knee. Patients were screened for CS preoperatively using the Central Sensitization Inventory (CSI) and categorized into a CS group (CSI ≥ 40; n = 26) and a non-CS group (CSI < 40; n = 95). Clinical outcomes, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS), and patient satisfaction, were assessed at the 2-year postoperative follow-up visit. A multivariate regression analysis was used to determine the risk factors for postoperative dissatisfaction. Results: The CS group reported significantly worse postoperative WOMAC pain, function, and total scores than the non-CS group (all p < 0.05). FJS was also significantly worse in the CS group than in the non-CS group (64.4 vs. 72.7, respectively, p = 0.005). Patient satisfaction was significantly lower in the CS group than in the non-CS group (65.4% vs. 95.8%, respectively, p < 0.001). The multivariate logistic regression analysis demonstrated that patients with a CSI score ≥ 40 had an 11.349-fold increased likelihood of dissatisfaction after UKA (95% CI: 2.315–55.626, p = 0.003). Conclusions: This study underscores the importance of recognizing CS as a critical determinant of postoperative pain and functional recovery following UKA. Patients with high CSI scores experience greater pain, increased joint awareness, and overall poorer satisfaction despite technically successful surgeries. Full article

Background: Robotic-assisted total knee arthroplasty (rTKA) has been introduced to improve surgical precision and alignment in knee replacement procedures. However, its impact on clinical outcomes, pain relief, and cost-effectiveness remains debated. This umbrella review synthesizes evidence from systematic reviews and meta-analyses comparing rTKA to conventional TKA. Methods: An umbrella review was conducted in PubMed, Scopus, Web of Science, Embase, and the Cochrane Database of Systematic Reviews. Systematic reviews and meta-analyses comparing rTKA with conventional TKA were included. Methodological quality was assessed using AMSTAR 2 and ROBIS tools. Primary outcomes included hospital stay, radiographic alignment, postoperative pain, functional outcomes, and patient satisfaction. Results: Ten systematic reviews were included. rTKA demonstrated superior alignment accuracy and a reduction in alignment outliers. Some studies reported shorter hospital stays and lower early postoperative pain scores for rTKA. However, these benefits did not consistently translate into improved long-term functional outcomes, patient satisfaction, or reduced revision rates. Cost-effectiveness analyses indicated that rTKA remains an expensive option, with benefits largely dependent on surgical volume and healthcare system resources. Conclusions: While rTKA improves surgical precision and may offer short-term advantages, its long-term superiority over conventional TKA remains unproven. Higher costs and longer operative times limit its widespread adoption. Further high-quality, long-term studies are needed to determine its clinical and economic value. Full article

Background: Obesity is a major risk factor for osteoarthritis (OA) and negatively impacts both short-term and long-term outcomes following total knee arthroplasty (TKA). Bariatric surgery has been proposed as a strategy to improve surgical outcomes in obese patients; however, its effects on postoperative complications, hospital stay, healthcare costs, and revision rates remain insufficiently explored. This study investigates whether bariatric surgery before TKA is associated with improved outcomes. Methods: This retrospective cohort study utilized data from the Nationwide Inpatient Sample (NIS) from 2016 to 2019, including 2,519,099 TKA patients, of whom 56,291 had a history of bariatric surgery. Propensity score matching was applied to balance baseline characteristics between groups. Statistical analyses compared the length of hospital stay (LOS), total healthcare costs, postoperative complications, and revision rates. Results: Patients with a history of bariatric surgery exhibited significantly lower rates of sepsis, deep vein thrombosis (DVT), pulmonary embolism (PE), acute kidney injury (AKI), and ileus compared to those without. Additionally, these patients had a shorter LOS and slightly lower total hospital charges. However, the bariatric surgery group had higher rates of blood loss anemia, intraoperative fractures, and blood transfusions. Revision surgery rates were also higher in the bariatric surgery group, with mechanical loosening and prosthesis instability being more common etiologies. Conclusions: Bariatric surgery is associated with fewer early postoperative complications and shorter hospital stays in TKA patients, suggesting potential perioperative benefits. However, increased risks of blood loss anemia, intraoperative fractures, and revision surgery highlight the need for further research on long-term outcomes and alternative weight-loss strategies, such as pharmacologic interventions. Full article

Background/Objectives: Total knee arthroplasty (TKA) is the gold-standard treatment for advanced knee arthritis, offering pain relief and improved joint function. However, tibial component malalignment, malrotation, and improper biomechanical loading remain critical factors contributing to implant failure, instability, and revision surgeries. This review systematically examines the impact of biomechanical loading on the tibial insert following primary TKA, with a focus on alignment, posterior tibial slope (PTS), and load distribution. Methods: A systematic literature search was conducted across the PubMed, Google Scholar, and Web of Science databases following the PRISMA guidelines. Studies investigating the effects of tibial component alignment, varus/valgus deviations, PTS, and load distribution on tibial inserts post-TKA were included. Seven studies meeting the inclusion criteria were analyzed and described narratively. Results: The reviewed studies highlighted that varus and valgus malalignment significantly alter tibiofemoral contact pressures and ligament strains, increasing the risk of aseptic loosening and implant failure. Excessive PTS was associated with posterior femoral translation, altered ligament tension, and increased contact stresses on polyethylene (PE) inserts. Kinematically aligned TKA demonstrated reduced tibial force imbalances and improved functional outcomes compared to mechanically aligned TKA. Computational and cadaveric studies revealed that even minor malalignments (e.g., 3° varus or valgus) can cause significant biomechanical changes. Conclusions: Biomechanical loading on tibial inserts after primary TKA is highly sensitive to the alignment and PTS. Optimal alignment and controlled biomechanical forces are essential. Kinematically aligned TKA has shown promising effects, preventing aseptic loosening and ensuring long-term implant survival. Further in vivo studies are needed to validate these findings and optimize surgical techniques. Full article

The optimal procedure for isolated end-stage medial compartment knee osteoarthritis (OA) remains uncertain, with debate persisting between unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). The aim of this narrative review is to evaluate current outcome measures in knee arthroplasty (KA) and explore how evolving patient populations and technological advancements may necessitate the use of different patient-reported outcome measures (PROMs) for evaluating UKA. While UKA offers potential advantages over TKA in early pain relief and functional outcomes, most randomised control trials using traditional PROMs have failed to show definitive superiority. The recent introduction of robotic assistance may have further enhanced the benefits of UKA. However, it remains uncertain whether the advantages outweigh the higher revision rates associated with UKA. Although traditional PROMs, such as the Oxford Knee Score or Knee Injury and Osteoarthritis Outcome Score, were designed for the KA population of 30 years ago, they continue to be employed today. The current KA population, particularly those undergoing UKA, are typically younger, physically fitter, and have higher functional demands than those for whom traditional PROMs were originally designed. As a result, these PROMs are now limited by ceiling effects. High-performance PROMs, such as the Forgotten Joint Score-12 or the metabolic equivalent of task score, have recently been utilised for high-demand patients and do not have postoperative ceiling effects. Return to work and sport are also important outcomes that are often overlooked for younger, high-demand patients. Future studies should aim to define the differences between UKA and TKA populations, identify patient factors that predict UKA success, and validate high-performance PROMs for UKA. This will provide deeper insights into the functional benefits of UKA and TKA, enabling patients and surgeons to make more informed decisions regarding implant selection. Full article

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

Background and Objectives: Total knee arthroplasty (TKA) is an effective treatment option for severe knee osteoarthritis. Understanding the impact of diabetes mellitus (DM) on postoperative outcomes is crucial for improving patient satisfaction after TKA. This study aimed to investigate the influence of DM on postoperative complications and mortality after TKA. Materials and Methods: We conducted a systematic review and meta-analysis by searching relevant studies published before December 2023 in the PubMed, EMBASE, Cochrane Library, Medline, and Web of Science databases. The assessment included demographic data, comorbidities, and postoperative complications after primary TKA for both DM and non-DM patients. The odds ratio (OR) was used to represent the estimate of risk of a specific outcome. Results: Thirty-nine studies were finally included in this meta-analysis. Patients with DM had higher rates of periprosthetic joint infection (OR: 1.71, 95% confidence interval [CI]: 1.46–2.00, p < 0.01) and prosthesis revision (OR: 1.37, 95% CI: 1.23–1.52, p < 0.01). Moreover, patients with DM showed an elevated incidence of pneumonia (OR: 1.54, 95% CI: 1.15–2.07, p < 0.01), urinary tract infection (OR: 1.86, 95% CI: 1.07–3.26, p = 0.02), and sepsis (OR: 1.61, 95% CI: 1.46–1.78, p < 0.01). Additionally, the postoperative risk of cardiovascular (OR: 2.49, 95% CI: 1.50–4.17, p < 0.01) and cerebrovascular (OR: 2.38, 95% CI: 1.48–3.81, p < 0.01) events was notably higher in patients with DM. The presence of DM increased the risk of deep vein thrombosis (OR: 1.58, 95% CI: 1.22–2.04, p < 0.01), but did not lead to an increased risk of pulmonary embolism. Most importantly, DM was associated with a higher mortality rate within 30 days after TKA (OR: 1.27, 95% CI: 1.02–1.60, p = 0.03). Conclusions: Patients with DM exhibited a higher rate of postoperative complications after TKA, and DM was associated with a higher mortality rate within 30 days after TKA. It is crucial to educate patients about the perioperative risk and develop evidence-based guidelines to prevent complications after TKA. Full article

Background and Objectives: Neglected patellar dislocation in the presence of end-stage osteoarthritis (OA) is a rare condition characterized by the patella remaining laterally dislocated without reduction. Due to the scarcity of reported cases, the optimal management approach is still uncertain. However, primary total knee arthroplasty (TKA) can serve as an effective treatment option. This study aimed to present the clinical and radiological outcomes achieved using our surgical technique. Materials and Methods: A retrospective review of 12 knees in 8 patients with neglected patellar dislocation and end-stage OA who underwent primary TKA was conducted. The surgical procedure involved conventional TKA techniques (e.g., medial parapatellar arthrotomy) and additional procedures specific to the individual pathologies of neglected patellar dislocation (e.g., lateral release, medial plication, and quadriceps lengthening). Clinical outcomes, including patient-reported outcome measures (PROMs) (Knee Society Scores and the Western Ontario and McMaster Universities Osteoarthritis Index) and knee range of motion (ROM), were assessed preoperatively and two years postoperatively. Radiological measures including mechanical femorotibial angle and patellar tilt angle were assessed preoperatively and until the last follow-up examinations. Any complications were also reviewed. Results: There were significant improvements in all PROMs, knee ROM, and radiological outcomes, including mechanical femorotibial angle and patellar tilt angle (all p < 0.05). At a mean follow-up of 68 months, no major complications requiring revision surgery, including patellar dislocation, were reported. Conclusions: Primary TKA is an effective procedure for correcting various pathologies associated with neglected patellar dislocation in end-stage OA without necessitating additional bony procedures. Satisfactory clinical and radiological outcomes can be expected using pathology-specific procedures. Full article

Culture-positive (CP) and culture-negative (CN) periprosthetic joint infections (PJI) remain a crucial area of research; however, current studies comparing these infections rely on unstandardized outcome reporting tools. Our study aimed to compare the outcomes of two-stage revision of CP and CN PJI using the standardized Musculoskeletal Infection Society (MSIS) outcome reporting tool. We retrospectively reviewed 138 patients who were diagnosed with PJI and indicated for two-stage revision total knee arthroplasty (rTKA). The majority of patients in both CP and CN cohorts achieved infection control without the need for reoperation (54.1% and 62.5%, respectively). There was a significant difference in the overall distribution of MSIS outcomes (p = 0.043), with a significantly greater rate of CN patients falling into Tier 1 (infection control without the use of suppressive antibiotics) (52.5% versus 29.6%, p = 0.011). There was also a significant difference in the distribution of septic versus aseptic reoperations after 2nd stage (p = 0.013), with more CP reoperations being septic and more CN reoperations being aseptic. The duration from first to second stage was significantly shorter in the CN cohort (p = 0.002). While overall infection control was similar between cohorts, these data suggest that the outcomes of two-stage rTKA are favorable in cases of CN PJI. Full article

Background: Unicompartmental knee arthroplasty (UKA) is increasingly used for knee osteoarthritis due to faster recovery, better range of motion, and lower costs compared to total knee arthroplasty (TKA). While TKA may offer longer-lasting results with lower revision rates, this study compares the relative benefits and limitations of UKA and TKA using the National Inpatient Sample (NIS) database. Methods: This retrospective analysis examined outcomes of elective UKA and TKA procedures from 2016 to 2019, identifying 2,606,925 patients via ICD-10 codes. Propensity score matching based on demographics, hospital characteristics, and comorbidities resulted in a balanced cohort of 136,890 patients. The present study compared in-hospital mortality, length of stay, postoperative complications, and hospitalization costs. Results: The results showed that UKA procedures increased significantly over the study period. Patients undergoing UKA were generally younger with fewer comorbidities. After matching, both groups had low in-hospital mortality (0.015%). UKA patients had shorter hospital stays (1.53 vs. 2.47 days) and lower costs (USD 55,976 vs. USD 61,513) compared to TKA patients. UKA patients had slightly higher rates of intraoperative fracture and pulmonary edema, while TKA patients had higher risks of blood transfusion, anemia, coronary artery disease, pulmonary embolism, pneumonia, and acute kidney injury. Conclusions: UKA appears to be a less-invasive, cost-effective option for younger patients with localized knee osteoarthritis. Full article

Tibial Periprosthetic fractures (PPF) after primary total knee arthroplasty (TKA) are uncommon and mainly occur after trauma. Various management options have been proposed; however, the decision mainly relies on the location of the fracture and the tibial baseplate stability and ranges between conservative (non-operative), fracture fixation, and revision TKA. We report a case of a 79-year-old female patient who presented with atraumatic lateral tibial plateau PPF (Felix type ⅠB) with a loose tibial implant after three weeks of having left primary TKA. The patient was treated successfully by revising the tibial component using a stemmed tibial baseplate and reconstructing the tibial bone defect using two metal wedges. The radiological, functional, and PROM outcomes were satisfactory and accepted both early on (eight weeks) and at the last follow-up (six months). Atraumatic insufficiency Felix type ⅠB PPF of the lateral tibial plateau after primary TKA is uncommon. Reconstructing the tibial bone defect, revising the tibial component, and adding a stem to offload the tibial plateau are the treatments of choice that lead to acceptable outcomes. Full article

Background: Total Knee Arthroplasty (TKA) is a prevalent surgical procedure for treating severe knee arthritis, aiming to alleviate pain and restore function. Recent advancements have introduced computer-assisted (CAS) and robot-assisted (RA-TKA) surgical techniques as alternatives to conventional methods, promising improved accuracy and patient outcomes. However, comprehensive comparative studies evaluating the short-term outcomes and prostheses survivorship among these techniques are limited. We hypothesized that the outcome of RA-TKA and/or CAS- TKA is advantageous in function and prosthesis survivorship compared to manually implanted prostheses. Methods: This prospective controlled study compared the short-term outcomes and prostheses survivorship following TKA using conventional, CAS, and RA-TKA techniques. One hundred seventy-eight patients requiring TKA were randomly assigned to one of the three surgical groups. The primary outcomes were knee function (KSS knee score) and functional recovery (KSS function score), which were assessed before surgery three years postoperatively. Secondary outcomes included prosthesis alignment, knee range of movements, and complication rates. Survivorship analysis was conducted using Kaplan–Meier curves, with revision surgery as the endpoint. Results: While all three groups showed significant improvements in knee function postoperatively (p < 0.001), the CAS and RA-TKA groups demonstrated superior prosthetic alignment and higher survivorship rates than the conventional group (100%, 97%, and 96%, respectively). However, although the RA-TKA group had a maximal 100% survivorship rate, its knee score was significantly lower than following CAS and conventional techniques (mean 91 ± 3SD vs. mean 93 ± 3SD, p = 0.011). Conclusion: The RA-TKA technique offers advantages over conventional and CAS methods regarding alignment accuracy and short-term survivorship of TKA prostheses. Since short-term prosthesis survivorship indicates the foreseen rates of mid- and long-term survivorship, the current data have a promising indication of the improved TKA prosthesis’s long-term survivorship by implementing RA-TKA. According to the presented data, although the survival rates were 100%, 97%, and 96% in the three study groups, no clinical difference in the functional outcome was found despite the better mechanical alignment and higher survivorship in the group of patients treated by the RA-TKA. Full article