[Management of bone and joint infections: update]. / Actualités thérapeutiques en orthopédie septique.

This article highlights four recent updates in infectious disease in the management of bone and joint infections (BJI). During the first six weeks of treatment of a BJI, with or without orthopedic implant, oral antimicrobial therapy is as effective as intravenous therapy. For periprosthetic joint infections, a randomized control study failed to demonstrate non-inferiority of 6 versus 12 weeks of antibiotic therapy. In diabetic foot osteomyelitis, a 3-week course of antibiotics appears to be non-inferior to a 6-week course. Phage therapy seems promising in adjunctive therapy of complex BJI.

Cet article expose quatre nouveautés thérapeutiques significatives en orthopédie septique. Durant les six premières semaines de traitement d'une infection ostéoarticulaire, avec ou sans matériel, une antibiothérapie per os est aussi efficace qu'une antibiothérapie intraveineuse. Concernant les arthroplasties infectées, il n'y a pas de preuve suffisante à raccourcir le traitement antibiotique à moins de douze semaines. Dans les ostéomyélites de pied diabétique, une antibiothérapie de trois semaines semble non inférieure à une thérapie de six semaines. Finalement, la phagothérapie est prometteuse dans les infections ostéoarticulaires, particulièrement dans les situations d'échec des traitements conventionnels.

Epidemiology and outcomes of bone and joint infections in solid organ transplant recipients.

Bone and joint infection (BJI) epidemiology and outcomes in solid organ transplant recipients (SOTr) remain largely unknown. We aim to describe BJI in a multi-center cohort of SOTr (Swiss Transplant Cohort Study). All consecutive SOTr with BJI (01.05.2008-31.12.2019) were included. A nested case-control study to identify risk factors for BJI was performed. Among 4482 patients, 61 SOTr with 82 BJI were included, at an incidence of 1.4% (95% CI 1.1-1.7), higher in heart and kidney-pancreas SOTr (Gray's test p < .01). Although BJI were predominately late events (median of 18.5 months post-SOT), most infections occurred during the first year post-transplant in thoracic SOTr. Diabetic foot osteomyelitis was the most frequent infection (38/82, 46.3%), followed by non-vertebral osteomyelitis (26/82, 31.7%). Pathogens included Gram-positive cocci (70/131, 53.4%), Gram-negative bacilli (34/131, 26.0%), and fungi (9/131, 6.9%). BJI predictors included male gender (OR 2.94, 95% CI 1.26-6.89) and diabetes (OR 2.97, 95% CI 1.34-6.56). Treatment failure was observed in 25.9% (21/81) patients and 1-year mortality post-BJI diagnosis was 14.8% (9/61). BJI remain a rare event in SOTr, associated with subtle clinical presentations, high morbidity and relapses, requiring additional studies in the future.

[Total knee arthroplasty and soft tissue defect: what are the reconstructive options?] / Prothèse totale de genou et lésion des tissus mous : quelles options pour la reconstruction ?

Wound healing issues are not rare after total knee arthroplasty. While most patients heal with local wound care, a minority is susceptible to develop serious complications such as peri-prosthetic joint infection. If direct closure is not feasible, we recommend a multidisciplinary approach based on the ortho-plastic model to determine the optimal wound closure strategy. Negative pressure wound therapy can be used while waiting for definitive coverage to optimise wound environment. Medial gastrocnemius flap is considered as the gold standard procedure for peri-prosthetic substance loss around the knee.

Les problèmes de cicatrisation ne sont pas rares après l'implantation d'une prothèse totale de genou. La plupart des patients guérissent avec des soins locaux mais une minorité d'entre eux peut développer des complications redoutables allant jusqu'à l'infection périprothétique. Hormis les situations pour lesquelles une fermeture directe de la cicatrice chirurgicale peut être réalisée, nous recommandons une approche multidisciplinaire basée sur le modèle de l'ortho-plastique afin de déterminer la stratégie de reconstruction la plus adaptée. La thérapie par pression négative peut être utilisée pour conditionner la plaie en vue d'un geste de couverture définitive. Le lambeau gastrocnémien médial est considéré comme la procédure de référence pour les pertes de substance périprothétique du genou.

[Management of a foot ulcer in a patient with diabetes]. / Ulcère du pied chez un patient avec un diabète : quelle prise en charge médico-chirurgicale ?

Despite a benign appearance, any foot injury occurring in a patient with diabetes requires multidisciplinary management if dreaded complications such as amputation are to be avoided. From a pathophysiological point of view, foot ulcer generally results from the combination of lower extremity neuropathy, mechanical overload, immunopathy and vascular insufficiency. The treatment associates in all cases an offloading and one or more debridements. Depending on the grade of the ulcer, adjuvant treatments, such as antibiotic therapy, revascularization, and hyperbaric oxygen therapy may be indicated.

En dépit d'un aspect bénin, toute plaie au niveau d'un pied survenant chez un patient avec un diabète nécessite une prise en charge multidisciplinaire si l'on veut éviter des complications redoutables comme une amputation. D'un point de vue physiopathologique, l'ulcère du pied résulte généralement de la combinaison entre une neuropathie des membres inférieurs, une surcharge mécanique, une immunopathie et une insuffisance vasculaire. La prise en charge associe dans tous les cas une décharge et un ou plusieurs débridements. Selon la gravité de l'ulcère, des traitements adjuvants sont indiqués, tels qu'une antibiothérapie, une revascularisation et une oxygénothérapie hyperbare.

EWS-FLI-1 modulates miRNA145 and SOX2 expression to initiate mesenchymal stem cell reprogramming toward Ewing sarcoma cancer stem cells.

Cancer stem cells (CSCs) display plasticity and self-renewal properties reminiscent of normal tissue stem cells, but the events responsible for their emergence remain obscure. We recently identified CSCs in Ewing sarcoma family tumors (ESFTs) and showed that they retain mesenchymal stem cell (MSC) plasticity. In the present study, we addressed the mechanisms that underlie ESFT CSC development. We show that the EWS-FLI-1 fusion gene, associated with 85%-90% of ESFTs and believed to initiate their pathogenesis, induces expression of the embryonic stem cell (ESC) genes OCT4, SOX2, and NANOG in human pediatric MSCs (hpMSCs) but not in their adult counterparts. Moreover, under appropriate culture conditions, hpMSCs expressing EWS-FLI-1 generate a cell subpopulation displaying ESFT CSC features in vitro. We further demonstrate that induction of the ESFT CSC phenotype is the result of the combined effect of EWS-FLI-1 on its target gene expression and repression of microRNA-145 (miRNA145) promoter activity. Finally, we provide evidence that EWS-FLI-1 and miRNA-145 function in a mutually repressive feedback loop and identify their common target gene, SOX2, in addition to miRNA145 itself, as key players in ESFT cell differentiation and tumorigenicity. Our observations provide insight for the first time into the mechanisms whereby a single oncogene can reprogram primary cells to display a CSC phenotype.

[Management of infection associated with prosthetic arthroplasty : What's new ?] / Prise en charge des infections sur prothèses : quoi de neuf ?

Total hip and knee arthroplasties are associated with a risk of infection ranging between 0.5 and 2 %, and pose a difficult diagnosis and prolonged treatment for the infected patient. The treatment must be multidisciplinary, consisting of orthopaedic surgeons, infectious diseases specialists, and radiologists, aiming at an accurate diagnosis and appropriate decisions, adapted to the clinical situation of the patient. We review the latest consensus on the diagnosis and management of these infections.

Les arthroplasties prothétiques de la hanche (PTH) et du genou (PTG) sont associées à un taux d'infection compris entre 0,5 et 2 %. En dépit d'un risque faible, cette complication est redoutable, car elle peut être difficile à diagnostiquer, et son traitement implique une ou plusieurs révisions chirurgicales associées à une antibiothérapie prolongée. La prise en charge des patients nécessite une collaboration entre chirurgiens orthopédistes, infectiologues et radiologues, afin de garantir le traitement le plus approprié. Dans ce contexte, cet article propose une synthèse des méthodes récentes de diagnostic et de traitement médico-chirurgical de l'infection périprothétique.

Knee Kinematic and Clinical Outcomes Evolution Before, 3 Months, and 1 Year After Total Knee Arthroplasty.

BACKGROUND: The aim of this study was to describe the evolution of kinematic and clinical outcomes of a large patient cohort with knee osteoarthritis from before surgery (V1) to 3 months (V2) and 1 year (V3) after a total knee arthroplasty (TKA). METHODS: The patients were evaluated at each visit (118 patients at V1, 93 patients at V2, and 79 patients at V3) during a clinical gait analysis and were compared with a matched control group of healthy adults (CG). The kinematic parameters, the Western Ontario and MacMaster Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Gait velocity and knee range of motion (ROM) as well as clinical parameters were compared at each visit with CG was based on the unpaired samples t-test. To determine changes in the data at baseline, 3 months, and 1 year after surgery in the patient groups, repeated-measure analysis of variance was conducted (P < .05). Pearson correlation was used to examine relationships between clinical and biomechanical outcomes. RESULTS: One year after TKA (V3) compared to V1 and V2, the ROM of the operated knee during gait was significantly improved (V1: 44.2 ± 8.8° vs V3: 47.5 ± 7.1°, P < .001, and V2: 42.2 ± 9.3° vs V3: 47.5 ± 7.1°, P = .001), as was the gait velocity (V1: 1.0 ± 0.2 and V2: 1.1 ± 0.2 m/s vs V3: 1.3 ± 0.2 m/s, P < .001). The WOMAC and knee pain were significantly better 1 year after TKA. No strong relationships have been found between clinical parameters and knee kinematics. CONCLUSION: This study showed that 1 year after TKA, patients exhibited improved gait velocity and ROM and experienced a significant decrease in the level of pain and an increased clinical score (although different from CG).

Influence of Body Mass Index on Sagittal Knee Range of Motion and Gait Speed Recovery 1-Year After Total Knee Arthroplasty.

BACKGROUND: The purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA). METHODS: Seventy-nine patients were evaluated before and 1 year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and 1 year after TKA), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Nonobese (BMI <30 kg/m2) and obese patients (BMI ≥30 kg/m2) were compared. Healthy controls were also assessed. Univariate and multivariate linear regression analyses were used to assess the association between gait speed and ROM gains. Adjustment was performed for gender, age, and WOMAC pain improvement. RESULTS: At baseline, gait velocity and knee ROM were significantly lower in obese compared with those in the nonobese patients (0.99 ± 0.27 m/s vs 1.11 ± 0.18 m/s; effect size, 0.53; P = .021; and ROM, 41.33° ± 9.6° vs 46.05° ± 8.39°; effect size, 0.52; P = .022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than nonobese (WOMAC pain: 36.1 ± 14.0 vs 50.4 ± 16.9; effect size, 0.9; P < .001), and their improvement was significantly higher (WOMAC pain gain, 44.5 vs 32.3; effect size, 0.59; P = .011). CONCLUSION: These findings show that all patients improved biomechanically and clinically, regardless of their BMI.

Clinical and epidemiological differences between implant-associated and implant-free orthopaedic infections.

PURPOSE: Although there have been many publications regarding the risk factors for implant-associated orthopaedic infections, none have investigated how clinical presentations and epidemiology may differ between infections with and without osteosynthetic material. METHODS: We pooled clinical data from several databases of adult patients with orthopaedic infections hospitalized at Geneva University Hospitals from January 2004 to December 2014. RESULTS: Among 2740 episodes of orthopaedic infections, 76% were implant-free osteoarticular or soft tissue infections. Among the 665 (24% of the total episodes) infections that involved osteosynthetic material, 319 (49%) were total joint arthroplasties, 143 single plates, and 50 single nails. The remainders were mixed implant infections, pins, wires, screws, cerclages or spondylodeses. The implant-associated, compared to the implant-free, infections were significantly more frequently associated with female sex, older age, bacteraemia and skin commensal infections, e.g. coagulase-negative staphylococci, corynebacteria or propionibacteria. In contrast, implant-associated infections were significantly less frequently associated with immune suppression, abscess formation, infections due to Staphylococcus aureus or streptococci, polymicrobial pathogens and foot infections. The serum CRP levels at admission were similar (median 82 vs. 75 mg/L). CONCLUSIONS: Compared to implant-free infections, implant-associated orthopaedic infections are more likely monomicrobial, bacteraemic and due to skin commensals. They involve more often female and older patients, but are less often associated with immune suppression, abscess formation and foot infections.

Factors Associated With Treatment Failure of Infected Pressure Sores.

OBJECTIVE: In this study, we assess interdisciplinary surgical and medical parameters associated to recurrences of infected pressure ulcers. BACKGROUND: There is a little in the published literature regarding factors associated with the outcome of treatment of infected pressure ulcers. METHODS: We undertook a single-center review of spinal injured adults hospitalized for an infected pressure ulcer or implant-free osteomyelitis and reviewed the literature on this topic from 1990-2015. RESULTS: We found 70 lesions in 31 patients (52 with osteomyelitis) who had a median follow-up of 2.7 years (range, 4 months to 19 years). The median duration of antibiotic therapy was 6 weeks, of which 1 week was parenteral. Clinical recurrence after treatment was noted in 44 infected ulcers (63%), after a median interval of 1 year. In 86% of these recurrences, cultures yielded a different organism than the preceding episode. By multivariate analyses, the following factors were not significantly related to recurrence: number of surgical interventions (hazard ratio 0.9, 95% confidence interval 0.5-1.5); osteomyelitis (hazard ratio 1.5; 0.7-3.1); immune suppression; prior sacral infections, and duration of total (or just parenteral) antibiotic sue. Patients with antibiotic treatment for <6 weeks had the same failure rate as those with as >12 weeks (χ test; P = 0.90). CONCLUSIONS: In patients with infected pressure ulcers, clinical recurrence occurs in almost two-thirds of lesions, but in only 14% with the same pathogen(s). The number of surgical debridements, flap use, or duration of antibiotic therapy was not associated with recurrence, suggesting recurrences are caused by reinfections caused by other extrahospital factors.

Diabetic foot infections: recent literature and cornerstones of management.

PURPOSE OF REVIEW: Diabetes mellitus has reached pandemic levels and will continue to increase worldwide. Physicians and surgeons should know to manage one of its most prevalent complications, the diabetic foot infection (DFI), in a scientifically based and resource-sparing way. We performed a nonsystematic review of recent scientific literature to provide guidance on management of DFIs. RECENT FINDINGS: Studies in the past couple of years provide data on which recommendations for diagnosing and treating DFI are based, especially with validated guidelines and reviews of the microbiology and selected aspects of the complex DFI problem. Recent literature provides approaches to prevention and studies support more conservative surgical treatment. Unfortunately, there have been virtually no new therapeutic molecules, antibiotic regimens, randomized trials, or surgical techniques introduced in the recent past; we briefly discuss how this may change in the future. SUMMARY: Recent scientific evidence on DFI strongly supports the value of multidisciplinary and some new care models, guideline-based management, more preventive approaches, and confirms several established therapeutic concepts. In contrast, there has been almost no new substantial information regarding the optimal antibiotic or surgical management in recent literature.

[Microbiology and antibiotic treatment of diabetic foot infection]. / Microbiologie et traitement antibiotique du pied diabétique infecté.

In diabetic patients, foot ulcer is a common problem which prevalence during life is about 25%. Infection occurs as a complication in almost 50% of cases, is associated with significant morbidity and a reduced quality of life and is sometimes the trigger leading to amputation. Ulcers and infections occur among patients with predisposing factors such as peripheral neuropathy and arterial insufficiency, and require a multi-disciplinary care system. The knowledge of the microbiology of diabetic foot infection is necessary for a wise use of empirical and targeted antibiotic therapy. This article will focus on the definition and diagnosis of diabetic foot infection, on the main aspects of its microbiology and antibiotic treatment.

Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus.

PURPOSE: The debridement, antibiotic and implant retention (DAIR) procedure is an option for patients with prosthetic hip joint infections for whom arthroplasty removal is problematic. Unfortunately, some of the guidelines proposed for deciding on DAIR management of arthroplasty infections fail to take into consideration the role of the infecting pathogen. While Staphylococcus aureus and streptococci are major contributors to infected hip arthroplasties, their respective contributions to treatment success or failure rates with the DAIR procedure have not been thoroughly analysed from a microbiological perspective. METHODS: This retrospective study included all patients who were hospitalised in Geneva University Hospitals between 1996 and 2012 and were initially treated with DAIR for prosthetic hip joint monomicrobial infection due to S. aureus or Streptococcus spp. The outcome of DAIR treatment was evaluated after a minimal follow-up of two years. A literature search was also performed to retrieve data from additional DAIR-treated cases in other institutions. RESULTS: In our institution, 38 DAIR-treated patients with hip arthroplasty monomicrobial infections underwent at least one surgical debridement (median two, range one to five), exchange of mobile parts and concomitant targeted antibiotic therapy for several weeks or months. A literature search identified outcome data in other institutions from 52 additional DAIR-treated cases according to our study criteria. After merging our own data with those retrieved from other reports, we found a failure rate of 21 % instead of 24 % for S. aureus-infected, DAIR-treated patients, but no failure in 14 streptococcal-infected patients. In the pooled data, the failure rate linked with S. aureus infections was significantly higher than that with Streptococcus ssp. (19/90 vs 0/14 episodes; Fisher's exact test, P = 0.07). CONCLUSIONS: DAIR-treated patients with prosthetic hip joint infections due to S. aureus tended to have worse outcomes than those infected with Streptococcus spp. The specific influence of the infecting pathogen should be considered in future guidelines and recommendations.

[Shuttle Challenger disaster: what lessons can be learned for management of patients in the operating room?]. / Catastrophe de la navette Challenger: quels enseignements pour la prise en charge des patients au bloc opératoire?

For many years hospitals have been implementing crew resource management (CRM) programs, inspired by the aviation industry, in order to improve patient safety. However, while contributing to improved patient care, CRM programs are controversial because of their limited impact, a decrease in effectiveness over time, and the underinvestment by some caregivers. By analyzing the space shuttle Challenger accident, the objective of this article is to show the potential impact of the professional culture in decision-making processes. In addition, to present an approach by cultural factors which are an essential complement to current CRM programs in order to enhance the safety of care.

[The infected diabetic foot: diagnosis and management]. / Pied diabétique infecté: du diagnostic a la prise en charge.

Foot infections are a frequent and potentially harmful complication of diabetes mellitus. In one skin ulceration out of two, further evolution towards infection occurs and often leads to amputation increasing morbidity and health care costs. Skin disruptions, favored by the sensorimotor neuropathy and vascular disease, constitute the initial factors leading to this complication. To ensure effective care, these cases must be managed by a multidisciplinary team in a specialized center. All caretakers involved with patients suffering from diabetes mellitus must be capable of preventing and recognizing diabetic foot infections, as well as informing the patients about this complication and its management.

Adipokines correlate with pain in lower limb osteoarthritis: different associations in hip and knee.

PURPOSE: Our aim was to investigate whether serum and synovial-fluid (SF) concentrations of interleukin-6 (IL-6), leptin, adiponectin, resistin or visfatin are associated with joint pain in hip and knee in end-stage osteoarthritis (OA). METHODS: A cross-sectional study assessing patients with hip and knee OA undergoing total joint arthroplasty between January and December 2010 was conducted at a large university hospital. Serum and SF cytokine and adipokine concentrations were determined in samples obtained on the day of surgery. The main outcome was pain severity measured pre-operatively using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) pain scores. RESULTS: A total of 206 patients were involved (112 with hip and 94 with knee OA). Median age was 72 years [interquartile range (IQR) 66-79], 59% were women. All adipokine levels were significantly higher in the SF of hip joints than in that of knee joints, except for leptin, which tended to be higher in the knee. In both hip and knee OA, median serum concentrations of leptin, adiponectin, resistin and visfatin exceeded those in SF, whereas for IL-6, median concentrations were much higher in SF than in serum. In hip OA, worse pain was significantly associated with high SF concentrations of IL-6, visfatin and leptin; in knee OA, it was associated with high SF leptin and low SF adiponectin concentrations and a low adiponectin-leptin ratio. CONCLUSION: Our findings support a connection between intra-articular concentrations of several adipokines and severity of preoperative OA pain. However, the specific adipokines differed by joints: in hip OA, pain was associated with IL-6 and visfatin and in knee OA with adiponectin; leptin played a role in both hip and knee OA.

Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures?

PURPOSE: In Gustilo grade III open fractures, it remains unknown which demographic or clinical features may be associated with an infection resistant to the administered prophylactic agent, compared to one that is susceptible. METHODS: This was a retrospective case-control study on patients hospitalized from 2004 to 2009. RESULTS: We identified 310 patients with Gustilo-III open fractures, 36 (12%) of which became infected after a median of ten days. In 26 (72%) of the episodes the pathogen was susceptible to the prophylactic antibiotic agent prescribed upon admission, while in the other ten it was resistant. All antibiotic prophylaxis was intravenous; the median duration of treatment was three days and the median delay between trauma and surgery was one day. In multivariate analysis adjusting for case-mix, only Gustilo-grade-IIIc fractures (vascular lesions) showed tendency to be infected with resistant pathogens (odds ratio 10; 95% confidence interval 1.0-10; p = 0.058). There were no significant differences between cases caused by antibiotic resistant and susceptible pathogen cases in patient's sex, presence of immune suppression, duration and choice of antibiotic prophylaxis, choice of surgical technique or materials, time delay until surgery, use of bone reaming, fracture localization, or presence of compartment syndrome. CONCLUSION: We were unable to identify any specific clinical parameters associated with infection with antibiotic resistant pathogens in Gustilo-grade III open fractures, other than the severity of the fracture itself. More research is needed to identify patients who might benefit from a broader-spectrum antibiotic prophylaxis.

[Lower limb amputation: indication, preoperative workup and complications]. / Amputations du membre inférieur: indications, bitan et complications.

The main causes of lower limb amputations are peripheral artery disease (92% of the cases) and trauma (7%). The selection of the amputation level aims at optimizing the chances of healing and the functionality of the involved limb. Foot preserving amputations offer the best functional outcome but the healing process is frequently slow and difficult. After a below-knee amputation, 60% of the patients are capable of ambulating again, whereas only 20% of the patients undergoing an above-knee amputation ambulate autonomously. Complications after amputations are frequent, can occur a long time after surgery and must be managed by a highly specialized team.

Distally based peroneus brevis flap: Reconstruction of complex soft-tissue defects with bony infection of the lateral malleolus.

BACKGROUND: Managing wounds of the lateral malleolus is challenging owing to limited nearby tissues and possibly injured or inadequate vessels for free flaps, especially in case of underlying infections. Moreover, free flaps require specialized skills and are not suitable for every patient. Therefore, identifying reliable local alternatives is crucial. This retrospective study investigated the efficacy and safety of the distally based peroneus brevis muscle flap in treating complex and infected soft-tissue defects of the lateral malleolus. MATERIALS AND METHODS: A retrospective medical chart review of all patients who underwent a distally based peroneus brevis muscle flap reconstruction in the context of an infected lateral malleolus defect at Geneva University Hospitals between October 2020 and January 2024 was performed. RESULTS: Ten patients underwent lateral malleolus reconstruction using a distally based peroneus brevis muscle flap primarily to address post-traumatic infections. Flap coverage was performed within 4 weeks of infection onset for post-traumatic cases, alongside antibiotic treatment. The defects were moderate in size, with a median width of 2.5 cm and length of 5.5 cm. There were no complete or partial flap failures. All patients regained the ability to walk within 5 days after surgery. CONCLUSIONS: The distally based peroneus brevis muscle flap was efficient in managing complex and infected soft-tissue defects of the lateral malleolus, with control of infection in all patients and minimal donor-site morbidity.

How gait and clinical outcomes contribute to patients' satisfaction three months following a total knee arthroplasty.

The objective of this study was to investigate how gait and clinical outcomes contribute to patients' satisfaction three months following a total knee arthroplasty (TKA). Seventy-eight patients with knee osteoarthritis (OA) and a control group of twenty-nine subjects were evaluated. The gait parameters, Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and functional levels, quality of life and patients' satisfaction following TKA were assessed. A multiple linear regression model shows that the WOMAC functional score explained 39% of the global satisfaction and 37% of the satisfaction related to pain relief following TKA. Finally, the model shows that 65% of the satisfaction related to the functional improvement was explained by a combination of clinical and gait parameters. This study demonstrated the contribution of both gait and clinical outcomes to patients' satisfaction following TKA.