Search Results (338)

Background/Objectives: Despite its beneficial effect on the healing of bone fractures and in the treatment of osteoporosis, there is still a lack of evidence on the impact of clinical outcomes after a total joint arthroplasty (TJA). This review aims to establish the role of vitamin D in clinical outcomes after a total knee arthroplasty (TKA). Methods: In this review, PubMed, Scopus and Web of Science databases were cross-checked by two reviewers independently. The inclusion criteria were original human studies published in English from 2014 to 2024. For identification-relevant studies, the search terms used were as follows: “Vitamin D” and “total knee arthroplasty” or “total knee replacement” or “total joint arthroplasty” or “total joint replacement”. Case reports, letters and expert consensuses were excluded from the analysis. Finally, 19 studies were included in this review. Results: A literature review shows that vitamin D may have an impact on patients treated for osteoarthritis (OA) of the knee with a significant prevalence of hypovitaminosis in orthopedic patients. The influence was observed for periprosthetic joint infections: PJI patients have significantly lower vitamin D levels than primary ones. Also, a greater incidence of revision knee surgery due to PJIs in the deficient group compared to the non-deficient group at a one-year follow-up was found, of up to a 2-fold increase. This affects the clinical outcome with a lower Knee Society Score (KSS) functional score in the vitamin D-deficient group. Conclusions: The current data suggest that the vitamin D metabolism pathway and its implications in orthopedic patients, especially those treated with TKA surgery, may be a significant factor that improves clinical and functional outcomes. A possible relation between a low preoperative concentration of vitamin D and its impact on the outcomes, such as the length of the hospital stay, implant survival, and risk of complications, is needed to support these findings in multicenter, prospective studies and randomized controlled trials. Full article

Background: Lower-limb performance is commonly assessed using maximal strength, isokinetic, jump, and anaerobic power tests, but whether these assessments provide overlapping or complementary information in healthy young adults without recent regular resistance training remains unclear. Methods: This exploratory cross-sectional secondary analysis examined associations among lower-limb maximal strength, selected isokinetic knee-extension variables, countermovement jump (CMJ) flight time, and 6 s Wingate peak power in 30 healthy male university students. Maximal dynamic strength was assessed using one-repetition maximum (1RM) tests for leg press, leg extension, and leg curl. Isokinetic knee function was evaluated using 60°/s knee extension peak torque and 180°/s knee extension total work. Pearson correlations, body-mass-adjusted partial correlations, and exploratory regression models were performed. Results: Leg press 1RM was strongly correlated with 6 s Wingate peak power, but not with CMJ flight time, in the zero-order analysis. After body-mass adjustment, leg press 1RM was associated with both outcomes. In exploratory regression models, leg press 1RM showed the most consistent associations, whereas the selected isokinetic variables showed less consistent relationships. Conclusions: In this exploratory sample, leg press 1RM showed the most consistent associations with the two performance outcomes examined, particularly 6 s Wingate peak power. The selected isokinetic knee-extension variables appeared to provide more joint-specific information. These findings should be interpreted as sample-specific associations, not as evidence that one test can predict or replace another. Full article

Perioperative anaphylaxis, though rare, is a potentially life-threatening complication. While antibiotics and neuromuscular blocking agents are common triggers, benzodiazepine-induced reactions have been considered uncommon. Remimazolam, a novel benzodiazepine sedative, has gained widespread use in Korea due to its rapid onset, short recovery, hemodynamic stability, and availability of flumazenil. However, increasing utilization has coincided with rising reports of hypersensitivity. We report the case of a 62-year-old female undergoing contralateral total knee replacement under spinal anesthesia. Continuous remimazolam infusion was initiated, but within ten minutes the patient developed chest discomfort followed by abrupt hypotension and oxygen desaturation, requiring urgent conversion to general anesthesia. Following a remimazolam bolus and rocuronium administration, sudden cardiac arrest occurred. Return of spontaneous circulation (ROSC) was achieved after approximately 28 min of cardiopulmonary resuscitation with a cumulative intravenous epinephrine dose of approximately 17 mg, and veno-arterial extracorporeal membrane oxygenation (ECMO) was required. Post-ROSC transesophageal echocardiography demonstrated a transient anteroseptal regional wall motion abnormality; subsequent coronary angiography demonstrated no significant coronary disease, and computed tomography pulmonary angiography was negative for embolism, leaving acute hypersensitivity as the most plausible mechanism. Acute serum tryptase was elevated at 11.6 µg/L and normalized to 3.4 µg/L (the patient’s individual baseline) prior to discharge, satisfying the World Allergy Organization (WAO) criterion. A skin prick test performed four weeks later was positive for remimazolam and negative for rocuronium and the other coadministered agents. An expanded multi-database literature review identified 16 prior cases of remimazolam-induced anaphylaxis. Most described cardiovascular collapse as the predominant manifestation. To our knowledge, based on available literature, this is among the first reports of remimazolam-induced anaphylaxis occurring in the setting of high spinal anesthesia with sympathetic blockade. Vigilance and adherence to established anaphylaxis management guidelines are essential. Full article

Background: Total knee arthroplasty in patients with hemophilia remains the most effective surgical intervention for end-stage hemophilic arthropathy, yet it poses unique surgical and perioperative challenges that are rarely encountered in standard osteoarthritis cases. This article synthesizes technical, anatomical, and perioperative considerations specific to hemophilic patients and integrates prospective clinical data derived exclusively from the hemophilic cohort of our long-term study (twenty patients, twenty knees; 2015–2024). Emphasis is placed on deformity correction, bone loss management, implant selection, hemostatic strategies, transfusion patterns, and perioperative pitfalls. The objective is to provide a comprehensive narrative reference for surgeons managing complex hemophilic knees, consolidating both evidence-based recommendations and practical perioperative “tips and tricks” accumulated across more than a decade of clinical experience. Methods: This prospective observational study evaluated twenty consecutive male patients with hemophilia who underwent primary total knee arthroplasty for advanced hemophilic arthropathy between 2015 and 2024 at our institution. The following variables were collected: operative time measured from skin incision to skin closure, postoperative transfusion requirement, length of hospitalization measured in days, early postoperative complications, and functional recovery as assessed by the Knee Society Score. Early complications included postoperative bleeding or hematoma, superficial or deep infection, and stiffness requiring intensive physiotherapy or manipulation under anesthesia. Results: The mean age at the time of surgery was 44.8 years with a standard deviation of 7.2 years, ranging from 31 to 59 years. The mean operative time in the hemophilic cohort was 154.54 min with a standard deviation of 18.36 min. The range of operative time was from 120 to 180 min. Nine of the twenty patients, representing 45 percent, required postoperative blood transfusion. The mean length of hospital stay in the hemophilic cohort was 12.3 days with a standard deviation of 2.38 days, ranging from 9 to 17 days. The mean Knee Society Score improved from 38 points preoperatively to 82 points at final follow-up, representing a mean increase of 44 points. Conclusions: Total knee arthroplasty in hemophilic patients is safe and effective when specialized surgical techniques, comprehensive synovectomy, precise deformity correction, optimized hemostasis, and structured postoperative coagulation factor replacement are implemented. Functional outcomes and prosthetic survival are excellent in experienced centers. Full article

Background: Periprosthetic joint infections (PJIs), a significant complication of total knee replacement surgery, are influenced by patient, surgeon, and healthcare system factors. Natural disasters can disrupt healthcare services and alter microbiological factors in the hospital environment. The impact of natural disasters on pathogen distribution in periprosthetic joint infection (PJI) is unclear. Therefore, this study investigated the association between the 2023 Kahramanmaraş-centered earthquakes in Türkiye and changes in microbiological patterns of PJI after knee arthroplasty. Methods: This retrospective cohort study included patients who developed PJI following total knee arthroplasty at the study center. The patients were divided into two groups based on the timing of their PJI diagnosis: pre-earthquake and post-earthquake. The demographic characteristics, comorbid diseases, and perioperative characteristics of each patient were recorded, and their microbiological profiles were analyzed. Logistic regression analysis examined the relationships between patient-related factors and causative agents. Results: 56 patients were studied and divided into two groups: 26 patients in the pre-earthquake group and 30 in the post-earthquake group. Furthermore, 79 bacterial isolates were obtained from these patients. Demographic, metabolic, and preoperative characteristics were similar between the two groups. No significant difference was found in the overall distribution of bacterial isolates. However, Gram-negative organisms, primarily Acinetobacter baumannii and Pseudomonas aeruginosa, increased in the isolate distribution after the earthquake. Patient analysis revealed that polymicrobial PJIs were significantly more frequent after the earthquake (56.7% vs. 23.1%; p = 0.011). Diabetes mellitus (DM) and smoking were associated with an increased risk of polymicrobial infection; the association was not statistically significant. Conclusions: In the post-earthquake period, patients who had undergone total knee arthroplasty and developed PJI showed a higher proportion of polymicrobial infections and a numerical increase in Gram-negative pathogens, along with more complex infection patterns compared to the pre-earthquake period. Although both patient groups demonstrated similar characteristics regarding patient-related and surgical factors, the observed changes indicate that the pressure on the healthcare system after a natural disaster can affect a hospital’s microbiological ecology. Identifying these indirect effects is crucial for guiding microbiological surveillance and infection control during post-disaster recovery periods, even for elective patients. Full article

Background: Early recovery after total hip (THA) and total knee arthroplasty (TKA) is often limited by pain and impaired antigravity function. Mechano-acoustic vibration therapy (VT) may enhance neuromuscular activation and analgesia, but evidence in arthroplasty is scarce. Methods: A total of 380 patients aged ≥65 years were retrospectively identified within 3 ± 1 days after primary unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA). All patients underwent standard inpatient physiotherapy; in the VT group, mechano-acoustic vibration therapy (ViSS^®, 30 min/day for 5 days at 200–300 Hz) was added as an adjunct treatment, whereas the control group received standard physiotherapy alone. Pain (VAS, McGill), muscle strength (MRC), thigh circumferences, and 10 s Sit-to-Stand were assessed at baseline (T0), end of treatment (T1), and 3-day follow-up (T2). Results: VT produced large, early and sustained improvements in both cohorts. In THA patients, VAS decreased from 7.1 ± 1.1 to 3.8 ± 0.6 at T1 and 3.0 ± 0.7 at T2 and Sit-to-Stand repetitions increased from 3.7 ± 1.9 to 6.3 ± 1.7 at T2, with significant gains in strength and circumferences. TKA VT patients showed similar patterns. Control groups reported smaller pain reductions and no clinically relevant changes in the reported outcomes. Conclusions: integrating a short cycle of mechano-acoustic VT into early inpatient rehabilitation after THA or TKA significantly enhances pain relief and restoration of antigravity function compared with standard physiotherapy alone. VT represents a promising adjunct to conventional rehabilitation strategies and may contribute to optimizing postoperative recovery pathways in major joint replacement. Full article

Background/objectives: Total knee arthroplasty is one of the most commonly performed orthopedic procedures of the lower extremities, primarily for patients with osteoarthritis or rheumatoid arthritis. Despite its widespread use, evidence remains limited regarding the association between patient satisfaction, kinesiophobia, and pain during the early postoperative period. The purpose of the present study was to examine the relationships and differences among satisfaction, kinesiophobia, and pain in hospitalized patients following total knee arthroplasty, as well as to compare these variables across four postoperative time points. Methods: A total of 41 patients, aged 65–85 years, participated in this study. Patient satisfaction was assessed using a structured satisfaction questionnaire, kinesiophobia was assessed using the Greek version of Tampa Scale of Kinesiophobia, and pain was assessed using the Visual Analogue Scale. Measurements were obtained on the first postoperative day, on the day of hospital discharge, fifteen days after discharge, and four weeks after discharge. Normality was assessed using the Shapiro–Wilk test, indicating non-normally distributed data. The relationship between the variables were examined using Spearman’s correlation coefficient. Comparisons between the four postoperative time points were conducted using the Friedman test with Kendall’s W for effect size estimation, followed by Wilcoxon post hoc analyses with Bonferroni corrections. Results: The results showed that a significant negative correlation between satisfaction and kinesiophobia was observed at the fourth phase (r = −0.41, p = 0.04). Satisfaction was also negatively correlated with pain from the third to the fourth phase (r = −0.41, p = 0.008), whereas kinesiophobia demonstrated a significant positive correlation with pain from the second to the fourth phase (r = 0.47–0.56, p = 0.002). Friedman test comparisons revealed a significant increase in satisfaction over time (χ² (3) = 13.88, p = 0.003), a significant progressive decrease in kinesiophobia with a moderate effect size (χ² (3) = 76.40, p < 0.001; Kendall’s W = 0.62), and a significant progressive reduction in pain with a large effect size (χ² (3) = 89.60, p < 0.001; Kendall’s W = 0.73). Conclusions: These findings indicate that satisfaction, kinesiophobia, and pain are significantly interrelated during the early postoperative period following total knee arthroplasty. Further studies with larger samples and longer follow-up periods are required to confirm these associations and support the development of targeted rehabilitation strategies. Full article

Background: Medial-compartment knee osteoarthritis (KOA) carries substantial disability and long-term cost. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are key joint-preserving or joint-replacing options for selected patients, but their comparative economic ranking remains uncertain. Methods: This critical narrative review synthesized comparative economic evidence on HTO versus UKA for isolated medial-compartment KOA. PubMed and Web of Science were searched as primary sources for English-language studies published from 1 January 2000 to 15 January 2026, while Google Scholar and citation tracking were used supplementarily to identify potentially missed records. Eligible studies were direct economic evaluations or comparative cost/resource studies with clear decision relevance to the HTO–UKA choice. Burden and cost-of-illness studies were used for contextual framing only and were not included in the core comparative synthesis. Results: The direct evidence base was small and methodologically heterogeneous and was dominated by decision-analytic models that differed in perspective, time horizon, utility metric, and assumptions regarding reoperation, revision, and conversion to total knee arthroplasty (TKA). These structural differences largely explain why a U.S. lifetime societal model favored HTO, a UK age-stratified 10-year model produced age-dependent findings, and a recent Canadian public-payer model favored UKA. Observational studies suggest that UKA episode costs can fall substantially in outpatient or ambulatory pathways, whereas HTO costs may rise when reoperations and technique-specific resource use are explicitly captured. Conclusions: Current evidence does not support a context-free economic ranking of HTO and UKA. Because the available studies are heterogeneous and incremental utility differences are often small, the findings should be interpreted cautiously and as scenario-dependent rather than definitive. Future comparative analyses should use contemporary pathway data, transparent and standardized costing, and explicit downstream event definitions for both procedures. Full article

Background: Total knee arthroplasty (TKA) is a common procedure aimed at alleviating knee pain and restoring function in patients with degenerative joint diseases. Traditional implants are typically designed to restore mechanical knee alignment, but personalized implants have shown promise in improving clinical outcomes. The Origin^® individualized TKA system provides a tailored approach to knee reconstruction by utilizing preoperative 3D planning to create individualized implants and cutting guides based on each patient’s unique anatomy. Surgical Technique: The Origin^® system employs a preoperative computed tomography (CT) scan and Knee-Plan^® software to design individualized implants that optimize alignment and joint anatomy. The surgical technique involves the use of patient-specific cutting guides for precise bone resections and the insertion of either cruciate-retaining (CR) or posterior-stabilized (PS) implants, depending on individual patient needs. This process aims to replicate the pre-arthritic alignment and kinematics of the pre-arthritic knee. Postoperative Protocol: The postoperative protocol allows for immediate weight-bearing, and patients are guided through a structured rehabilitation program to ensure optimal recovery. Full range-of-motion exercises begin early to promote knee mobility and strength. Discussion: The individualized TKA system offers several advantages, including precise restoration of pre-arthritic anatomy, reduced bone resection, and improved implant fit. These benefits are particularly valuable in patients with unique anatomical challenges, such as deformities or previous surgeries. Despite the potential advantages, challenges remain, including the costs and time associated with individualized manufacturing, as well as increased radiation exposure from the required CT scans. Conclusions: The Origin^® individualized TKA system represents a significant advancement in knee arthroplasty by providing a tailored approach to patient care. Future studies are needed to further evaluate the long-term outcomes and cost-effectiveness of this personalized system compared to conventional TKA approaches. Full article

Background/Objectives: Knee joint instability is frequently reported in individuals with knee osteoarthritis (OA) and may persist after total knee replacement (TKR), where it represents a leading cause of revision. However, neuromuscular factors associated with knee instability remain poorly understood. This systematic review and meta-analysis aimed to compare neuromuscular characteristics between individuals with stable and unstable knees in OA and TKR populations. Methods: PubMed, CENTRAL, Scopus, and EMBASE were searched from inception to 10 January 2025. Studies comparing neuromuscular outcomes between stable and unstable knees were included. Neuromuscular parameters included: muscle strength, muscle power, muscle activation pattern, and joint stiffness. Where appropriate, pooled standardized mean differences (SMD) were calculated using random-effects models. Certainty of evidence was evaluated using the GRADE approach. Results: Nineteen studies (16 OA, 3 TKR; n = 7369 participants) were included, with eleven studies eligible for meta-analysis. OA individuals with unstable knees demonstrated significantly lower limb muscle strength compared with stable counterparts (SMD = −0.49, 95% CI −0.81 to −0.16, p = 0.003). Muscle co-contraction did not differ significantly between groups (SMD = 0.12, 95% CI −0.70 to 0.94, p = 0.77). The overall certainty of evidence was rated as very low. Conclusions: Knee instability in OA populations is associated with reduced lower limb muscle strength, although evidence quality is limited and findings regarding neuromuscular control strategies remain inconclusive. Evidence in TKR populations is scarce. Future studies should investigate muscle activation patterns and dynamic joint stabilization during functional tasks to clarify the neuromuscular mechanisms underlying knee instability. Full article

Background and Objectives: Hip and knee replacement joint surgeries are experiencing constant growth, and anticipating future needs allows decision-makers and stakeholders involved in the healthcare system to allocate the necessary resources for safe and effective services. The objective of this study is to estimate the volumes of primary and revision hip and knee surgeries expected to be performed in Romania by 2060. Materials and Methods: We used data from the Romanian Arthroplasty Register regarding the total volume of primary hip replacement surgery (cumulative n = 51,252 across five years), hip revision surgery (cumulative n = 3579), primary knee replacement surgery (cumulative n = 32,283), and knee revision surgery (cumulative n = 943) performed in 2017–2019, 2023 and 2024—the last five years of complete registrations, excluding the pandemic period. We projected future numbers of hip and knee primary and revision surgeries using the arithmetic mean of annual procedure rates observed during the study period, combined with the average annual trend in these rates. Projections were stratified by age group (0–39, 40–49, 50–59, 60–69, 70–79, and ≥80 years) and sex and were applied to population forecasts from the National Institute of Statistics of Romania up to 2060. Results: By 2060, primary hip replacement surgery volumes will increase by 40.14% relative to 2024 levels (from 13,526 in 2024 to 18,965 in 2060), and primary knee replacement surgery volumes will increase by 79.78% (from 9003 in 2024 to 16,186 in 2060). Revision hip surgery volumes will increase by 42.02% (from 759 in 2024 to 1078 in 2060), and revision knee surgery volumes will increase by 109.25% (from 227 in 2024 to 475 in 2060). The largest relative increases are concentrated in patients aged ≥80 years, with projected growth substantially exceeding those in younger age groups across all procedure types and both sexes. These percentages represent the projected growth in procedure volumes for this age group compared with 2024 baseline volumes. Conclusions: By 2060, we project substantial increases in all arthroplasty procedure types in Romania, with the most pronounced growth among patients aged ≥80 years. Given that resource utilization and morbidity are higher in this population, the increased demand for medical interventions requires advance planning, which will have significant implications for the healthcare system. Full article

Background: Medical progress and sustainability pressures have made reducing hospital Length Of Stay (LOS) for total joint arthroplasty increasingly feasible and necessary. Monitoring rehabilitation duration and outcomes after surgical ward discharge needs equal attention. The aim of this retrospective, cohort study is to evaluate perioperative predictors of Inpatient Rehabilitation LOS (IRLOS), Discharge Destination (DD) (home versus residential care unit) and Need for Assistance at Discharge (NAD), in patients undergoing inpatient rehabilitation after total hip or knee arthroplasty in a high-volume, specialized research hospital. Methods: Electronic hospital datasets were employed to identify all adults with hip or knee osteoarthritis who received specialistic inpatient rehabilitation after total joint replacement between January and December 2019. Associations between demographic, clinical, surgical and functional variables and postoperative outcomes were examined using binary logistic regression for dichotomous outcomes (DD, NAD) and linear regression for continuous outcomes (IRLOS). Results: Based on a cohort of 1679 patients, we found various patient-related (age, working status, living alone, pre-existing comorbidities, osteoarthritic characteristics), surgical (duration of intervention, LOS, joint approach) and postoperative (hemoglobin levels, functional status) predictors. Overall, the regression models explained a modest but meaningful proportion of the variability in rehabilitation duration and post-discharge outcomes (R² ranging from 0.12 to 0.34), resulting in marginal changes compared to a preliminary version of the same study on a smaller dataset. Conclusions: External validation on another cohort from the same hospital could be used to test the model’s predictivity at the local level, supporting the continuity of care between an orthopedic hospital hub and outpatient care and rehabilitation. Gains in predictive capacity may follow from including local factors like the operating surgeon and team. Although these factors could significantly improve the model performance at the local level, they would not be generalizable in different settings. Full article

Background/Objectives: Total knee arthroplasty (TKA) is often associated with extensive bleeding and the need for intraoperative and postoperative blood transfusions. Due to concern about the risks associated with them, a push has been made in surgery toward the development of new intraoperative blood management devices and innovative postoperative care strategies. Tranexamic acid (TXA), fibrin sealant and standard electrocautery are widely used in orthopedic surgery, since several studies provided evidence about their efficacy and safety. A new device, the bipolar sealer system (BSS), provides hemostasis at lower temperature (<100°) than conventional electrocautery. It does not produce smoke, necrosis or burn tissue. Methods: In this study, we retrospectively analyzed data from 480 patients who underwent TKA between January 2017 and December 2024. The cohort was divided into two groups based on the hemostatic protocol adopted. The control group enrolled 240 patients who received the standard protocol with TXA and fibrin sealant, while the study group enrolled 240 patients who followed protocol with Aquamantys BSS and TXA. Hematological parameters, including hemoglobin (Hb), hematocrit (HCT) and red blood cells (RBCs) were analyzed preoperatively (T0) and postoperatively: immediately after surgery (T1), at day one (T2) and day three (T3). Results: Changes in hemoglobin from baseline to postoperative follow-up were significantly lower among patients who received TXA plus BSS and those receiving TXA plus fibrin sealant, with p-values of 0.0003 at T1 (immediately after surgery), 0.027 at T2 (one day post-op), and 0.0001 at T3 (three days post-op). Comparable results were observed for HCT and RBC values. Conclusions: These data demonstrate that Aquamantys is more effective than fibrin glue in controlling blood loss after knee replacement surgery, not only immediately after the procedure but also in the following days. Full article

Smart knee replacement technology seeks to provide an in vivo method of tracking long-term postoperative joint loads with the goal of identifying clinically relevant phenomena linked to postoperative dissatisfaction in real time. This study evaluated the ability of a piezoelectric compartmental force and compartmental center of pressure sensing total knee replacement to sense condylar lift-off, which is a clinically relevant phenomenon commonly attributed to postoperative dissatisfaction. A commercially available total knee replacement was modified to include six piezoelectric transducers capable of measuring compartmental forces and tibiofemoral centers of pressure on the articular surface of the tibial bearing insert. The smart knee replacement was evaluated with a six-degree-of-freedom joint motion simulator applying a varus lift-off profile. The study demonstrated that the lift-off was evident in both the sensed joint loads and the localized tibiofemoral centers of pressure obtained from the piezoelectric sensing system. The results indicated that the piezoelectric smart knee replacement could be effective for detecting this clinically problematic mechanical issue. Full article

Background: Knee arthrodesis markedly alters lower limb biomechanics and creates a challenging scenario when associated with end-stage ankle osteoarthritis. No prior reports have specifically described treatment with total ankle replacement (TAR) in the presence of an ipsilateral fused knee. This study evaluated the feasibility and mid-term outcomes of TAR in this rare condition. Methods: Two patients with post-traumatic end-stage ankle osteoarthritis and long-standing knee arthrodesis underwent TAR using a lateral transfibular approach with a Zimmer Trabecular Metal™ implant. Surgical planning aimed to restore coronal and sagittal alignment. Postoperative management and rehabilitation were specifically adapted to the absence of knee motion, with emphasis on gait re-education. Clinical and radiographic follow-up was performed up to 36 months. Results: At final follow-up, both patients showed substantial pain reduction, improved ankle range of motion, and recovery of a stable, functional gait compatible with knee fusion. Imaging demonstrated well-aligned, stable components without loosening or subsidence. No major complications or reoperations occurred. Conclusions: Lateral transfibular TAR appears feasible and effective for end-stage ankle osteoarthritis in patients with ipsilateral knee arthrodesis, preserving ankle motion and supporting functional ambulation in this complex setting. Full article