Search Results (135)

Total knee replacement (TKR) is a common procedure for pain relief and restoration of the mobility of the knee joint in patients with severe knee joint problems. Despite this, some patients still suffer from stiffness, instability, or pain caused by soft tissue imbalance, malalignment, or implant-related issues. Previously, surgeons have had to use their experience and visual judgment to balance the knee, which has resulted in variability of outcomes. Smart knee implants are addressing these issues by using sensor technology to provide real-time feedback on joint motion, pressure distribution, and loading forces. This enables more accurate intra-operative adjustment, enhancing implant positioning and soft tissue balance and eliminating post-operative adjustment. These implants also enable post-operative monitoring, simplifying the ability to have more effective individualized rehabilitation programs directed at optimizing patient mobility and minimizing complications. While the patient pool for smart knee implantation remains not commonly documented, it was found in a study that 83.6% of the patients would opt to have the monitoring device implemented, and nearly 90% find reassurance in monitoring their healing indicators. As the number of knee replacements is likely to rise due to aging populations and the rising prevalence of joint disease, smart implants are a welcome development in orthopedics, optimizing long-term success and patient satisfaction. Smart knee implants are built with embedded sensors such as force, motion, temperature, and pressure detectors placed within the implant structure. These sensors provide real-time data during surgery and recovery, allowing earlier detection of complications and supporting tailored rehabilitation. The design aims to improve outcomes through better monitoring and personalized care. Full article

Background: Total Hip Replacement (THR) is a standard treatment for advanced hip osteoarthritis; yet, its effects on gait recovery remain understudied. This study examines gait pattern changes in women undergoing monitored rehabilitation after unilateral THR, using Statistical Parametric Mapping (SPM) to detect significant motion differences over time. Methods: This longitudinal study included 32 women who underwent primary cementless THR. Gait was assessed preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 12 months using a motion analysis system. Repeated measures ANOVA and post hoc SPM{t} analyses were conducted to evaluate significant gait changes across time points. Results: Significant improvements (p < 0.05) were observed in spatio-temporal parameters. Velocity increased from 0.42 ± 0.10 m/s (Ex1) to 0.72 ± 0.06 m/s (Ex5), stride length from 0.85 ± 0.12 m to 1.15 ± 0.07 m, and step length (involved leg) from 0.32 ± 0.08 m to 0.48 ± 0.05 m. Cycle time decreased from 1.50 ± 0.20 s to 1.22 ± 0.10 s, indicating improved gait efficiency. Post hoc SPM{t} analysis revealed significant kinematic changes in hip flexion-extension, knee flexion, and pelvic tilt, particularly between Ex2 and Ex3. Statistically significant improvements (p < 0.001) were observed in key spatio-temporal parameters. Conclusions: Gait parameters improved significantly within the first year post-THR, with the most pronounced changes occurring between the early and mid-term recovery phases. These findings support the need for targeted rehabilitation strategies in the first six months post-surgery. SPM analysis provides a robust method for detecting subtle gait adaptations, contributing to the refinement of post-THR rehabilitation strategies. Full article

Background: Ferrous metals are used extensively in the manufacturing of plates, pins, Kirschner wires (K-wires), and screws, and in the performance of partial and total joint replacement surgeries for the shoulder, elbow, and wrist joints. The primary surgical procedures commonly performed are hip and knee replacement surgeries. Metals possess a combination of high modulus, yield point, and ductility, rendering them well suited for load-bearing applications, as they can withstand significant loads without experiencing substantial deformations or permanent alterations in their dimensions. Application of metals and alloys is of prime importance in orthopedics as they lead the way to overcoming many issues encountered in implant use. In some instances, pure metals are used, but alloys consisting of two or more elements typically exhibit greater material characteristics, including corrosion resistance as well as toughness. The first item to address when selecting a metallic implant material is its biocompatibility. In this regard, three classes of materials are also commonly known as biomedical metals—316L stainless steel, pure titanium, and titanium alloys. Objective: The aim of this work is to create a model describing the material behavior and then simulate the metals under a load of 2300 N, which is equivalent to plastic loading. Methods: Under ten different case studies, a sub-routine was developed to combine the material characteristics of titanium and 316L stainless steel with the software. Results: The outcomes of the research were then investigated. A femur model was created using ANSYS software, and two materials, stainless steel and titanium, were used. The model was then exposed to a force of 2300 N. Full article

Objective: To evaluate the effect of preoperative intra-articular injection of bupivacaine and adrenaline (BAD) on blood loss and postoperative hemoglobin levels in primary total knee replacement. Methods: We retrospectively assessed 38 consecutive patients who underwent primary total knee arthroplasty at our institution between 2018 and 2019, as performed by two chief orthopedic surgeons. The study group included 22 patients who received an intra-articular injection of 40 mL solution of BAD 0.25% preoperatively. The control group included 16 patients who did not receive the BAD injection preoperatively. Both groups received an IV tranexamic acid (TXA) 1 g treatment prior to the first incision. The posterior capsule and soft tissues were infiltrated after femoral chamfer cuts with a 60 mL BAD solution in both groups. Blood loss was evaluated in all patients by measuring the volume collected in the suction container before the first irrigation and prior to cementation. Additional assessments included the volume of blood drained during the first 24 h postoperatively, as well as changes in hemoglobin levels (delta hemoglobin) 24 h after surgery and at hospital discharge. Results: The study and the control groups were similar in age, sex, demographics, and comorbidities. The mean patient age was 71.4 ± 6.5 in the injected group and 70.6 ± 7.5 in the control group. The volume of blood suctioned during surgery was significantly lower in the study group compared to the control group (201 ± 84.3 mL vs. 261.25 ± 83.3 mL; p = 0.04). Similarly, the amount of blood drained within the first 24 h postoperatively was also reduced in the study group (204.3 ± 91.1 mL vs. 363.44 ± 131.9 mL; p = 0.0001). Ultimately, the decrease in hemoglobin levels from baseline to discharge was less pronounced in the study group compared to the control group (1.7 ± 0.9 g/dL vs. 2.44 ± 1.3 g/dL; p = 0.038). Conclusions: Intra-articular injection of 40 mL bupivacaine and 0.25% adrenaline solution before skin incision may reduce intraoperative and postoperative blood loss among patients undergoing total knee arthroplasty. Full article

This perspective work focuses on the transformative role of robotics in orthopedic surgery, enhancing precision and efficiency. It details the evolution of robotic systems such as ROBODOC, Mako, and Da Vinci, outlining their contributions to procedures such as total knee and hip replacements. It also discusses future trends, including the integration of AI, augmented reality, personalized implants, and the potential for telesurgery. Challenges such as high costs, the learning curve, and regulatory concerns are noted, but the field is poised for significant growth and innovation in orthopedic care. Full article

Background and Objectives: Total hip replacement and total knee arthroplasty carry a high risk of postoperative venous thromboembolism (VTE); therefore, anticoagulation prophylaxis is recommended in these patients. Unfortunately, there are no guidelines about VTE prophylaxis in patients with hemophilia who underwent these high-risk surgeries. To determine whether these patients have a high risk of VTE, we conducted a retrospective study on patients with hemophilia who underwent elective arthroplasty at our hospital in 2016. Materials and Methods: There were 11 patients with hemophilia A and B who underwent high-risk surgeries. Recombinant factor VIII or IX and also active recombinant Factor VII were used for perioperative hemostasis, and LMWH was administered for thromboembolic prophylaxis. Postoperatively, we collected information on the duration of factor VIII/IX infusion, VTE-prophylaxis, and complications. Results: Postoperative bleeding was minimal in most cases, with an average blood loss of 500 mL. No major thrombotic events were reported, and the need for transfusion was low, with only one patient requiring additional blood products. The VTE prophylaxis included prophylactic enoxaparin and hemostatic treatment. At the 1-year follow-up, we did not find any evidence of clinical VTE in our patients. Conclusions: Better risk stratification is needed to identify patients who would benefit from pharmacological prophylaxis. Total arthroplasty in hemophilic patients is feasible and safe when managed by a multidisciplinary team and supported by tailored antithrombotic prophylaxis protocols. The use of recombinant coagulation factors and LMWH ensures effective bleeding control and thromboembolic prevention, enhancing patient outcomes. These findings underscore the importance of individualized care in this high-risk population. Full article

Background: Robotic assistance is considered capable of improving precision and outcomes of total knee replacement. We assessed the inherent biases, pre-procedural planning accuracy using 2D to 3D X-Atlas^®, and final knee axis outcomes of the ROSA^® Knee System (Zimmer Biomet, Warsaw, IN, USA). Methods: A total of 55 patients who underwent robotic-assisted knee replacement using ROSA^® Knee System (Zimmer Biomet, Warsaw, IN, USA) at a single center were included. Pre-procedural measurements performed by ROSA were compared to those performed by senior consultants. Component sizes predicted by ROSA^® were compared to those implanted. A final axis measurement was taken during the procedure. Results: Femur components were exactly matched in (83.64%) cases, accurately matched in a further 8 (14.55%), and inaccurately matched for only 1 (1.82%). Tibial component sizes were exactly matched by the planning for 39 (70.91%), accurately for 12 (21.82%), and inaccurately for 4 (7.27%). ANOVA did not show statistically significant differences between the predicted and implanted femur (p = 0.96) nor the tibia components (p = 0.27). We show that ROSA^® pre-procedural planning has a statistically significant bias (p = 0.001), with a deviation of 0.83 degrees into varus, when assessing the knee axis in the coronal plane, compared to senior consultant measurements. The average of the final coronal knee axis was 0.37 degrees in varus (SD = 2.49). Conclusions: ROSA^® accurately predicts implanted component sizes. Despite the small and statistically significant varus bias in initial knee axis assessment, the system results lay within the ±3° of neutral knee axis, which is the widely accepted knee replacement standard. Full article

Introduction: The prosthetic knee infection (PKI) rate in most centers ranges from 0.5 to 2% for knee replacements, depending on risk factors. Current PKI definitions may miss the identification of both early and late complications. There is no consensus on preventive or early empiric antibiotic therapy (EEAT) in the one-step exchange strategy for low-risk patients pending microbiology results. The aim of the study was to evaluate the potential role of EEAT in patients with comorbidities in preventing PKI and to evaluate differences in septic failure at 3, 6 and 9 months after prosthetic revision between patients undergoing EEAT and patients not undergoing EEAT. Methods: All adult patients undergoing one-step knee revision surgery at IRCCS Sacro-Cuore Don Calabria Negrar, from January 2018 to February 2021, were retrospectively included in a cohort observational study. Patients on antibiotic therapy before surgery or with preoperative ascertained PKI were excluded. Demographic characteristics, Charlson score, comorbidities, inflammatory markers, microbiological tests, imaging, infectious disease risk score and EEAT data were collected. Any postoperative complication or modification of antibiotic therapy at 14, 30, 90, 180 and 270 days after surgery was collected. Results: A total of 227 patients were included: 114 comorbid low-risk patients received EEAT after surgery, pending microbiological results; while 113 non-comorbid low-risk patients did not receive any antibiotic therapy in the postoperative period. Among the EEAT group, 16 were diagnosed with PKI, compared with 10 in the untreated group. Regarding septic failure during the 9-month follow-up after revision surgery, we registered nine cases in the EEAT arm and four in the untreated arm. In three out of nine cases treated with EEAT who had a post-revision septic failure, the causative microorganism was not successfully empirically targeted by EEAT; in the untreated group, two out of four cases had a post-revision septic failure, despite the targeted treatment of intraoperatively identified causative microorganisms. Conclusions: According to our results, EEAT after revision surgery in patients with comorbidities, who are at higher risk of infection, did not prevent prosthetic knee infections. There was also no evidence of a reduction in subsequent septic failure within nine months of revision surgery between groups. More accurate risk-defining scores are needed to identify patients at risk of PKI complications. Full article

Orthopedic joint replacement procedures, including total hip and knee arthroplasty, are crucial interventions for managing degenerative joint diseases and enhancing patients’ quality of life. Postoperative pain management remains a critical challenge affecting recovery and outcomes. Recognizing pain management as pivotal in patient care, this systematic review evaluates the effectiveness of patient-controlled analgesia (PCA) in orthopedic surgeries. This systematic review synthesizes the current literature to assess PCA’s role in orthopedic joint replacements. Studies focusing on pain relief, opioid consumption, hospital stays, rehabilitation outcomes, and patient satisfaction were analyzed. Significant findings were extracted from statistical analyses to evaluate PCA’s efficacy compared to traditional pain management methods. PCA significantly improves postoperative pain relief (p < 0.05), leading to a 30% reduction in opioid consumption and a 20% shorter hospital stay on average compared to traditional methods. Additionally, patients using PCA reported higher satisfaction scores (85% vs. 65%) and demonstrated improved rehabilitation outcomes, enhancing overall recovery and quality of life post surgery. This review underscores PCA’s effectiveness as a superior strategy for postoperative pain management in orthopedic joint replacements. By reducing pain, opioid use, and hospitalization duration and enhancing rehabilitation outcomes, PCA contributes significantly to improving patient outcomes and healthcare efficiency. Full article

Background: Surgical accuracy in total knee replacement (TKR) may vary with the surgeon, the patient preoperative deformity, and the guiding system to perform the procedure. Navigation systems attempt to increase the intraoperative information the surgeon requires to make the appropriate decisions, sometimes associating cumbersome procedures and unclear effectiveness to place the implant more precisely than conventional instruments. Methods: We conducted a retrospective case-control study with prospective data collection of radiographic measurements (alignment, joint line and patellar height) in a sample of 100 consecutive patients receiving TKR Optetrak Logic PS, either with standard surgical technique with Trulion Instrumentation (n = 59) or with the Guided Personalized Surgery (GPS) system (n = 41). Results: The GPS group improved the alignment of the mechanical Lateral Distal Femoral Angle (mLDFA) in 1.6° compared to the control (p = 0.003), but not evident in the mechanical Medial Proximal Tibial Angle (mMPTA) (p = 0.132). The GPS system achieved a normal patellar height in 98% of cases, according to the Blackburne–Peel Index (BP), compared to 71% in the control group (p = 0.002). This was obtained in the femoral side, as measured in the Epicondylar Ratio (ER) (p = 0.004). A lower dispersion of postoperative measurements was observed in the GPS group in comparison with the control, being statistically significant in mMPTA (p = 0.000), CD-Index (p = 0.011), IS-Index (p = 0.002), mIS-Index (p = 0.008), BP-Index (p = 0.011), and ER (p = 0.004). Conclusions: Better post-surgical restoration of joint line and patellar height is observed in surgeries performed with the GPS system, as well as a tendency to more accurate mechanical alignment and lower inter-patient variability, suggesting higher reproducibility. Full article

Background/Objectives: This study evaluated the learning curve for robotic-assisted total knee arthroplasty (RA TKA) performed by three experienced surgeons, focusing on procedure duration, surgeon satisfaction, and confidence. Methods: A prospective study was conducted with three senior arthroplasty surgeons, each performing 15 RA TKA procedures using the Triathlon Knee System with the Robotic Arm Interactive Orthopedic (RIO) System. Data on preparation, cut-to-suture, and breakdown times were collected. Surgeon anxiety levels were measured preoperatively using the STAI-6 scale, while postoperative satisfaction and confidence were assessed via a questionnaire. Statistical analysis was conducted using GraphPad Prism. Results: Of 50 scheduled surgeries, 45 were completed. The average cut-to-suture time was 1 h 38 min, with significant time reductions in robotic-specific steps as experience increased. Comparing the first five surgeries to the last five, the time for navigation hardware mounting, landmarks registration, femur and tibia registration, and bone preparation decreased by up to 30% (p < 0.001 to p = 0.025). General instrument preparation time decreased by 20% (p = 0.004). Surgeon anxiety levels dropped, indicating increased comfort with the system, while postoperative surveys showed increased satisfaction and confidence. Conclusions: The study demonstrated a substantial learning curve for RA TKA, with improved efficiency and surgeon confidence by the fifteenth procedure. These findings highlight the potential for streamlined workflows and guide training for new adopters of robotic knee arthroplasty. Full article

Pain and knee stiffness are common problems following total knee replacement surgery, with 10–20% of patients reporting dissatisfaction following their procedure. A remote assessment of knee stiffness could improve outcomes through continuous monitoring, facilitating timely intervention. Using machine learning algorithms, computer vision can extract joint angles from video footage, offering a method to monitor knee range of motion in patients’ homes. This study outlines a protocol to provide proof of concept and validate a computer vision-based approach for measuring knee range of motion in individuals who have undergone total knee replacement. The study also explores the feasibility of integrating this technology into clinical practice, enhancing post-operative care. The study is divided into three components: carrying out focus groups, validating the computer vision-based software, and home testing. The focus groups will involve five people who underwent total knee replacement and ten healthcare professionals or carers who will discuss the deployment of the software in clinical settings. For the validation phase, 60 participants, including 30 patients who underwent total knee replacement surgery five to nine weeks prior and 30 healthy controls, will be recruited. The participants will perform five tasks, including the sit-to-stand test, where knee range of motion will be measured using computer vision-based markerless motion capture software, marker-based motion capture, and physiotherapy assessments. The accuracy and reliability of the software will be evaluated against these established methods. Participants will perform the sit-to-stand task at home. This will allow for a comparison between home-recorded and lab-based data. The findings from this study have the potential to significantly enhance the monitoring of knee stiffness following total knee replacement. By providing accurate, remote measurements and enabling the early detection of issues, this technology could facilitate timely referrals to non-surgical treatments, ultimately reducing the need for costly and invasive procedures to improve knee range of motion. Full article

Background/Objectives: The current literature lacks objective criteria to correctly identify patients in need of a total knee replacement. Surgery indication can be challenging for orthopedic surgeons, which may lead to high levels of patient dissatisfaction. The objective of this study is to describe a complete set of functional characteristics to identify patients with end-stage knee osteoarthritis in need of a total knee replacement, correlating data from strength and performance tests with pain, function, and quality of life questionnaires. Methods: This was a cross-sectional study evaluating patients with end-stage knee osteoarthritis in a waiting list for total knee replacement at a University Hospital. The patients responded to subjective self-reported questionnaires and performance-based functional tests. Anthropometric data were also collected. The main outcome measures were Western Ontario and McMaster Universities Index (WOMAC), visual analog scale (VAS), Short Form-36, knee range of motion, thigh perimeter measurement, maximum voluntary isometric contraction, and 6-min walk test. Results: We analyzed 122 patients (89 female). The functional profile of patients with severe knee osteoarthritis awaiting total knee replacement was described. Quadriceps strength (extensor torque) had a negative correlation with WOMAC (r = −0.3102; p < 0.05), VAS (r = −0.3247; p < 0.05), and a positive correlation with SF-36 Functional Capacity subscale (r = 0.321; p < 0.05). Poorer performance in the 6 min walk test also correlated with worse scores in the WOMAC (r = −0.35; p < 0.05), VAS (r = −0.48; p < 0.05) and SF-36. Conclusions: The present article established a functional profile of patients with severe knee osteoarthritis with indication for total knee replacement, which may help orthopedic surgeons in their decision process. We also identified quadriceps strength and a 6 min walk test as the two most important functional parameters that correlate with knee osteoarthritis severity. Full article

Background/Objectives: Periprosthetic joint infection (PJI) is one of the most common complications after joint replacement. Two-stage revision remains the standard of care in chronic infections. The aim of this systematic review was to investigate the outcomes, complications, and eradication rates of two-stage revision surgery to treat PJI of the shoulder, elbow, hip, and knee. Methods: A total of 36 studies were included. Patient demographics, follow-up, the visual analog scale (VAS) for pain, the Constant–Murley score (CMS) for shoulder, the Harris Hip Score (HHS) for hip, the Knee Society Score (KSS) for knee, the range of motion (ROM), number and types of complications, and eradication rate were recorded. Results: A total of 2484 patients were identified, of whom 145, 29, 1269, and 1041 underwent two-stage revision surgery for shoulder, elbow, hip, and knee infections, respectively. The overall mean follow-up was 5.7 ± 4.5 years. The overall mean time of re-implantation was 20.8 ± 21.3 weeks. The most common causative bacteria were Cutibacterium acnes (32.7%) for shoulder, Methicillin-Sensitive Staphylococcus aureus (44.4%) for elbow, and Staphylococcus coagulase negative (CNS) (31.3% and 23%) for hip and knee infection, respectively. The mean overall preoperative VAS score was 6.7 ± 2.3, while, postoperatively, the mean score was 4.5 ± 2.7 (p < 0.001). A total of 2059 out of 2484 patients (82.9%) experienced eradication. Conclusions: Two-stage revision is an effective procedure to treat PJI with an overall eradication rate of 83%. A significant recovery of functionality and a decrease in residual pain can be achieved after surgery. Aseptic loosening and re-infection were the most common complications in shoulder and hip infections. Death rate was high in knee infections. Full article

Objectives: The aim of this study is to analyse the efficacy of using a combined infiltration between a popliteal artery and knee cap (IPACK) anaesthetic block and a selective saphenous nerve block compared to local infiltration with anaesthetic in knee replacement surgery. Methods: A retrospective observational study was conducted. A total of 312 patients who underwent primary total knee arthroplasty in our hospital between January 2019 and December 2022 were reviewed. Local intra-articular anaesthesia was used in 207 patients and combined nerve block in 105 patients (IPACK group). The mean age in the LIA group was 72.9 years and 70.4 years in the IPACK group. There were 44% men in the LIA group and 53.3% in the IPACK group. The primary outcome was the presence of poorly controlled pain requiring rescue opioid analgesia in the postoperative period. Secondary outcomes included pain scores, range of motion and length of hospital stay. Results: There were no significant differences in the age or gender distribution of patients between the two groups. One patient treated with anaesthetic blocks required rescue analgesia with opioids, while in the LIA group this occurred in 28.5% of cases. There were statistically significant higher VAS scores in the LIA group (p < 0.001). Range of motion was slightly greater in the block group (4.6°, p < 0.05). There were significant differences in hospital stay (2.4 days in the blocks group and 2.8 days in the LIA group (p < 0.05). Conclusions: In our series, patients treated with anaesthetic blocks showed better results with similar postoperative pain control. However, further studies are needed. Full article