Search Results (475)

Background: Fear of falling (FOF) is a significant concern among older adults, especially after total knee arthroplasty (TKA). FOF can limit daily activities, reduce quality of life, and hinder recovery. This study aimed to investigate the prevalence, severity, and impacts of FOF in patients undergoing TKA and identify factors contributing to increased FOF. Methods: A prospective observational study was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, from April 2024 to December 2024. This study included 52 participants aged 20 to 75 years who had undergone primary TKA. Data were collected at two time points: after TKA and at three months post-surgery. The Short Falls Efficacy Scale-International (SFES-I) was used to assess the severity of FOF, and the Short Form 36 (SF-36) was used to measure the quality of life. Descriptive statistics, t-tests, and logistic regression were used for analysis. Results: This study included 52 participants (mean age: 63.77 ± 6.65 years; 82.7% female). Post-TKA, all participants exhibited high FOF (mean SFES-I score: 56.75 ± 8.30). After three months, the mean SFES-I score decreased significantly to 49.04 ± 12.45 (t = 4.408, p < 0.05). Post-TKA, SF-36 showed significant improvements in the physical function, role of physical limitations, bodily pain, vitality, social function, role of emotional limitations, and mental health subdomains. Bilateral total knee arthroplasty, body mass index, and some SF-36 subcomponents—such as general health, vitality, and role of emotional limitations—were identified as factors leading to increased FOF. Conclusions: FOF remains prevalent and severe in TKA patients, even at three months post-surgery, affecting rehabilitation outcomes. Early identification and tailored interventions for FOF should be considered essential components of comprehensive TKA recovery programs. Full article

Background: The long-term success of total knee arthroplasty (TKA) is often compromised by stress shielding, which can lead to bone resorption and even implant loosening. This study employs finite element analysis (FEA) to compare the stress-shielding effects of a knee prosthesis made from polyether ether ketone (PEEK) with a traditional titanium Ti6Al4V implant on an osteoporotic tibial bone model. Methods: Stress distribution and the stress-shielding factor (SSF) were evaluated at seven critical points in the proximal tibia under physiological loading conditions. Results: Results indicate that the PEEK prosthesis yields a more uniform stress transmission, with von Mises stress levels within the optimal 2–3 MPa range for bone maintenance and consistently negative or near-zero SSF values, implying minimal stress shielding. Conversely, titanium implants exhibited significant stress shielding with high positive SSF values across all points. Additionally, stress concentrations on the polyethylene liner were lower and more evenly distributed in the PEEK model, suggesting reduced wear potential. Conclusions: These findings highlight the biomechanical advantages of PEEK in reducing stress shielding and preserving bone integrity, supporting its potential use to improve implant longevity in TKA. Further experimental and clinical validation are warranted. Full article

Total knee arthroplasty is an extensive orthopedic surgery for patients with severe cases of osteoarthritis. This surgery restores the range of motion in the knee joint and allows for pain-free movement. Advancements in medical techniques used in the surgical zone and implant technology, as well as the management of operations and administration for around two decades prior, have hugely improved surgical outcomes for patients. In this study, advancements in TKA were examined through exploring aspects such as robotic surgery, new implants and materials, minimally invasive surgery, and post-surgery rehabilitation. This paper entails a review of the peer-reviewed literature published between 2005 and 2025 in the PubMed and Google Scholar databases. For predictors, we incorporated clinical relevance together with methodological soundness and relation to review questions to select relevant research articles. We used the PRISMA flowchart to illustrate the article selection system in its entirety. Since robotic surgical and navigation systems have been implemented, surgical accuracy has improved, there is an increased possibility of ensuring alignment, and the use of cementless and 3D-printed implants has increased, offering durable long-term fixation features. The trend in the current literature is that minimally invasive knee surgery (MIS) techniques reduce permanent pain after surgery and length of hospital stays for patients, though the long-term impact still needs to be established. There is various evidence outlining that the enhanced recovery after surgery (ERAS) protocols show positive results in terms of functional recovery and patient satisfaction. The integration of these new advancements enhances TKA surgeries and translates them into ‘need of patient’ procedures, ensuring improved results and increases in patient satisfaction. The aim of this study was to perform a comprehensive analysis of the existing literature regarding TKA advancement studies to identify current gaps and problems. Full article

Approximately 15% of total knee arthroplasty (TKA) patients remain dissatisfied after surgery, with joint line obliquity (JLO) potentially affecting patient outcomes. This study investigated whether JLO restoration influenced lower extremity frontal plane joint moments during stair negotiation by TKA patients. Thirty unrestored and twenty-two restored JLO patients participated in this study and were asked to perform five trials on each limb for stair negotiation while three-dimensional kinematics and ground reaction forces were recorded. Frontal plane moments at the ankle, knee and hip were calculated using Visual 3D. The restoration of JLO did not alter frontal plane joint moments during stair negotiation. Both groups showed symmetrical moment profiles, indicating no significant biomechanical differences between the restored and unrestored JLO groups. Restoring JLO did not affect frontal plane joint moments during stair negotiation, suggesting it may not contribute to patient satisfaction disparities post-TKA. Further research should explore other factors, such as surgical technique and implant design, that might influence recovery. Full article

Total Knee Arthroplasty (TKA) is a well-established surgical intervention for the management of end-stage knee osteoarthritis. While the procedure is generally successful, postoperative rehabilitation remains a key determinant of long-term functional outcomes. Traditional rehabilitation protocols, particularly those requiring in-person clinical visits, often encounter limitations in accessibility, patient adherence, and personalization. In response, emerging sensor technologies have introduced innovative solutions to support and enhance recovery following TKA. This review provides a thematically organized synthesis of the current landscape and future directions of sensor-assisted rehabilitation in TKA. It examines four main categories of technologies: wearable sensors (e.g., IMUs, accelerometers, gyroscopes), smart implants, pressure-sensing systems, and mobile health (mHealth) platforms such as ReHub^® and BPMpathway. Evidence from recent randomized controlled trials and systematic reviews demonstrates their effectiveness in tracking mobility, monitoring range of motion (ROM), detecting gait anomalies, and delivering real-time feedback to both patients and clinicians. Despite these advances, several challenges persist, including measurement accuracy in unsupervised environments, the complexity of clinical data integration, and digital literacy gaps among older adults. Nevertheless, the integration of artificial intelligence (AI), predictive analytics, and remote rehabilitation tools is driving a shift toward more adaptive and individualized care models. This paper concludes that sensor-enhanced rehabilitation is no longer a future aspiration but an active transition toward a smarter, more accessible, and patient-centered paradigm in recovery after TKA. Full article

Patients undergo total knee arthroplasty (TKA) at younger ages with the expectation that the devices will perform well over two to three decades. During this time, the ultra-high molecular weight polyethylene (UHMWPE) bearing material properties of the implant may change due to aging induced by radiation and oxygen diffusion or other effects. Vitamin E or other antioxidants are promoted since several years to improve the oxidation resistance of UHMWPE. To compare the effectivity of these substances against established materials, a six weeks aging process was used and the chemical, mechanical and bio-tribological properties were analysed. Highly crosslinked and two weeks aged UHMWPE served as a reference for the currently established aging standards and virgin UHMWPE was aged for six weeks to separate the effects of crosslinking and vitamin E blending. Six weeks artificially aging changed the chemical, mechanical and bio-tribological properties of cross-linked UHMWPE significantly compared to only two weeks artificially aging, leading to cracks and delamination during the highly demanding activities wear test. The degradative effect of extended aging was also observed for virgin UHMWPE. These observations are in good accordance to retrieval findings. Minor changes on the chemical properties were observed for the cross-linked UHWMPE blended with vitamin E without impact on the mechanical and bio-tribological properties. Full article

Whole-leg radiographs (WLRs) are widely used to assess coronal alignment before total knee arthroplasty (TKA), but may be inaccurate in patients with atypical morphotypes or malrotation. This study evaluated the discrepancy between WLR and 3D computed tomography (CT) scans across coronal plane alignment of the knee (CPAK) morphotypes and introduced a novel projection index—the femoral notch projection ratio (FNPR). In CPAK III knees, 19% of cases exceeded a clinically relevant threshold (>3° difference), prompting investigation of underlying projection factors. In 187 knees, coronal angles—including the medial distal femoral angle (MDFA°), medial proximal tibial angle (MPTA°), femoral mechanical angle (FMA°), and arithmetic hip–knee–ankle angle (aHKA°)—were measured using WLR and CT. Rotational positioning on WLR was assessed using FNPR and the patellar projection ratio (PPR). CPAK classification was applied. WLR systematically underestimated alignment, with the greatest bias in CPAK III (MDFA° + 1.5° ± 2.0°, p < 0.001). FNPR was significantly higher in CPAK III and VI (+1.9° vs. −0.3°, p < 0.001), indicating a tendency toward internally rotated limb positioning during imaging. The PPR–FNPR mismatch peaked in CPAK III (4.1°, p < 0.001), suggesting patellar-based centering may mask rotational malprojection. Projection artifacts from anterior osteophytes contributed to outlier measurements but were correctable. Valgus morphotypes with oblique joint lines (CPAK III) were especially prone to projection error. FNPR more accurately reflected rotational malposition than PPR in morphotypes prone to patellar subluxation. A 3D method (e.g., CT) or repeated imaging may be considered in CPAK III to improve surgical planning. Full article

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: Total knee arthroplasty (TKA) is an effective surgical intervention for end stage knee osteoarthritis in elderly patients, with emerging robotically assisted techniques aiming to enhance surgical precision and patient outcomes. This study aimed to compare medium-term balance and functional outcomes between robotically assisted and conventional manual TKA in community-dwelling elderly patients. Methods: This cross-sectional study included 50 elderly patients undergoing TKA, who were divided into robotically assisted (n = 25) and conventional manual (n = 25) groups. Demographic and clinical data, balance performance, and functional outcomes were compared at nearly 1.5 years postoperatively. Outcome measures included balance performance assessed by the Berg Balance Scale (BBS), pain via the Visual Analog Scale (VAS), knee function as measured by the Lysholm Knee Scoring Scale, quality of life using the Short Form-12 (SF-12), joint awareness as evaluated by the Forgotten Joint Score-12 (FJS-12), and surgical satisfaction. Results: The groups had similar demographic and clinical data regarding age, gender, follow-up duration, surgical time, and anesthesia type (p > 0.05). The robotically assisted group demonstrated better balance performance on the BBS (p = 0.043) and had a statistically shorter length of hospital stay (1.22 vs. 1.42 days; p = 0.005). However, no statistically significant differences were observed in VAS activity pain (p = 0.053), Lysholm Knee Scoring Scale (p = 0.117), SF-12 physical and mental scores (p = 0.174 and p = 0.879), FJS-12 (p = 0.760), and surgical satisfaction (p = 0.218). Conclusions: Robotically assisted TKA is associated with advantageous postoperative recovery, particularly in terms of balance performance, showing no clinical difference in other functional outcomes compared to the conventional manual technique. From a physical therapy perspective, these findings emphasize the importance of developing tailored and effective rehabilitation strategies in the medium term for functional recovery in the elderly population. Full article

Background and Objectives: Adequate bone quality is essential for promoting initial bone ingrowth and preventing early migration during cementless total knee arthroplasty (TKA). However, gold-standard criteria for identifying suitable bone strength have yet to be established. Dual-energy computed tomography (DECT)-based volumetric bone mineral density (vBMD) is an emerging tool for assessing bone quality. This study aimed to determine whether DECT-derived vBMD can accurately predict suitable bone strength for cementless TKA. Materials and Methods: A total of 190 patients undergoing primary TKA with a standardized posterior-stabilized implant were prospectively enrolled. Prior to TKA, DECT-derived vBMD was measured in the femoral box region. Actual bone strength was evaluated using an indentation test on resected femoral box specimens. Correlation and linear regression analyses were performed to assess the relationship between DECT vBMD and actual bone strength. Receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) calculations were used to determine the optimal cut-off value and diagnostic accuracy of DECT vBMD in identifying candidates suitable for cementless TKA. Results: DECT-derived vBMD exhibited a strong correlation with actual bone strength (correlation coefficient = 0.719, p < 0.01), while linear regression analysis revealed a moderate association (R² = 0.51, p < 0.01). In addition, it demonstrated excellent diagnostic performance in predicting adequate bone quality for cementless TKA, yielding an AUC of 0.984, with a sensitivity of 91.9% and a specificity of 92.0%. Conclusions: DECT-derived vBMD is a reliable and accurate tool for assessing bone strength around the knee and predicting the suitable bone quality for cementless TKA. Full article

Background: Proximal tibial fractures can lead to post-traumatic osteoarthritis (PTOA), and subsequent total knee arthroplasty (TKA) in such patients is associated with elevated complication rates. A two-stage approach, involving the elective removal of osteosynthetic hardware prior to TKA, is recommended. The utility of microbiological sampling from macroscopically unremarkable tissue during TKA implantation remains controversial. Objective: To retrospectively evaluate the rate of periprosthetic joint infection (PJI) following TKA after PTOA and to assess the potential benefit of intraoperative microbiological sampling. The secondary objective was to evaluate the presence of prior colonization in osteosynthetic hardware among the affected cases. Patients and Methods: A retrospective screening of the hospital database was conducted between 2008 and 2022, including only AO/OTA type 41-B and 41-C fractures. Patients were assigned to a sampling group (with microbiological sampling during TKA) or a control group (without sampling). All patients received structured follow-up to assess postoperative complications. Results: A total of 40 patients met the screening criteria. In the sampling group (n = 29), 17.24% required surgical revision, and the rate of PJI was 3.45%. In the control group (n = 11), 18.14% underwent revision surgery, with a PJI rate of 9.09%. The average follow-up period was 4.35 years (range 2–11.6 years). Discussion: TKA in patients with PTOA is associated with a heightened risk of complications. A noteworthy possible correlation between systematic microbiological sampling and reduced PJI incidence was observed. While the small sample size limits definitive conclusions regarding causality, the findings support the potential value of consistent intraoperative sampling. Full article

Background/Objectives: The importance of resistance training for functional recovery in Total Knee Arthroplasty (TKA) patients has been emphasized. Therefore, this systematic review and meta-analysis was conducted to analyze its effects on pain, muscle strength, and function in patients with TKA. Methods: The following databases were used: PubMed, Web of Science, the Cochrane Library, and Embase. Randomized controlled trials that administered resistance training to patients undergoing TKA and measured pain, strength, and function were included. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes were calculated using Hedges’ g and are presented as Standardized Mean Differences (SMDs) with 95% Confidence Intervals (CIs). Subgroup analyses were conducted to determine the effect size based on the type and duration of the intervention. Results: The study selection process resulted in the inclusion of seven studies comprising a total of 439 participants. The bias assessment found that three studies had a low risk of bias and four had some concerns. Resistance training was effective in improving pain (SMD: 0.84, 95% CI: 0.11; 1.57, I²: 89.6%), muscle strength (SMD: 1.03, 95% CI: 0.29; 1.77, I²: 83.1%), self-reported function (SMD: 1.58, 95% CI: 0.15; 3.01, I²: 93.1%), and performance-based function (SMD: 0.74, 95% CI: 0.38; 1.11, I²: 68.9%). Subgroup analysis revealed significant differences in pain, strength, and performance-based function by comparison group, performance-based function by intervention duration, and self-reported function by intervention type. Conclusions: Resistance training improves pain, muscle strength, and function in TKA patients. Additionally, resistance training appears particularly effective when implemented as a standalone intervention or for durations under 12 weeks. These findings suggest that the design of resistance training protocols should be considered in clinical practice. Full article

Background: Arthrofibrosis, mixed contracture, and patellofemoral impingement are frequent complications following total knee arthroplasty (TKA), potentially leading to chronic pain and poor recovery of range of motion (ROM). The comprehensive management of these complications remains challenging and controversial. Methods: This study analyzed the outcomes of arthroscopic arthrolysis performed in 27 patients diagnosed with arthrofibrosis, mixed contracture, and patellofemoral impingement post-TKA to evaluate the efficacy of this technique in improving knee function, enhancing ROM, and reducing pain, as assessed by the Knee Society Score (KSS). A total of 27 patients underwent arthroscopic arthrolysis following unsuccessful conservative rehabilitation. The arthroscopic procedure included removal of fibrous adhesions within the suprapatellar pouch, restoration of medial and lateral gutters, and lateral retinacular release of the patella. Intensive physiotherapy and continuous passive motion commenced immediately postoperatively. The mean follow-up period ranged from 24 to 60 months. Pain and functional outcomes were evaluated using KSSs. Results: Clinical improvements were evident in 26 cases, with the Knee Society Score rising from a preoperative average of 48 to 86, and pain scores improving from 30 to 41. Only one patient did not experience positive outcomes following the procedure. Arthroscopic arthrolysis appears beneficial for patients suffering from arthrofibrosis, patellofemoral impingement, and mixed contracture post-TKA, significantly improving clinical pain scores and KSS outcomes. Conclusions: Further research is recommended to refine specialized surgical instruments and enhance arthroscopic arthrolysis techniques. Full article

Introduction: Total knee arthroplasty (TKA) is a treatment for knee pain, but some patients are not satisfied with their outcomes. Utilizing shared decision making (SDM) can lead to better decisions, satisfaction, and fewer regrets. However, healthcare professionals have little knowledge of risk factors for regret. The aim of this study is to evaluate decisional regret using the Decision Regret Scale (DRS) after primary TKA among patients who engaged in SDM. Method: A total of 118 patients who underwent TKA surgery between March 2020 and May 2022 participated in this study, and they were able to reflect on their outcomes. The primary outcome was decisional regret assessed using the DRS, and the secondary outcome was post-operative pain at a three-month follow-up, measured using the Lequesne Index. Result: The study found that 49% of the patients reported no regret, 25% reported mild regret, and 26% reported moderate-to-severe regret. There was a significant correlation between greater levels of decision regret and a higher three-month Lequesne Index. Post-operative pain and post-operative mobility status and the range of motion of the knee joint were also strongly correlated. Conclusion: The study found that more than half of the patients undergoing primary TKAs experienced regret even following SDM counseling. Regret levels were associated with higher post-operative pain and poorer mobility. This underscores the importance of informing patients about potential adverse effects of TKA to manage their expectations and reduce regret in future SDM interviews. Practice implications: This study incorporated patient perspectives through their direct engagement in the SDM process prior to surgery. Patients participated in the design of the SDM framework, which included educational pamphlets and structured interviews to assess their values and preferences. Their involvement ensured that the SDM procedure was tailored to patient-centered outcomes. Furthermore, the follow-up assessments were conducted with patients to evaluate decisional regret and post-operative outcomes, providing valuable insights into the effectiveness of the SDM process. By actively participating in the research through decision making and outcome reflection, the patients contributed to the understanding of factors influencing decisional regret after undergoing TKA. Full article

(1) Introduction: Precise femoral component rotation is critical for achieving symmetric flexion-gap balance and physiologic patellofemoral tracking in mechanically aligned total knee arthroplasty (TKA). Surgeons often infer an appropriate rotational target from the patient’s coronal limb alignment, yet the strength of this relationship remains uncertain. (2) Methods: We identified 695 consecutive patients undergoing primary TKA with a preoperative planning CT scan. The surgical transepicondylar axis (sTEA) and posterior condylar axis (PCAxis) were identified and the angle between them was measured. The angle between the mechanical axis of the femur and tibia was used to measure the coronal alignment of the limb. (3) Results: The mean sTEA was 3.0° externally rotated to the PCAxis (range 3.1° internal to 9.2° external). The mean coronal alignment was 4.3° varus (range −12.5° valgus to 24.5° varus). There were 465 patients with >2° varus and 101 patients with >2° valgus. The mean sTEA was 2.9 ± 1.9° externally rotated relative to the PCAxis in the valgus group and 2.8 ± 2.0° in the varus group, with no statistically significant difference (p = 0.7). (4) Conclusions: There is significant variation in the femoral rotation axes between patients, but no significant relationship between overall limb coronal alignment and the magnitude of femoral rotation axes variation. This reinforces the need for independent assessment of rotational landmarks when performing mechanically aligned TKA. Full article