Effectiveness of Periarticular Pin Tracker Placement Through a Single Main Incision in Robotic-Assisted Total Knee Arthroplasty: Technical Note and Short-Term Results.

Background and Objectives: Robotic-assisted total knee arthroplasty (TKA) is gaining popularity worldwide, leading to a potential increase in the number of pin tracker-related complications. This study determined the effectiveness of periarticular pin tracker placement in the distal femur and proximal tibia through a single main incision during robotic-assisted TKA over a minimum follow-up period of 6 months. Materials and Methods: A consecutive series of 149 TKAs was performed in 108 patients using the triathlon posterior-stabilized total knee prosthesis with a robotic-assisted system at our hospital from December 2023 to February 2024. Clinical outcomes and complications associated with pin tracker sites, including pin-site infection, neurovascular injury, hematoma, soft-tissue morbidity, and pin-site fracture, were assessed. Results: The mean Knee Society knee score improved from 42.5 preoperatively to 76.3 points at the final follow-up, whereas the mean Knee Society function score improved from 43.1 preoperatively to 78.1 points at the final follow-up (both p < 0.05). No patient experienced any minor or major complications related to the use of pin trackers in the distal femur and proximal tibia. Conclusions: This periarticular technique that uses pin trackers in the distal femur and proximal tibia through a single main incision could be a useful option for orthopedic surgeons while performing robotic-assisted TKA.

Comparison of Pain and Complications between Outpatients and Inpatients Treated with Bone Marrow Aspirate Concentrate for Knee Osteoarthritis.

Bone marrow aspirate concentrate (BMAC) has been increasingly used as an injectable treatment for knee osteoarthritis (OA). However, there remains a lack of studies on the pain and complications associated with BMAC treatment. This study compared the pain and complications of BMAC treatment between outpatients and inpatients with Kellgren-Lawrence grade II-III knee osteoarthritis (OA) during a follow-up period of ≥3 months. This study included 40 outpatients (40 knees) and 80 inpatients (80 knees) as controls who received BMAC articular injections for knee OA between December 2023 and March 2024. Outpatients were administered BMAC under local anesthesia alone, whereas inpatients were administered BMAC under local anesthesia and intravenous anesthesia. The outcomes were the visual analog scale (VAS) pain score during the BMAC procedure and the complications associated with harvest and injection sites. The mean VAS pain score in the outpatient group was significantly higher than that in the inpatient group during trocar insertion (5.2 vs. 1.3, p < 0.05) and bone marrow aspiration (6.2 vs. 1.4, p < 0.05), but it was similar between the two groups during BMAC injection (2.2 vs. 2.3, p = 0.858). Transient post-treatment complications were observed in 17.5% (7/40) of outpatients and 16.3% (13/80) of inpatients. No significant differences were observed in complications between the two groups, all of which were resolved within 2 months without any specific problem. Moreover, no major complications occurred in any group. In conclusion, outpatients who received only local anesthesia reported significant pain during BMAC treatment. The addition of intravenous anesthesia is necessary to alleviate pain during the BMAC procedure.

Surgical Technique for Complementing Robotic-Assisted Total Knee Arthroplasty in Middle-Aged Patients with Rigid Knee Bones.

This study reports 12 cases of inaccurate bone cutting from a single-surgeon series of 509 consecutively performed robotic-assisted total knee arthroplasty (TKA) for 1 year. In addition, a complementary technique with the combined benefits of robotic-assisted and manual techniques that address this issue is described. From June 2020 to May 2021, a consecutive series of 509 TKAs was performed on 338 patients using a posterior-stabilized total knee prosthesis with a robotic-assisted system at our hospital. The surgical records were reviewed to identify the causative bone locations and bone re-cutting events correlated with improper trial instrument positioning. The re-cutting rate was 2.4% (12/509). All re-cutting attempts occurred because of improper cutting of the femoral posterior chamfer. Re-cutting was attempted mostly on middle-aged male patients. This complementary technique can facilitate manual bone cutting while retaining the advantages of robotic surgery during robotic-assisted TKA. Additionally, the combined technique of manual bone cutting and robotic-assisted surgery can be a useful alternative for middle-aged male patients with rigid knee bones.

Benchmarking clustering, alignment, and integration methods for spatial transcriptomics.

BACKGROUND: Spatial transcriptomics (ST) is advancing our understanding of complex tissues and organisms. However, building a robust clustering algorithm to define spatially coherent regions in a single tissue slice and aligning or integrating multiple tissue slices originating from diverse sources for essential downstream analyses remains challenging. Numerous clustering, alignment, and integration methods have been specifically designed for ST data by leveraging its spatial information. The absence of comprehensive benchmark studies complicates the selection of methods and future method development. RESULTS: In this study, we systematically benchmark a variety of state-of-the-art algorithms with a wide range of real and simulated datasets of varying sizes, technologies, species, and complexity. We analyze the strengths and weaknesses of each method using diverse quantitative and qualitative metrics and analyses, including eight metrics for spatial clustering accuracy and contiguity, uniform manifold approximation and projection visualization, layer-wise and spot-to-spot alignment accuracy, and 3D reconstruction, which are designed to assess method performance as well as data quality. The code used for evaluation is available on our GitHub. Additionally, we provide online notebook tutorials and documentation to facilitate the reproduction of all benchmarking results and to support the study of new methods and new datasets. CONCLUSIONS: Our analyses lead to comprehensive recommendations that cover multiple aspects, helping users to select optimal tools for their specific needs and guide future method development.

Percutaneous Epidural Neuroplasty for Symptomatic Lumbar Juxtafacet Cysts.

Background and Objectives: The term "Juxtafacet cyst" refers to both synovial cysts and ganglion pseudocysts associated with the lumbar facet joint. As conservative treatment for the juxtafacet cyst has a minimal effect, complete excision through surgery is considered the first choice of treatment. In this study, we retrospectively reviewed the clinical outcomes of percutaneous epidural neuroplasty for symptomatic lumbar juxtafacet cysts. Materials and Methods: We conducted a retrospective review of 34 patients with symptomatic juxtafacet cysts who visited a single institute from January 2010 to September 2023. Patients who received conservative treatment for at least 6 weeks but experienced no or insufficient effects were eligible for this study. After neuroplasty, a medical history check and neurological examination were performed during follow-up at 2 weeks, 1 month, 2 months, 3 months, 6 months, and once a year thereafter. Results: The pain improved for all patients to a VAS score of 3 or less immediately after neuroplasty; however, four of those patients (11%) had pain that worsened eventually to the same level as before the procedure and required surgery. The results showed that, regardless of cyst size, in cases with severe stenosis of the spinal canal, the outcome of neuroplasty was poor and often eventually required surgery. The cyst size was not associated with the procedure results. In addition, if the cyst was present at the L4-L5 level, or if diabetes mellitus was present, the likelihood of future surgery was significant (p-value = 0.003). Conclusions: Percutaneous neuroplasty showed a better success rate than other non-surgical treatments. In addition, severe spinal stenosis (Schizas grade C or higher), L4-L5 level, or diabetes mellitus produced a high possibility of surgery due to recurrence.

Effectiveness and Complications of Bone Marrow Aspirate Concentrate in Patients with Knee Osteoarthritis of Kellgren-Lawrence Grades II-III.

This study aimed to identify the effectiveness and potential complications on the harvest site and knee of bone marrow aspirate concentrate (BMAC) treatment of patients with Kellgren-Lawrence (K-L) grades II-III knee osteoarthritis (OA) over a minimum follow-up period of 6 months. This study retrospectively evaluated data from 231 patients (285 knees) with knee OA treated with BMAC articular injection at a single center from August 2023 to October 2023. The inclusion criteria were a longstanding knee pain unresponsive to conservative treatments for at least 6 weeks with K-L grades II-III OA. The exclusion criteria were age of <40 years or >80 years, previous knee surgery, rheumatological or other systemic disease, malignancy, uncontrolled diabetes mellitus, or infections. Bone marrow was aspirated from the anterior iliac crest and concentrated by the single-spin centrifugation technique. The visual analog scale (VAS) pain score and Knee Society Score were used to evaluate the clinical outcomes and complications associated with harvest and injection sites were evaluated. The mean follow-up period was 7.2 months (range: 6-8 months). The pretreatment VAS pain score decreased from 4.3 to 0.4 points at the final follow-up (p < 0.05). Pretreatment Knee Society knee and function scores were improved from 86.9 to 98.1 (p < 0.05) and from 68.4 to 83.3 points (p < 0.05), respectively. A total of 15 complications (5.3%, 15/285) were observed, including 3 hematomas, 2 numbness, 2 contact dermatitis, and 1 superficial infection in the harvest site and 4 mild and moderate swelling and 3 severe swelling and pain in the injection site. BMAC is a reliable and effective treatment for patients with K-L grades II-III knee OA, but the orthopedic surgeon should consider that bleeding tendency by heparin causes severe joint swelling and pain after intra-articular knee injection.

Pain Classification using Evoked EEG Induced by Thermal Grill Illusion - Deep Neural Network Approach.

As the quantification of pain has emerged in biomedical engineering today, studies have been developing biomarkers associated with pain actively by measuring bio-signals such as electroencephalogram (EEG). Recently, some EEG studies of cold and hot pain have been reported. However, they used one type of stimulus condition for each trial and a relatively long stimulation time to collect EEG features. In this study, EEG signals during Cool (20 °C), Warm (40 °C), and Thermal Grill Illusion (TGI, 20-40 °C) stimuli were collected from 43 subjects, and were classified by a deep convolutional neural network referred to as EEGNet. Three binary classifications for the three conditions (TGI, Cool, Warm) were conducted for each subject individually. Classification accuracies for TGI-Cool, TGI-Warm, and Warm-Cool were 0.74±0.01, 0.71±0.01, and 0.74±0.01, respectively. For subjects who rated the TGI significantly hotter than the Warm stimulus, the classification accuracy for TGI-Cool (0.74±0.01) was significantly higher than for TGI-Warm (0.71±0.01). In contrast, the classification accuracy for TGI-Cool (0.72±0.03) did not differ statistically from TGI-Warm (0.73±0.01) in subjects without illusion. We found that the TGI and Cool stimuli were classified better than the TGI and Warm stimuli, implying that objective EEG features are consistent with subjective behavioral results. Further, we observed that most discriminative features between the TGI and the Cool or Warm conditions appeared in the parietal area for subjects who perceived the illusion. We postulate that the somato-sensory cortex may be activated when TGI is perceived to be hot pain.

No higher tibial post fracture rate with highly cross-linked polyethylene inserts in total knee arthroplasty at a minimum 10-year follow-up.

PURPOSE: The purpose of this study was to assess tibial post fracture between highly cross-linked polyethylene (HXPE) and conventional polyethylene inserts in consecutive posterior-stabilized (PS) total knee arthroplasty (TKA) over a minimum 10-years follow-up period. METHODS: Between July 2008 and December 2011, a consecutive series of 3264 primary TKAs was performed in 2098 patients using a PS total knee prosthesis at a single institution. The final cohort was classified into the HXPE group (792 cases) and the conventional group (2113 cases) according to insert material used during the procedure. RESULTS: The mean follow-up period was 11.4 years in the HXPE group and 11.8 years in the conventional group. Both cases of tibial post fracture occurred in the HXPE group, a complication rate of 0.25%. These two cases required replacement with a thicker tibial insert with retention of the femoral and tibial components. There were no cases of tibial post fracture in the conventional group. CONCLUSION: There was no difference in tibial post fracture rate between the HXPE group and the conventional group in PS TKA on long-term follow-up. LEVEL OF EVIDENCE: IV.

Tibial Post Refracture in Posterior-Stabilized Total Knee Arthroplasty Following Isolated Tibial Insert Exchange.

Background: We report 4 cases with a tibial post refracture following isolated tibial insert exchange in posterior-stabilized total knee arthroplasty at a single center. Methods: In our institution, 27 cases (26 patients) underwent reoperation due to tibial post fracture in posterior-stabilized total knee arthroplasty between July 2008 and November 2020. Of these 27 cases, 4 (4 patients) tibial post refractures occurred at a mean follow-up period of 9.1 years. Results: All 4 cases of tibial post refracture occurred in a group of 21 cases with isolated tibial insert exchange. There was no tibial post refracture in patients with a tibial revision surgery. The incidence of this complication following isolated tibial insert exchange was 19.0%. The mean elapsed time from tibial insert exchange to the diagnosis of a post refracture was 2.5 years (range: 1.1-6.6 years). Conclusions: Isolated exchange of a tibial insert with excessive thickness as a treatment for tibial post fracture is associated with a high probability of tibial post refracture. The treatment method should be selected after a thorough analysis according to the cause of fracture. Level of evidence: IV.

Distal Femoral Tracker Pin Placement Prevents Delayed Pin Tract-Induced Fracture in Robotic-Assisted Total Knee Arthroplasty: Results of Minimum 1-Year Follow-Up.

The purpose of this study was to determine the outcomes of the placement of a pin tracker in the distal femur in robotic-assisted total knee arthroplasty (TKA) over a minimum follow-up period of 1 year. A consecutive series of 81 TKAs were performed in 59 patients using a robotic-assisted system (Mako) at our hospital. The mean follow-up period was 1.1 years (range, 1-1.2 years). No periprosthetic fracture at a pin tracker site was reported at a minimum of 1 year of follow-up. No patients reported minor or major complications associated with the distal femoral pins. In addition, unicortical pin-site drilling marks in all patients disappeared on one-postoperative-year follow-up radiographs. Our technique, which used unicortical pin placement in the distal femur in robotic-assisted TKA, demonstrated that it was a safe and reliable method at a minimum follow-up period of 1 year. The level of evidence is IV.

Distal Femoral Pin Tracker Placement Prevents Pin Tract-induced Fracture in Robotic-Assisted Total Knee Arthroplasty.

The purpose of this study was to determine the effectiveness of the placement of pin trackers in the medial sagittal plane of the distal femur in robotic-assisted total knee arthroplasty (TKA) over a minimum follow-up period of 3 months. From August 2020 to October 2020, a consecutive series of 81 TKAs were performed in 59 patients using the Triathlon posterior-stabilized total knee prosthesis with a robotic-assisted system (Mako) at our hospital. Patient charts were reviewed for complications associated with the pin sites, including fracture, infection, thigh pain, and the need for reoperation. No patients had any minor or major complications associated with distal femoral pins. This technique, which used pin trackers in the medial sagittal plane of the distal femur, could be a useful option for surgeons performing robotic-assisted TKA. This is a Level IV study.

Long-term outcomes of total knee arthroplasty in patients with windswept deformity.

BACKGROUND: This study compared the functional outcomes, implant survival rates, and complications of total knee arthroplasty (TKA) performed in patients with windswept deformity (WSD) and non-WSD patients over at least 10 years of follow-up. METHODS: From January 2008 to December 2010, 40 TKAs were performed in 20 patients with WSD (WSD group). Additionally, 60 propensity score-matched patients without WSD who had undergone primary bilateral TKA were chosen for the control group in a three-to-one ratio. Then, the functional outcomes, implant survival rates, and complications of TKA in the two groups were compared. The mean follow-up periods were 10.8 years in the WSD group and 11.5 years in the control group. RESULTS: The mean Knee Society knee scores in the WSD and control groups improved from 37.7 to 38.1 points preoperatively to 79.5 and 79.2 points at final follow-up (p = 0.974), while the mean function scores in the WSD and control groups improved from 36.5 to 37.2 points preoperatively to 77.8 and 77.4 points at final follow-up (p = 0.863). Two knees in the WSD group required revision surgery, including one due to septic loosening and one due to aseptic loosening. Five knees in the control group required revision surgery, including three due to septic loosening and two due to aseptic loosening. Kaplan-Meier survivorship analysis with the revision of either component as an endpoint in the WSD and control groups estimated 95.0% and 95.8% chances of survival for 10 years, respectively (p = 0.824). CONCLUSIONS: TKA performed in patients with WSD yielded good clinical outcomes and survivorship at least 10 years later. LEVEL OF EVIDENCE: IV.

Early aseptic loosening of primary total knee arthroplasty in patients with osteonecrosis of the knee: A case series.

The cause of early aseptic loosening in total knee arthroplasty (TKA) is uncertain, although several possibilities could be offered. We report that osteonecrosis of the knee should be considered as a possible cause or contributing etiologic factor for early aseptic loosening following primary TKA.

Coronal Correction for Post-Traumatic Malalignment Using Robot-Assisted Total Knee Arthroplasty: A Case Series.

Background: Achieving proper axis alignment can be difficult in the presence of posttraumatic extra-articular deformities in either the femur or the tibia. We present radiological outcomes following robot-assisted total knee arthroplasty (TKA) in patients with osteoarthritis of the knee accompanied by posttraumatic extra-articular deformities. Methods: We analyzed the outcomes of five knees in five patients with (1) Kellgren-Lawrence (K-L) Grade III-IV osteoarthritic knees, (2) the presence of posttraumatic extra-articular deformities either in the femur or the tibia, and (3) who underwent robot-assisted TKA. Their radiological findings were evaluated. Results: All five knees with initial deformity (mean 14.8°, range 12.7-18.5°) were corrected to neutral alignment (mean 0.7°, range -1.1-2.7°). There was no postoperative outlier of hip-knee-ankle (HKA) angle. Conclusion: Our results indicate that robot-assisted TKA can be used to achieve proper limb alignment in patients with posttraumatic extra-articular deformities.

Robot-assisted total knee arthroplasty improves mechanical alignment and accuracy of component positioning compared to the conventional technique.

PURPOSE: The purpose of this study was to compare the mechanical axis, accuracy of component positioning, and polyethylene liner thickness between robot-assisted total knee arthroplasty (TKA) and conventional TKA. METHODS: From July 2020 to December 2020, 154 TKAs were performed in 110 patients with Kellgren-Lawrence grade IV varus knees using a robot-assisted system (MAKO group). Additionally, 110 propensity score-matched patients who had undergone primary conventional TKA were chosen in a one-to-one ratio for the conventional group. Post-operative radiographs were used to evaluate mechanical axis and component coronal and sagittal positioning. The polyethylene liner thickness was investigated. The respective mean error values and outliers were obtained for the two study groups and were compared to determine the mechanical axis and the accuracy of the postoperative component positioning. RESULTS: Patients in the MAKO group achieved better accuracy than those in the conventional group in terms of postoperative mean mechanical axis (1.9˚ vs. 2.8˚, p < 0.05), femur coronal inclination (91.2˚ vs. 91.8˚, p < 0.05), tibia coronal inclination (90.8˚ vs. 91.1˚, p < 0.05), and tibia sagittal inclination (90.7˚ vs. 91.7˚, p < 0.05). However, there was no difference between the two groups in polyethylene liner thickness. CONCLUSIONS: Robot-assisted TKA showed improved mechanical axis and higher accuracy of component positioning compared to the conventional TKA technique, with no significant difference in polyethylene liner thickness between the two groups. Long-term follow-up studies are needed to compare the clinical outcomes of robot-assisted TKA. LEVEL OF EVIDENCE: IV.

Usefulness of Trabecular Metal Cones in Revision Total Knee Arthroplasty in a Korean Population: A Case Series.

Purpose: The purpose of this study was to assess the medium-term results of trabecular metal cones for the reconstruction of large bone defects in revision TKA. Methods: Thirteen patients who had undergone revision TKA using trabecular metal cones for femoral and/or tibial large bone defects were identified. We included patients who had a minimum of three years follow-up in the study. We evaluated their functional outcomes, implant survivorship, radiological findings, and complications. Results: At a mean follow-up of 6.9 years (range of 3.5-9.4 years), all trabecular metal cones and implants were well fixed and did not exhibit any radiographic evidence of migration or loosening. At the final follow-up, the mean Knee Society knee scores had improved from 37.2 to 78.1 (p < 0.05), and function scores had improved from 35.5 to 77.5 points (p < 0.05). One intraoperative fracture in the distal femur occurred in an 85-year-old woman during impaction of a single trabecular metal cone. The fracture was successfully affixed to the femoral cone and bone three months postoperatively. Conclusion: The present study of trabecular metal cones demonstrates excellent clinical outcomes and survivorship in revision TKA during medium-term follow-up periods. However, longer-term follow-up studies are needed to further investigate these implants in revision TKA. Additionally, the necessity of metal cones in revision procedures should be carefully considered depending on patient needs and economic capabilities.

Long-term outcomes of primary total knee arthroplasty in patients with hepatitis B virus infection.

AIMS: The purpose of this study was to compare the clinical outcomes, mortalities, implant survival rates, and complications of total knee arthroplasty (TKA) in patients with or without hepatitis B virus (HBV) infection over at least ten years of follow-up. METHODS: From January 2008 to December 2010, 266 TKAs were performed in 169 patients with HBV (HBV group). A total of 169 propensity score-matched patients without HBV were chosen for the control group in a one-to-one ratio. Then, the clinical outcomes, mortalities, implant survival rates, and complications of TKA in the two groups were compared. The mean follow-up periods were 11.7 years (10.5 to 13.4) in the HBV group and 11.8 years (11.5 to 12.4) in the control group. RESULTS: The mean Knee Society scores in the HBV and control groups improved from 37.1 (SD 5.6) and 38.4 (SD 5.4) points preoperatively to 78.1 (SD 10.8) and 81.7 (SD 10.2) points at final follow-up (p = 0.314), while the mean function scores in the HBV and control groups improved from 36.2 and 37.3 points preoperatively to 77.8 and 83.2 points at final follow-up (p = 0.137). Nine knees in the HBV group required revision surgery, including seven due to septic loosening and two due to aseptic loosening. Four knees in the control group required revision surgery, including three due to septic loosening and one due to aseptic loosening. Kaplan-Meier survivorship analysis with the revision of either component as an endpoint in the HBV and control groups estimated 96.6% and 98.5% chances of survival for ten years, respectively (p = 0.160). CONCLUSION: TKA in patients with HBV infection resulted in good clinical outcomes and survivorship. However, there was a higher revision rate over a minimum ten-year follow-up period compared to TKA in patients without HBV infection. Cite this article: Bone Jt Open 2022;3(6):470-474.

Regeneration of the lateral discoid meniscus after arthroscopic saucerization in an adult patient undergoing high tibial osteotomy: A case report.

Arthroscopic saucerization of the lateral discoid meniscus is considered due to an increase in the load of the lateral compartment after high tibial osteotomy (HTO). We report a case of lateral discoid meniscus regeneration after arthroscopic saucerization in a middle-aged female patient who underwent HTO.

High rate of tibial post-fracture in highly cross-linked polyethylene compared to conventional polyethylene in posterior-stabilized total knee arthroplasty at a minimum 12-year follow-up.

PURPOSE: The purpose of this study was to assess tibial post-fracture between highly cross-linked polyethylene (HXPE) and conventional polyethylene inserts in consecutive posterior-stabilized (PS) total knee arthroplasty (TKA) over a minimum 12-year follow-up period. METHODS: Between January 2007 and June 2008, a consecutive series of 2446 primary TKAs was performed in 1478 patients at a single institution. The final cohort was classified into two groups (1559 in the HXPE group and 887 in the conventional group) based on the insert material used during the procedure. RESULTS: The mean follow-up period was 13.1 years in the HXPE group and 13.4 years in the conventional group. All 16 cases of tibial post-fracture occurred in the HXPE group. This complication rate was 1.03%. The mean elapsed time from primary TKA to the diagnosis of post-fracture was 3.9 years (range 0.5-10.0 years). Ten cases required replacement with a thicker polyethylene insert, and six cases underwent tibial revision surgery. There were no cases of tibial post-fracture in the conventional group. CONCLUSION: Tibial post-fracture is not a rare complication in PS TKA with HXPE. Therefore, the possibility of a tibial post-fracture should be considered if newly developed pain, acute subluxation, effusion, patellar clunking, or instability occurs in patients treated with PS Scorpio knee system TKA using an HXPE insert. LEVEL OF EVIDENCE: IV.

Usefulness of robot-assisted total knee arthroplasty in patients with retained hardware: A report of two cases.

Total knee arthroplasty (TKA) is technically demanding in patients with pre-existing hardware around the knee. We report two cases of knee osteoarthritis in patients with retained hardware who would have difficulty undergoing conventional TKA. Robot-assisted TKA can be a useful treatment for knee osteoarthritis in patients with retained hardware.