Postero-Central Slice Osteotomy of the Proximal Tibia: A Novel Technique for Correcting Resistant Tight Extension Gaps in Posterior-Stabilized Total Knee Arthroplasty for Varus Osteoarthritis.

BACKGROUND: The aim of total knee arthroplasty (TKA) is to circumvent the pain due to advanced osteoarthritis of the knee joint and correct the limb alignment and biomechanics to improve patients' quality of life. Apart from medio-lateral balancing, balancing flexion and extension gaps is a prerogative to achieve good results. This study proposes a novel surgical technique of postero-central slice osteotomy of the proximal tibia (PCSO-PT) for correcting tight extension gaps in posterior-stabilized (PS) knees and assesses its clinical and functional outcomes. METHODS: A prospective study was conducted on 84 consecutive knees with tricompartmental osteoarthritis and varus deformity, requiring PCSO of the proximal tibia during PS TKA between January 2016 and July 2018. Knee Society scores, flexion deformity, range of motion, antero-posterior instability, and complications were assessed at regular intervals for a minimum of two years postoperatively. RESULTS: Residual flexion deformities less than 11° after posterior capsular release were successfully corrected by the osteotomy. The mean preoperative flexion deformity of 18.1 ± 2.5° improved to 8.6 ± 2.2° intraoperatively after posterior capsular release from the femoral end and to 0.65 ± 0.76° intraoperatively immediately after the osteotomy, with no residual flexion deformity noted in any patient six weeks postoperatively. It had no negative effect on the significant post-TKA improvement of the mean Knee Society score from 32 ± 12 preoperatively to 94 ± 3 at the terminal follow-up. A direct correlation between preoperative flexion deformity and a resistant, tight extension gap (P = 0.003) was noted. There was no increase in coronal plane or sagittal plane instabilities in midflexion or on mobilization throughout the follow-up period, nor were any major adverse effects noted in this period. CONCLUSION: A postero-central slice osteotomy of the proximal tibia is an effective and safe alternative to overcoming tight extension during TKA after femoral-end capsular release, instead of capsular release from the tibial end or midcapsular region.

Limitations of the knee society score in kinematically aligned total knee arthroplasty.

Purpose: The Knee Society Scoring System (KSS) is a frequently used outcome score which quantifies functional patients' outcomes before and after total knee arthroplasty (TKA). Several problems arise when trying to implement KSS for obtaining postoperative outcomes after more personalised aligned TKAs. Scoring for valgus femorotibial angle (FTA) intervals outside moderate ranges is often poorly explained, the specific version of KSS used for outcome collection is frequently unclear and the exact measuring methods are typically not described in the literature. The aims of this systematic review were to investigate the latest user practice, the application of KSS and its limitations after kinematically aligned (KA) TKA. Methods: A systematic literature search following PRISMA guidelines was conducted on PubMed, Embase, Medline and Scopus to identify potentially relevant articles for this review, published from the beginning of January 2013 until the end of January 2023. Broad Mesh terms such as 'kinematic alignment', 'total knee arthroplasty' and 'knee society score' were used for building search strategy in each database accordingly. Articles reporting postoperative values of the objective surgeon-assessed KSS after KA TKA or KA and mechanically aligned TKA were included. For assessing included randomised control trials (RCTs), an Agency for Healthcare Research and Quality's design-specific scale for assessing RCTs was used. The non-RCTs were assessed by using the Joanna Briggs Institute Critical Appraisal Tool. The Ottawa-Newcastle Score system was also used. Studies were additionally evaluated for their radiological methodology by using a five-question checklist (Radiological Assessment Qualit criteria). Results: The initial search identified 167 studies, of which 129 were considered for screening. Ten studies reporting outcomes after KA TKA did not use the objective surgeon-assessed part of KSS for clinical outcome measurement, and 30 studies reporting outcomes after KA TKA did not use KSS at all for clinical and/or functional outcomes. From the 10 included studies, only six have used the latest KSS score (2011), the rest using its 1989 variant; and out of these six studies, only two presented values of the FTA, which is needed for calculating the KSS's 'alignment' subcomponent, the rest presenting hip-knee-ankle angle (HKA) values. Additionally, when converting these HKA values to FTA intervals, the authors of this systematic review found that KA TKA FTA intervals display limits, which tend to be outside the 'well-scored' KSS anatomical alignment interval. Conclusion: The inconsistent and nonstandardised use of the surgeon-assessed KSS across studies reviewed compromises assessment reliability and patient outcome scores. To enhance precision and comparability, it is crucial to standardise the KSS application, incorporating personalised alignment strategies for more accurate patient evaluations. Level of Evidence: Level III.

Comparison of Clinical and Radiological Outcomes of Total Knee Arthroplasty in Osteoarthritic Patients.

Background The knee is the joint most commonly affected by osteoarthritis, more than any other. Osteoarthritis is a progressive, long-term condition that leads to the deterioration of joint tissue and cartilage, resulting in pain and impairment. Total knee arthroplasty (TKA) is a successful intervention that improves functional capability, decreases pain, and enhances quality of life. We conducted this study to evaluate whether radiological parameters following TKA influence the clinical outcomes of patients with knee osteoarthritis. Methods The study was conducted on patients treated for knee osteoarthritis at the Department of Orthopedics, Rajindra Hospital and Government Medical College, Patiala, Punjab, in collaboration with the Department of Radiology over a period of 1.5 years. A total of 152 patients diagnosed with knee osteoarthritis were included in the study; all underwent TKA. Patients underwent clinical evaluation and were graded using the Knee Society Score (KSS) during follow-up examinations. Pain was evaluated using the Visual Analog Scale (VAS). Postoperative X-rays were obtained, and various angles, including the distal femoral angle (DFA), the proximal tibial angle (PTA), and the posterior slope angle (PSA), were measured. Patient follow-up was conducted at three days, three months, and six months. Subsequently, a comparison of the clinical and radiological outcomes of TKA was performed. Results In this study, a total of 152 patients participated, with the majority falling into the 61-70 age group. Of these patients, 40.13% were female and 59.87% were male. The average medial DFA was 94.05°, the average medial PTA was 89.31°, and the PSA was 6.6°. Patients with a medial DFA of 94.05° (±3), a medial PTA of 89.31° (±3), and a PSA of 6.6° (±3) were categorized into the normal group. Conclusion Patients with DFA, PTA, and PSA in the normal range demonstrate improved KSS and clinical outcomes.

Computer-Assisted Surgery in Total Knee Arthroplasty: Our Experience.

Background: Total knee arthroplasty (TKA) is a reliable orthopedic procedure for knee osteoarthritis with long-term success rates of 90% after 15 years. Computer-assisted surgery (CAS) has been developed to improve the accuracy of the alignment and orientation of the components in TKA. Methods: A prospective study involving 103 subjects who underwent CAS-TKA was conducted over a 3-year period. Subjects were assessed for pre- and post-operative varus and valgus deformity, BMI, comorbidities, and Knee Society Score (KSS). Outcome measures of post-operative KSS, post-operative alignment, and hospital stay were examined by Spearman correlation coefficients. Categorical outcomes of complication and secondary procedures were compared by chi-squared test and odds ratio. Results: The study considered 103 TKA patients with a mean ± SD age of 63.7 ± 8.4 years (33-88 years). Unilateral knee replacement was performed on 56 patients (54.3%) and remaining 47 (45.6%) had simultaneous bilateral TKA. Forty (34.8%) patients were obese, and severe pre-operative deformity (> 15°) was observed in 47 (31.3%) patients. Mean coronal alignment of the knee joint was 91.33° (SD: 90.69° valgus-88.92° varus). The mean post-operative KSS noted in obese and non-obese subjects were 93.43 (84-98) and 94.76 (85-98) respectively. Post-operative KSS for knees with severe deformity was 94.08 (80-98), while it was 95.76 (83-98) in those with mild to moderate deformities. Conclusion: The study confirms that navigation in CAS-TKA consistently achieved coronal alignment of the knee joint within ± 3°, irrespective of the patient BMI and degree of deformity.

Lateral versus medial approach for total knee arthroplasty for valgus knee deformity shows comparable functional outcomes, hip-knee-ankle angle values, and complication rates: a meta-analysis of comparative studies.

INTRODUCTION: The aim of this meta-analysis of comparative studies was to update the current evidence on functional and radiographic outcomes and complications between medial and lateral approaches for total knee arthroplasty (TKA) for valgus knee deformity. MATERIALS AND METHODS: The PubMed, MEDLINE, Scopus, and the Cochrane Central databases were used to search keywords and a total of ten studies were included. The methodological quality of the included studies was assessed. Data extracted for quantitative analysis included the Knee Society score (KSS), range of motion (ROM), surgical time, hip-knee-ankle angle (HKA), and number and types of complications. Random- and fixed-effect models were used for the meta-analysis of pooled mean differences (MDs) and odds ratios (ORs). The Mantel-Haenszel method was adopted. RESULTS: A total of 1008 patients were identified, of whom 689 and 319 underwent TKA for valgus knee deformity with lateral and medial approach, respectively. The mean age was 70 ± 9.5 and 67.3 ± 9.6 years for the lateral and medial approaches, respectively. The mean follow-up was 37.8 ± 21.9 and 45.9 ± 26.7 months for the lateral and medial approach groups, respectively. Significantly higher functional outcomes were found for the medial approach, as measured by the postoperative KSS (MD = 1.8, 95% CI [0.48, 3.12], P = 0.007) and flexion ROM (MD = 3.12, 95% CI [0.45, 5.79], P = 0.02). However, both of these differences were lower than the minimal clinically important difference. Comparable surgical time and postoperative HKA angle values (MD = 0.22, 95% CI [- 0.30, 0.75], P = 0.40) between the two surgical approaches were found. The incidence of periprosthetic joint infections, fractures, transient peroneal nerve injuries, and deep vein thrombosis was comparable. CONCLUSION: This meta-analysis of comparative studies showed that when lateral and medial approaches are used for total knee arthroplasty for valgus knee deformity, comparable functional outcomes in terms of the KSS and ROM, surgical time, and postoperative hip-knee-ankle angle values can be expected. Similar rates of periprosthetic joint infection, fracture, and peroneal nerve injury were also found. LEVEL OF EVIDENCE: I. PROSPERO REGISTRATION NUMBER ID: CRD42023392807.

Comparison of Postoperative Pain and Clinical Outcomes of Total Knee Arthroplasty Among Patients with Rheumatoid Arthritis and Osteoarthritis Referred to Clinic or Emergency Department.

Background: Total knee arthroplasty (TKA) is among the most frequent orthopedic procedures. TKA has been shown to provide significant benefits to patients with rheumatoid arthritis (RA) and osteoarthritis (OA). We hypothesized that patients undergoing primary TKA with diverse preoperative diseases would have varying expectations for both pain and function following TKA. Materials and Methods: Patients diagnosed with OA or RA participated in this prospective cohort investigation. We assessed variables including Knee society score (KSS), and patient's quality of life using 36-Item Short Form Survey Instrument (SF-36). Pain was also measured using the Visual Analogue Scale (VAS). Results: In this study, 606 patients including 412 females and 194 males with a mean age of 65.5 ± 8.7 years were included in the study. Among patients, 46 patients underwent TKA due to RA and 560 patients due to knee OA. There was no statistically significant difference in term of KSS clinical score before the operation (P = 0.101). The mean of KSS clinical score and functional score variables at 6 months and 12 months after the operation were higher in OA group in comparison to RA group. SF-36 was significantly improved in OA group in comparison to RA group. Also, VAS in the RA group is significantly higher than in the OA group after 12 months of follow-up. Conclusion: Our results demonstrate that patients with OA after TKA have better KSS clinical and functional results than patients with RA.

Early- to Mid-Term Review of a Prospective, Multi-Center, International, Outcomes Study of an Anatomically Designed Implant with Posterior-Stabilized Bearing in Total Knee Arthroplasty.

Background and Objectives: National joint registries report higher total knee arthroplasty (TKA) revision rates in posterior-stabilized (PS) systems compared to non-posterior-stabilized designs. The purpose of this study was to investigate the implant survivorship and clinical outcomes of an anatomic implant with a PS bearing. Materials and Methods: An early- to mid-term follow-up of a prospective, multi-center, non-controlled outcomes study of patients who received primary TKA between November 2014 and June 2017 was performed. A total of 800 cases using PS bearings that were implanted in 664 patients were monitored post-operatively for their implant survivorship and adverse events for up to five years. The Knee Society Knee and Function scores, patient satisfaction, the five-dimensional European Quality of Life questionnaire, and range of motion (ROM) were evaluated pre-operatively and post-operatively at six weeks, six months, one year, two years, three years, and five years. Results: The mean follow-up period was 3.7 ± 1.3 years, and the three-year implant survival rate was 99.3% (95% CI: 98.4%, 99.7%) with five revisions during the five-year follow-up. Patient satisfaction was 96.1% at six weeks and increased to 99.3% at one year. All patient-reported outcome measures significantly (p < 0.0001) increased up to the one-year follow-up and then remained stable up to the five-year follow-up. Conclusions: This study supports the excellent survivorship and patient-reported outcomes of the Persona® Knee system using cemented, fixed bearing, posterior-stabilized components with minimal complications at early- to mid-term follow-up in an international Asian population. Ongoing observations are being performed to investigate the mid- to long-term survivorship and clinical outcomes associated with this knee system.

Total knee arthroplasty for neuropathic arthropathy in a patient with leprosy.

Patients with leprosy are known to tend to develop neuropathic arthropathy, known as Charcot joint. There are no case reports of total knee arthroplasty (TKA) in patients with leprosy with polyarticular neuropathic arthropathy, and the results are unknown. In this study, we report a case of TKA in a patient with leprosy with polyarticular neuropathic arthropathy and discuss its outcomes and indications. Right TKA using the NexGen Legacy Constrained Condylar Knee implant was performed in a 62-year-old man with neuropathic arthropathy in multiple joints with clinical symptoms, particularly in the right knee. Seven years post-operation, the American Knee Society Score-knee and -function, which represent knee function and activities of daily living on a scale of 100 points, were significantly improved compared with preoperative values, from 30 to 99 points and 0 to 60 points, respectively. Indications for arthroplasty for neuropathic arthropathy should be carefully considered in each individual case. In this case, the patient had neuropathic arthropathy in multiple joints; however, TKA was performed because recovery of function in the right knee was expected to significantly improve the patient's activities of daily living, and a good mid-term clinical outcome was achieved. Therefore, indications for arthroplasty should be considered in patients with systemic neuropathic arthropathy such as leprosy, and with accurate assessment and appropriate implant selection, good long-term outcomes may be expected.

Improved Knee Function with Customized vs. Off-the-Shelf TKA Implants-Results of a Single-Surgeon, Single-Center, Single-Blinded Study.

BACKGROUND: Recent studies have been able to show certain benefits of Customized, Individually Made (CIM) compared to Off-the-Shelf (OTS) total knee arthroplasties (TKAs), but evidence is still lacking regarding the benefits of these implant systems. This study aimed to find differences in scores and functional outcome by comparing CIM and OTS implants, using Patient-Reported Outcome Measures (PROMs) and functional tests for activities of daily living in a single-surgeon setup. METHODS: A total of 48 patients (16 CIM vs. 32 OTS) were consecutively enrolled and blindly examined. Functional testing was performed using four timed functional tests (TUG, WALK, TUDS, and BBS) and the VAS for pain. The Aggregated Locomotor Function (ALF) score was then calculated based on the addition of the average times of the three functional tests. RESULTS: The CIM group showed significantly faster times in all functional tests and significantly better ALF scores. There were remarkable differences in the assessment of maximum pain sensation between the two groups, with superiority in the CIM group. The PROMs analysis revealed a higher proportion of excellent and good ratings for the items objective and function (KSS) in the CIM group. CONCLUSION: The study showed that time-limited activities of daily living (ADLs) can be completed significantly faster with a CIM prosthesis and that a significantly higher percentage in this group reports freedom from pain during certain loads. Partial aspects of the PROM scores are also better in this group; however, this superiority could not be shown with regard to most PROM scores collected in this study.

Midvastus Versus Medial Parapatellar Approach in Simultaneous Bilateral Total Knee Arthroplasty.

BACKGROUND: The purpose of this study was to compare the postoperative outcomes over a period of 3 years in patients who underwent bilateral total knee arthroplasty (TKA) using midvastus (MV) versus medial parapatellar (MPP) approaches. METHODS: In this retrospective study, 2 propensity-matched cohorts of patients who underwent simultaneous bilateral TKA via MV (n = 100) and MPP (n = 100) approaches from January 2017 to December 2018 were compared. Surgical parameters compared were surgery time and the incidence of lateral retinacular release (LRR). Clinical parameters including the visual analog score for pain, time for straight leg raise (SLR), range of motion, the Knee Society Score, and the Feller patellar score were assessed in the early postoperative and follow-up periods up to 3 years. Radiographs were evaluated for alignment, patellar tilt, and displacement. RESULTS: LRR was performed on 17 knees (8.5%) in the MPP group and 4 knees (2%) in the MV group which was significant (P = .03). The time to SLR was significantly lower in the MV group. There was no statistically significant difference in the length of hospital stay between the groups. The visual analog score, range of motion, and Knee Society Score were better in the MV group within 1 month (P < .05), but no statistically significant differences were found later. Patellar scores, radiographic patellar tilt, and displacements were similar at all follow-up periods. CONCLUSION: In our study, the MV approach had faster SLR, less LRR, and better pain and function scores in the first few weeks after TKA. However, its effect on different patient outcomes has not been sustained at 1 month and further follow-up points. We recommend that surgeons use the surgical approach with which they are most familiar.

Biological Reconstruction of Posteromedial Tibial Defect with Autogenous Bone Graft in Complex Knee Arthroplasty.

Purpose: We conducted this study to examine the clinical outcomes of primary total knee arthroplasty (TKA) with autogenous bone graft for a tibial bony defect with a minimum follow-up of 12 months. Methods: A total of 21 individuals underwent primary TKA with autogenous on-lay bone grafting (ABG) for restoration of posteromedial tibial deformities between January 2016 and November 2021. The patients were clinically assessed using the knee society score (KSS), varus score, and range of motion (ROM) preoperatively and postoperatively to compare using a single sample t test. Postoperative complications were also considered. Results: KSS before and after surgery was reported to be statistically significant [mean difference = -55.32 (6.81); P < 0.001]. The mean KSS before surgery was 21.14 (7.03) while improved to the mean KSS after surgery of 76.45 (3.05). ROM score before and after surgery was reported to be statistically significant [mean difference = -30.45 (8.99); P < 0.001]. The mean ROM before surgery was 75.45 (6.71) while the improved mean ROM after surgery of 105.91 (5.03). Varus score before and after surgery was reported to be statistically significant [mean difference = 18.45 (3.75); P < 0.001]. Conclusion: The mechanical axis and stability of the knee were effectively restored, with significant differences in preoperative and postoperative results, indicating that this technique is a reasonable and versatile option when reconstructing moderate-to-severe bone loss in TKA.

All-polyethylene versus metal-backed tibial components in total knee arthroplasty: a meta-analysis of randomized controlled trials.

OBJECTIVES: The design of tibial trays for total knee arthroplasty (TKA) has been a topic of research for several decades. Although all-polyethylene trays were developed to address issues such as osteolysis and to enhance the longevity of the prosthesis, as well as knee range of motion, metal-backed designs have remained the most commonly used type of prosthesis. This meta-analysis aimed to compare the clinical, radiological, and survival outcomes of both designs. METHODS: Five databases were searched from inception until October 1, 2020, for randomized controlled trials (RCTs) that compared the outcomes of all-polyethylene and metal-backed tibial components in TKA. The outcomes of interest included range of motion, knee society score, stairs climbing scores, radiostereographic analysis, survivorship and complication. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was assessed using the Newcastle-Ottawa tool. RESULTS: A total of 14 RCTs with 1367 TKA were included with a mean age of - years and - years for all-polyethylene and metal-backed tibial components groups, respectively. All-polyethylene group demonstrated statistically significant differences in five-year survivorship (OR 0.27; 95% CI 0.10-0.75; p value 0.01) and stairs climbing score (OR - 2.07; 95% CI - 3.27-0.87; p value 0.0007) when compared to the metal-backed group. The metal-backed design was significantly more radiographically stable in anterior-posterior, varus-valgus, and internal-external rotations at the 2-year follow-up compared to all-polyethylene tibias (OR - 0.09; 95% CI - 0.16 to - 0.02; p value 0.02) as per the pooled radiostereographic analysis. However, ten-year survivorship (OR 0.92; 95% CI 0.53-1.60; p value 0.78), range of motion (OR - 0.57; 95% CI - 2.00-0.85, p value 0.43), knee society scores (OR 1.38; 95% CI - 0.47-3.23, p value 0.14), and complications (OR 0.83; 95% CI 0.5-1.39, p value 0.48) were comparable between both groups. CONCLUSIONS: While this meta-analysis suggests that all-polyethylene tibial components in total knee arthroplasty may offer advantages over metal-backed components in terms of five-year survivorship, and stairs climbing score, this finding should be considered in the context of potential confounding factors. Nonetheless, based on the results, the all-polyethylene implant should be considered a viable choice for primary knee replacement. LEVEL OF EVIDENCE: I.

Evaluation of Radiological and Functional Outcome of Intra-articular Proximal Tibia Plateau Fracture Treated with Plating.

Introduction: Proximal tibial plateau fractures are one of the major problems in orthopaedic surgery and are associated with high complication rates. Intra-articular proximal tibia plateau fractures represent approximately 1% of fractures in adults. Various modalities of proximal tibial plateau fracture management have been considered, ranging from simple external fixators in impending compartment syndrome to periarticular proximal tibia plates and inter-locking nails with poller screws. Purpose of this study is to determine clinical outcomes of proximal tibial plateau fractures treated with plate. Materials and methods: We did this study of proximal tibial plateau fracture according to Schatzker's classification treated with proximal tibial periarticular plates in 53 patients prospectively admitted at the author's institute from June 2018 to May 2020 with follow-up period of 6 months. Results: In our study, the average knee score was 89.30 (ranging from 79 to 93) and functional knee score was 97.92 (ranging from 75 to 100). Fifty-one (51) patients (96.23%) showed excellent results and 2 patients (3.77%) showed good results according to Knee Society Score, which suggest that internal fixation of proximal tibia plateau fracture with plating provides better results. Out of 53 patients, 9 patients had post-operative complications. Average radiological union was seen at 14 weeks. Conclusion: Locking compression plate in proximal tibia plateau fractures act as a good biological fixation provide stable fixation, articular reduction and limb alignment even in difficult fracture situations. Fixation of proximal tibia plateau fractures with plate gives excellent to good knee society score, with satisfactory functional and radiological outcome.

Bridge Plating Versus Hybrid External Fixation in the Management of Proximal Tibia Metaphyseal Fractures.

BACKGROUND: Due to the surge in high-speed road traffic accidents during the past few years, extra-articular proximal tibia fractures have also risen in number. For the treatment of such fractures, various options are available like conservative treatment with casting, surgical treatment with plate osteosynthesis, or a hybrid external fixator. Exposure of the bone surface and extensive soft tissue dissection is needed in bridge plating, posing a risk of bleeding, infection, and soft-tissue healing issues, and the blood supply of the fractured area is also hampered as the periosteum is also destroyed. To avoid these complications, a hybrid external fixator can be used but it has its own risks of malunion, non-union, and pin-tract infections; another drawback is patient compliance. In this study, we compare the clinical and functional outcomes of two treatment modalities, i.e., bridge plating and hybrid external fixator, in the treatment of proximal tibia metaphyseal fractures. MATERIALS AND METHODS: This prospective randomized study was conducted from February 2021 to June 2022 on 46 adult patients diagnosed with proximal tibia metaphyseal fracture and willing to participate. An odd number of patients were treated with a bridge plate and even with a hybrid external fixator. RESULTS: A total of 46 patients were included in the study, sustaining proximal tibia metaphyseal fracture, out of which 23 patients underwent hybrid external fixation with an outcome of 69.43 ± 8.11 according to the Knee Society Score (KSS) and 23 for bridge plating which showed better results as their score at final follow-up was 75.00 ± 8.22. CONCLUSION: According to our study, we found that bridge plating is a better treatment modality than the hybrid external fixator as the former showed better postoperative knee range of motion and functional outcome and led to a smaller number of complications. But the clinical outcome would also be influenced by the type of fracture, degree of comminution, type of injury, i.e., open or closed, and quality of bone.

Clinical outcomes and survival comparison between NexGen all-poly and its metal-backed equivalent in total knee arthroplasty.

PURPOSE: This study aims to compare total knee replacement (TKA) with NexGen All-Poly (APT) and NexGen Metal-Backed (MBT) in terms of implant survivorship, reasons leading to implant failure and functional results of defined age categories. METHODS: A single-centre, retrospective evaluation of 812 patients who underwent knee replacement with NexGen CR between 2005 and 2021, comparing a modern congruent APT component to a modular MBT equivalent component using a similar surgical technique at a notable mean follow-up duration. Implant survival, functional outcomes using the Knee Society Score and range of motion were evaluated and compared in different age categories. RESULTS: Of the 812 NexGen CR TKAs performed at our institution, 410 (50.4%) used APT components and 402 (49.6%) MBT components. The survival rate of NexGen APT was 97.1% and that of NexGen MBT was 93.2% (p = 0.36). Removal of the implant occurred overall in 15 cases, for MBT in ten cases, and for APT in four cases. The FS was proved to be significantly higher when APT components were implanted in younger patients than for MBT (p = 0.005). A similar range of motion between the components was recorded (p = 0.1926). CONCLUSION: Under defined conditions, we measured the clinical results of implants from a single manufacturer implanted in a single department using a similar surgical technique. Considering the limitations, we suggest that all-polyethylene tibial components are equal or even superior to metal-backed ones across the examined age categories.

The effect of tibial component rotational alignment on clinical outcomes of mobile-bearing unicompartmental knee arthroplasty.

BACKGROUND: The optimal tibial component rotational alignment in unicompartmental knee arthroplasty has not been defined. This study aimed to explore the effect of tibial component rotational alignment on the clinical outcomes of UKA. METHODS: Clinical and follow-up data from 269 patients were retrospectively analysed. They were assigned into Groups A (- 5° to 0°), B (0°-3°), C (3°-6°) and D (> 6°) according to the external rotation of the tibial component to Akagi's line. The Knee Society Score clinical (KSS-c), Knee Society Score function (KSS-f), Forgotten Joint Score (FJS) and postoperative complications at 2 years postsurgically were analysed. RESULTS: The mean rotation of the tibial component relative to Akagi's line in 269 patients was 4.56 ± 3.79°. There were 15, 84, 89 and 81 patients in Groups A, B, C and D, respectively. The postoperative KSS-c and KSS-f in Groups B and C were significantly higher than those in Group D. No significant differences in KSS-c and KSS-f were detected between Groups B and C. The postoperative FJS in Group B was significantly higher than that in Group C, which was significantly higher in Group C than in Group D. There were 5, 8 and 15 cases of postoperative knee pain in Groups B, C and D, respectively, and the difference was statistically significant. CONCLUSION: Tibial component rotational alignment is of significance to Oxford Phase III UKA in patients. External rotation of the tibial component by 0°-3° is optimal to achieve satisfactory clinical outcomes.

Does design change in total knee arthroplasty implants affect patient-reported outcomes?

PURPOSE: The purpose of this study is to compare the early results of patient-reported outcomes between two generations of a total knee system. METHODS: Between June 2018 and April 2020, 121 first-generation, cemented TKAs (89 patients) and 123 s-generation, cemented TKAs (98 patients) were performed by a single surgeon. Demographic and surgical data were collected from all patients. Starting at the 6-month follow-up, patient-reported outcome measures Knee Injury and Osteoarthritis Outcome Score, Joint Reconstruction (KOOS-JR) and Knee Society (KS) clinical and radiographic scores were prospectively recorded. This study represents a retrospective review of these prospectively collected data. RESULTS: There were no statistically significant differences between the two groups in terms of demographic variables such as age, body mass index, gender and race. KOOS-JR and Knee Society (KS) scores improved significantly (p < 0.001) from their preoperative values in both device generations. There were no differences, pre-operatively, between the two groups in terms of KOOS-JR, KS functional, KS objective, patient satisfaction, and expectation scores; however, there were statistically significant (p < 0.001) lower values of KOOS-JR and KS functional scores for first versus second generation at 6 months (81 vs. 89 and 69 vs. 74, respectively). CONCLUSION: While significant improvement in KS objective, subjective, and patient satisfaction scores were noted with both knee systems, KOOS-JR and KS function scores were significantly higher at the early (6-month) follow-up in the second-generation group. Patients responded acutely to the design change as evidenced by significantly improved patient-reported outcome scores for the second generation.

Higher knee survivorship in young patients with monocompartmental osteoarthritis and constitutional deformity treated by high tibial osteotomy then total knee arthroplasty compared to an early total knee arthroplasty : a comparative study at a minimum follow-up of ten years.

AIMS: The use of high tibial osteotomy (HTO) to delay total knee arthroplasty (TKA) in young patients with osteoarthritis (OA) and constitutional deformity remains debated. The aim of this study was to compare the long-term outcomes of TKA after HTO compared to TKA without HTO, using the time from the index OA surgery as reference (HTO for the study group, TKA for the control group). METHODS: This was a case-control study of consecutive patients receiving a posterior-stabilized TKA for OA between 1996 and 2010 with previous HTO. A total of 73 TKAs after HTO with minimum ten years' follow-up were included. Cases were matched with a TKA without previous HTO for age at the time of the HTO. All revisions were recorded. Kaplan-Meier survivorship analysis was performed using revision of metal component as the endpoint. The Knee Society Score, range of motion, and patient satisfaction were assessed. RESULTS: Mean follow-up was 13 years (SD 3) after TKA in both groups. The 20-year Kaplan-Meier survival estimate was 98.6% in TKA post-HTO group (HTO as timing reference) and 81.4% in control group (TKA as timing reference) (p = 0.030). There was no significant difference in clinical outcomes, radiological outcomes, and complications at the last follow-up. CONCLUSION: At the same delay from index surgery (HTO or TKA), a strategy of HTO followed by TKA had superior knee survivorship compared to early TKA at long term in young patients.Level of evidence: IIICite this article: Bone Jt Open 2023;4(2):62-71.

Do we still need to screen our patients?-Orthopaedic scoring based on motion tracking.

PURPOSE: Orthopaedic scores are essential for the clinical assessment of movement disorders but require an experienced clinician for the manual scoring. Wearable systems are taking root in the medical field and offer a possibility for the convenient collection of motion tracking data. The purpose of this work is to demonstrate the feasibility of automated orthopaedic scorings based on motion tracking data using the Harris Hip Score and the Knee Society Score as examples. METHODS: Seventy-eight patients received a clinical examination and an instrumental gait analysis after hip or knee arthroplasty. Seven hundred forty-four gait features were extracted from each patient's representative gait cycle. For each score, a hierarchical multiple regression analysis was conducted with a subsequent tenfold cross-validation. A data split of 70%/30% was applied for training/testing. RESULTS: Both scores can be reproduced with excellent coefficients of determination R2 for training, testing and cross-validation by applying regression models based on four to six features from instrumental gait analysis as well as the patient-reported parameter 'pain' as an offset factor. CONCLUSION: Computing established orthopaedic scores based on motion tracking data yields an automated evaluation of a joint function at the hip and knee which is suitable for direct clinical interpretation. In combination with novel technologies for wearable data collection, these computations can support healthcare staff with objective and telemedical applicable scorings for a large number of patients without the need for trained clinicians.

Primary constrained condylar knee arthroplasty in severe varus deformity: a prospective 5-year functional follow-up study in Iraqi patients.

PURPOSE: The outcomes of the constrained condylar knee (CCK) implant used during primary total knee arthroplasty (TKA) in knees with severe varus in patients from low- and middle-income countries (LMICs) such as Iraq are not known. Hence, this study aimed to analyze and report the functional outcome of CCK TKA in patients with severe varus deformities at the end of 5 years in Iraqi patients. METHODS: In this prospective study, pre- and post-operative (at the end of 5 years) clinical outcome using Knee Society Score (KSS) and radiological deformity using hip-knee-ankle (HKA) angle was analyzed in 76 CCK TKAs (20 bilateral and 36 unilateral TKAs) performed in 56 patients with severe varus deformity (> 15°). RESULTS: At a mean follow-up of 60.3 months (range 60-68 months), the mean preoperative KSS knee score of 6.6 ± 4.5 improved significantly (p < 0.0001) to 87.2 ± 6.6 and the mean preoperative KSS function score of 7.1 ± 6.4 improved significantly (p < 0.0001) to 70.4 ± 7.8. The function score was good to excellent in 64.3% (36 patients), fair in 28.5% (16 patients), and poor in 7.1% (4 patients) at the end of 5 years. The mean preoperative HKA angle significantly improved (p < 0.001) from 25.5° ± 6° varus (range 17°-37°) to 3° ± 2.5° varus (range 0°-7.5°) at final follow-up. CONCLUSION: The CCK implant significantly improved pain and function in patients with severe varus deformity at the end of 5 years. The CCK implant is a good option during primary TKA in severe varus knees in patients from LMICs and can help achieve clinical outcomes similar to patients from high-income countries.