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Drainage and agricultural use transform natural peatlands from a net carbon (C) sink to a net C source. Rewetting of peatlands, despite of high methane (CH4 ) emissions, holds the potential to mitigate climate change by greatly reducing CO2 emissions. However, the time span for this transition is unknown because most studies are limited to a few years. Especially, nonpermanent open water areas often created after rewetting, are highly productive. Here, we present 14 consecutive years of CH4 flux measurements following rewetting of a formerly long-term drained peatland in the Peene valley. Measurements were made at two rewetted sites (non-inundated vs. inundated) using manual chambers. During the study period, significant differences in measured CH4 emissions occurred. In general, these differences overlapped with stages of ecosystem transition from a cultivated grassland to a polytrophic lake dominated by emergent helophytes, but could also be additionally explained by other variables. This transition started with a rapid vegetation shift from dying cultivated grasses to open water floating and submerged hydrophytes and significantly increased CH4 emissions. Since 2008, helophytes have gradually spread from the shoreline into the open water area, especially in drier years. This process was periodically delayed by exceptional inundation and eventually resulted in the inundated site being covered by emergent helophytes. While the period between 2009 and 2015 showed exceptionally high CH4 emissions, these decreased significantly after cattail and other emergent helophytes became dominant at the inundated site. Therefore, CH4 emissions declined only after 10 years of transition following rewetting, potentially reaching a new steady state. Overall, this study highlights the importance of an integrative approach to understand the shallow lakes CH4 biogeochemistry, encompassing the entire area with its mosaic of different vegetation forms. This should be ideally done through a study design including proper measurement site allocation as well as long-term measurements.
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Ecossistema , Metano , Typhaceae , Dióxido de Carbono/análise , Pradaria , Solo , Água , Áreas AlagadasRESUMO
Interest in measuring displacement gradients, such as rotation and strain, is growing in many areas of geophysical research. This results in an urgent demand for reliable and field-deployable instruments measuring these quantities. In order to further establish a high-quality standard for rotation and strain measurements in seismology, we organized a comparative sensor test experiment that took place in November 2019 at the Geophysical Observatory of the Ludwig-Maximilians University Munich in Fürstenfeldbruck, Germany. More than 24 different sensors, including three-component and single-component broadband rotational seismometers, six-component strong-motion sensors and Rotaphone systems, as well as the large ring laser gyroscopes ROMY and a Distributed Acoustic Sensing system, were involved in addition to 14 classical broadband seismometers and a 160 channel, 4.5 Hz geophone chain. The experiment consisted of two parts: during the first part, the sensors were co-located in a huddle test recording self-noise and signals from small, nearby explosions. In a second part, the sensors were distributed into the field in various array configurations recording seismic signals that were generated by small amounts of explosive and a Vibroseis truck. This paper presents details on the experimental setup and a first sensor performance comparison focusing on sensor self-noise, signal-to-noise ratios, and waveform similarities for the rotation rate sensors. Most of the sensors show a high level of coherency and waveform similarity within a narrow frequency range between 10 Hz and 20 Hz for recordings from a nearby explosion signal. Sensor as well as experiment design are critically accessed revealing the great need for reliable reference sensors.
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BACKGROUND: Effective antimicrobial treatment is key to reduce mortality associated with bacterial sepsis in patients on intensive care units (ICUs). Dose adjustments are often necessary to account for pathophysiological changes or renal replacement therapy. Extracorporeal membrane oxygenation (ECMO) is increasingly being used for the treatment of respiratory and/or cardiac failure. However, it remains unclear whether dose adjustments are necessary to avoid subtherapeutic drug levels in septic patients on ECMO support. Here, we aimed to evaluate and comparatively assess serum concentrations of continuously applied antibiotics in intensive care patients being treated with and without ECMO. METHODS: Between October 2018 and December 2019, we prospectively enrolled patients on a pneumological ICU in southwest Germany who received antibiotic treatment with piperacillin/tazobactam, ceftazidime, meropenem, or linezolid. All antibiotics were applied using continuous infusion, and therapeutic drug monitoring of serum concentrations (expressed as mg/L) was carried out using high-performance liquid chromatography. Target concentrations were defined as fourfold above the minimal inhibitory concentration (MIC) of susceptible bacterial isolates, according to EUCAST breakpoints. RESULTS: The final cohort comprised 105 ICU patients, of whom 30 were treated with ECMO. ECMO patients were significantly younger (mean age: 47.7 vs. 61.2 years; p < 0.001), required renal replacement therapy more frequently (53.3% vs. 32.0%; p = 0.048) and had an elevated ICU mortality (60.0% vs. 22.7%; p < 0.001). Data on antibiotic serum concentrations derived from 112 measurements among ECMO and 186 measurements from non-ECMO patients showed significantly lower median serum concentrations for piperacillin (32.3 vs. 52.9; p = 0.029) and standard-dose meropenem (15.0 vs. 17.8; p = 0.020) in the ECMO group. We found high rates of insufficient antibiotic serum concentrations below the pre-specified MIC target among ECMO patients (piperacillin: 48% vs. 13% in non-ECMO; linezolid: 35% vs. 15% in non-ECMO), whereas no such difference was observed for ceftazidime and meropenem. CONCLUSIONS: ECMO treatment was associated with significantly reduced serum concentrations of specific antibiotics. Future studies are needed to assess the pharmacokinetic characteristics of antibiotics in ICU patients on ECMO support.
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Antibacterianos/análise , Monitoramento de Medicamentos/métodos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Terapia de Substituição Renal/estatística & dados numéricos , Adulto , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/sangue , Ceftazidima/administração & dosagem , Ceftazidima/análise , Ceftazidima/sangue , Monitoramento de Medicamentos/instrumentação , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Alemanha , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Linezolida/administração & dosagem , Linezolida/análise , Linezolida/sangue , Masculino , Meropeném/administração & dosagem , Meropeném/análise , Meropeném/sangue , Pessoa de Meia-Idade , Combinação Piperacilina e Tazobactam/administração & dosagem , Combinação Piperacilina e Tazobactam/análise , Combinação Piperacilina e Tazobactam/sangue , Estudos Prospectivos , Terapia de Substituição Renal/métodosRESUMO
Drainage has turned peatlands from a carbon sink into one of the world's largest greenhouse gas (GHG) sources from cultivated soils. We analyzed a unique data set (12 peatlands, 48 sites and 122 annual budgets) of mainly unpublished GHG emissions from grasslands on bog and fen peat as well as other soils rich in soil organic carbon (SOC) in Germany. Emissions and environmental variables were measured with identical methods. Site-averaged GHG budgets were surprisingly variable (29.2 ± 17.4 t CO2 -eq. ha-1 yr-1 ) and partially higher than all published data and the IPCC default emission factors for GHG inventories. Generally, CO2 (27.7 ± 17.3 t CO2 ha-1 yr-1 ) dominated the GHG budget. Nitrous oxide (2.3 ± 2.4 kg N2 O-N ha-1 yr-1 ) and methane emissions (30.8 ± 69.8 kg CH4 -C ha-1 yr-1 ) were lower than expected except for CH4 emissions from nutrient-poor acidic sites. At single peatlands, CO2 emissions clearly increased with deeper mean water table depth (WTD), but there was no general dependency of CO2 on WTD for the complete data set. Thus, regionalization of CO2 emissions by WTD only will remain uncertain. WTD dynamics explained some of the differences between peatlands as sites which became very dry during summer showed lower emissions. We introduced the aerated nitrogen stock (Nair ) as a variable combining soil nitrogen stocks with WTD. CO2 increased with Nair across peatlands. Soils with comparatively low SOC concentrations showed as high CO2 emissions as true peat soils because Nair was similar. N2 O emissions were controlled by the WTD dynamics and the nitrogen content of the topsoil. CH4 emissions can be well described by WTD and ponding duration during summer. Our results can help both to improve GHG emission reporting and to prioritize and plan emission reduction measures for peat and similar soils at different scales.
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Gases/análise , Pradaria , Efeito Estufa , Dióxido de Carbono/análise , Alemanha , Metano/análise , Óxido Nitroso/análise , Solo/químicaRESUMO
We report on few-cycle pulse characterization based on third harmonic generation dispersion scan (THG d-scan) measurements using thin films of different TiO(2)-SiO(2) compositions as nonlinear media. By changing the TiO(2) concentration in the thin film the band gap and therefore the position of the absorption edge were varied. The retrieved pulse durations from different nonlinear media agree within 5%, and the reconstructed pulse shapes prove to be immune against the absorption edges as well. The reason is the robust retrieval algorithm which takes the influence of wavelength dependent nonlinearity into account by a spectral weight function.
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Modern agriculture's goal of improving crop resource acquisition efficiency relies on the intricate relationship between the root system and the soil. Root and rhizosphere traits play a critical role in the efficient use of nutrients and water, especially under dynamic environments. This review emphasizes a holistic perspective, challenging the conventional separation of nutrient and water uptake processes and the necessity for an integrated approach. Anticipating climate change-induced increase in the likelihood of extreme weather events that result in fluctuations in soil moisture and nutrient availability, the study explores the adaptive potential of root and rhizosphere traits to mitigate stress. We emphasize the significance of root and rhizosphere characteristics that enable crops to rapidly respond to varying resource availabilities (i.e. the presence of water and mobile nutrients in the root zone) and their accessibility (i.e. the possibility to transport resources to the root surface). These traits encompass for example root hairs, mucilage and extracellular polymeric substance (EPS) exudation, rhizosheath formation and the expression of nutrient and water transporters. Moreover, we recognize the challenge of balancing carbon investments, especially under stress, where optimized traits must consider carbon-efficient strategies. To advance our understanding, the review calls for well-designed field experiments, recognizing the limitations of controlled environments. Non-destructive methods such as mini rhizotron assessments and in-situ stable isotope techniques, in combination with destructive approaches such as root exudation analysis, are proposed for assessing root and rhizosphere traits. The integration of modeling, experimentation, and plant breeding is essential for developing resilient crop genotypes capable of adapting to evolving resource limitation.
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Enhancing the agroecosystems carbon (C) sink function for climate mitigation faced challenges, particularly with traditional measures with limited suitability for increasing soil organic carbon (SOC) stocks. Inducing a SOC undersaturation in the topsoil by abrupt subsoil admixture is a way to create an additional C sink. However, the deep tillage traditionally used for this topsoil dilution was not always successful. It was due to a lack of knowledge and suitable approaches to record the effect of all relevant factors in SOC recovery, including soil conditions and fertilizer forms. We addressed these problems by establishing a three-factorial experiment: I) "moderate topsoil dilution," II) "N fertilization form," and III) "soil erosion state," representing three soil types in the hummocky ground moraine landscape of NE Germany. SOC dynamics were determined over a year of winter rye cropping using a novel robotic chamber system capable of measuring CO2 exchange on 36 experimental plots with a reduced methodological bias than previous measuring systems. The averaged net ecosystem carbon balance, a proxy for SOC stock change, indicated that topsoil dilution only reduced further SOC losses. The N fertilizer form had a significantly stronger and more differentiated effect. While the mineral N fertilization consistently produced only C sources, the organic fertilization, in combination with the diluted topsoil, led to a C sink. This C-sink function was, however, more pronounced in the eroded soil than in the non-eroded soil. Overall, the results have made clear that the impact of topsoil dilution on the further development of the SOC stock is only possible if the effect of other relevant factors, such as N fertilizer form and erosion state, are taken into account.
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Erosion-induced topsoil dilution strongly affects cropland biogeochemistry and is associated with a negative effect on soil health and crop productivity. While its impact on soil C cycling has been widely recognized, there is little information about its impact on soil N cycling and N fertilizer dynamics. Here, we studied three factors potentially influencing N cycling and N fertilizer dynamics in cropping systems, namely: 1.) soil type, 2.) erosion-induced topsoil dilution and 3.) N fertilizer form, in a full-factorial pot experiment using canola plants. We studied three erosion affected soil types (Luvisol, eroded Luvisol, calcaric Regosol) and performed topsoil dilution in all three soils by admixing 20 % of the respective subsoil into its topsoil. N fertilizer dynamics were investigated using either mineral (calcium ammonium nitrate) or organic (biogas digestate) fertilizer, labeled with 15N. The fertilizer 15N recovery and the distribution of the fertilizer N in different soil fractions was quantified after plant maturity. Fertilizer N dynamics and utilization were influenced by all three factors investigated. 15N recovery in the plant-soil system was higher and fertilizer N utilization was lower in the treatments with diluted topsoil than in the non-diluted controls. Similarly, plants of the organic fertilizer N treatments took up significantly less fertilizer N in comparison to mineral fertilizer treatments. Both topsoil dilution and organic fertilizer application promoted 15N recovery and N accumulation in the soil fractions, with strong differences between soil types. Our study reveals an innovative insight: topsoil dilution due to soil erosion has a negligible impact on N cycling and dynamics in the plant-soil system. The crucial factors influencing these processes are found to be the choice of fertilizer form and the specific soil type. Recognizing these aspects is essential for a precise and comprehensive assessment of the environmental continuum, emphasizing the novelty of our findings.
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Wet grasslands, which are vital for water and nutrient regulation, are characterised by distinct water, carbon (C) and nitrogen (N) dynamics, and their interactions. Due to their shallow groundwater table, wet grasslands promote a strong interconnection between diverse vegetation and soil water. Researchers have investigated how wet grasslands respond to environmental changes, using various simulation models to understand how these sites contribute to water, C and N dynamics. However, a comprehensive, simultaneous study of all three of these dynamics is still lacking. This study makes use of a grassland lysimeter study with differently managed groundwater levels and employs the process-based MOdel for NItrogen and Carbon dynamics in Agroecosystems (MONICA) to simulate these dynamics. By using SPOTPY (Statistical Parameter Optimization Tool) to optimise the relevant parameters, we find that MONICA performs well in simulating vegetation growth (aboveground biomass), and elements of the water (evapotranspiration), C (gross primary productivity, ecosystem respiration) and N (N in aboveground biomass, nitrate in soil solution, Nitrous oxide emissions) balance, with Willmott's Refined Index of Agreement always larger than 0.35. This level of accuracy demonstrates that MONICA is ready to be applied for scenario simulations of groundwater management and climate change to evaluate their impact on greenhouse gas emissions and long-term carbon storage, as well as water and nitrogen losses in wet grasslands.
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Arctic soils are the largest pool of soil organic carbon worldwide. Temperatures in the Arctic have risen faster than the global average during the last decades, decreasing annual freezing days and increasing the number of freeze-thaw cycles (temperature oscillations passing through zero degrees) per year as the temperature is expected to fluctuate more around 0 °C. At the same time, proceeding deepening of seasonal thaw may increase silicon (Si) and calcium (Ca) concentrations in the active layer of Arctic soils as the concentrations in the thawing permafrost layer might be higher depending on location. We analyzed the importance of freeze-thaw cycles for Arctic soil CO2 fluxes. Furthermore, we tested how Si (mobilizing organic C) and Ca (immobilizing organic C) interfere with the soil CO2 fluxes in the context of freeze-thaw cycles. Our results show that with each freeze-thaw cycle the CO2 fluxes from the Arctic soils decreased. Our data revealed a considerable CO2 emission below 0 °C. We also show that pronounced differences emerge in Arctic soil CO2 fluxes with Si increasing and Ca decreasing CO2 fluxes. Furthermore, we show that both Si and Ca concentrations in Arctic soils are central controls on Arctic soil CO2 release, with Si increasing Arctic soil CO2 release especially when temperatures are just below 0 °C. Our findings could provide an important constraint on soil CO2 emissions upon soil thaw, as well as on the greenhouse gas budget of high latitudes. Thus we call for work improving understanding of freeze-thaw cycles as well as the effect of Ca and Si on carbon fluxes, as well as for increased consideration of those factors in wide-scale assessments of carbon fluxes in the high latitudes.
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Increased crop production is a main goal to feed the predicted human population in future. The current management practice is, however, not sustainable as it depends on high amounts of fertilizer application and is highly vulnerable to decreased soil water availability. At the same time it becomes more and more crucial to reduce or even mitigate anthropogenic greenhouse gas (GHG) emissions. A possible way to enable this, might be the increase of the soil C sequestration and thus the C sink function of arable lands. A recent and potentially more sustainable idea is the single time fertilization with amorphous silicon (ASi) which is known to increase both nutrient and water availability. Here we show for the first time on the basis of a field plot experiment how a fertilization with ASi is affecting both, crop yield and the C sequestration of the soils in an agricultural system cultivating wheat. We found a strong increase in wheat yield and biomass production after ASi fertilization by increasing soil moisture during the whole growing season. Additionally, despite a relatively short growing season, Si fertilization increased the net C uptake by soils, i.e., C sequestration with both Si fertilized treatments showing a negative net ecosystem C balance (soil C gain) during the measurement period, while the control showed a small positive net ecosystem C balance (soil C loss). To our best knowledge, this is the first time such effect has ever been observed. In summary, our study demonstrates a new management strategy for crop production increasing yield and biomass production as well as soil C uptake on a more sustainable basis, by a single time fertilization with ASi.
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BACKGROUND: Managed grasslands are global sources of atmospheric methanol, which is one of the most abundant volatile organic compounds in the atmosphere and promotes oxidative capacity for tropospheric and stratospheric ozone depletion. The phyllosphere is a favoured habitat of plant-colonizing methanol-utilizing bacteria. These bacteria also occur in the rhizosphere, but their relevance for methanol consumption and ecosystem fluxes is unclear. Methanol utilizers of the plant-associated microbiota are key for the mitigation of methanol emission through consumption. However, information about grassland plant microbiota members, their biodiversity and metabolic traits, and thus key actors in the global methanol budget is largely lacking. RESULTS: We investigated the methanol utilization and consumption potentials of two common plant species (Festuca arundinacea and Taraxacum officinale) in a temperate grassland. The selected grassland exhibited methanol formation. The detection of 13C derived from 13C-methanol in 16S rRNA of the plant microbiota by stable isotope probing (SIP) revealed distinct methanol utilizer communities in the phyllosphere, roots and rhizosphere but not between plant host species. The phyllosphere was colonized by members of Gamma- and Betaproteobacteria. In the rhizosphere, 13C-labelled Bacteria were affiliated with Deltaproteobacteria, Gemmatimonadates, and Verrucomicrobiae. Less-abundant 13C-labelled Bacteria were affiliated with well-known methylotrophs of Alpha-, Gamma-, and Betaproteobacteria. Additional metagenome analyses of both plants were consistent with the SIP results and revealed Bacteria with methanol dehydrogenases (e.g., MxaF1 and XoxF1-5) of known but also unusual genera (i.e., Methylomirabilis, Methylooceanibacter, Gemmatimonas, Verminephrobacter). 14C-methanol tracing of alive plant material revealed divergent potential methanol consumption rates in both plant species but similarly high rates in the rhizosphere and phyllosphere. CONCLUSIONS: Our study revealed the rhizosphere as an overlooked hotspot for methanol consumption in temperate grasslands. We further identified unusual new but potentially relevant methanol utilizers besides well-known methylotrophs in the phyllosphere and rhizosphere. We did not observe a plant host-specific methanol utilizer community. Our results suggest that our approach using quantitative SIP and metagenomics may be useful in future field studies to link gross methanol consumption rates with the rhizosphere and phyllosphere microbiome.
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The purpose of the StaPlaRes project was to evaluate two innovative techniques of urea fertiliser application and to quantify greenhouse gas (GHG) emissions. All GHG emissions, as well as other gaseous emissions, agronomic and environmental variables were collected for three years (2016/2017-2018/2019) at three experimental field sites in Germany. All management activities were consistently documented. Multi-variable data sets of gas fluxes (N2O and NH3), crop parameters (grain and straw yield, N content, etc.), soil characteristics (NH4-N, NO3-N, etc.), continuously recorded meteorological variables (air and soil temperatures, radiation, precipitation, etc.), management activities (sowing, harvest, soil tillage, fertilization, etc.), were documented and metadata (methods, further information about variables, etc.) described. Additionally, process-related tests were carried out using lab (N2 emissions), pot and lysimeter experiments (nitrate leaching). In total, 2.5 million records have been stored in a Microsoft Access database (StaPlaRes-DB-Thuenen). The database is freely available for (re)use by others (scientists, stakeholders, etc.) on the publication server and data repository OpenAgrar for meta-analyses, process modelling and other environmental studies.
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Drought and the availability of mineable phosphorus minerals used for fertilization are two of the important issues agriculture is facing in the future. High phosphorus availability in soils is necessary to maintain high agricultural yields. Drought is one of the major threats for terrestrial ecosystem performance and crop production in future. Among the measures proposed to cope with the upcoming challenges of intensifying drought stress and to decrease the need for phosphorus fertilizer application is the fertilization with silica (Si). Here we tested the importance of soil Si fertilization on wheat phosphorus concentration as well as wheat performance during drought at the field scale. Our data clearly showed a higher soil moisture for the Si fertilized plots. This higher soil moisture contributes to a better plant performance in terms of higher photosynthetic activity and later senescence as well as faster stomata responses ensuring higher productivity during drought periods. The plant phosphorus concentration was also higher in Si fertilized compared to control plots. Overall, Si fertilization or management of the soil Si pools seem to be a promising tool to maintain crop production under predicted longer and more serve droughts in the future and reduces phosphorus fertilizer requirements.
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BACKGROUND: The unrestricted use of linezolid has been linked to the emergence of linezolid-resistant Staphylococcus epidermidis (LRSE). We report the effects of combined antibiotic stewardship and infection control measures on the spread of LRSE in an intensive care unit (ICU). METHODS: Microbiological data were reviewed to identify all LRSE detected in clinical samples at an ICU in southwest Germany. Quantitative data on the use of antibiotics with Gram-positive coverage were obtained in defined daily doses (DDD) per 100 patient-days (PD). In addition to infection control measures, an antibiotic stewardship intervention was started in May 2019, focusing on linezolid restriction and promoting vancomycin, wherever needed. We compared data from the pre-intervention period (May 2018-April 2019) to the post-intervention period (May 2019-April 2020). Whole-genome sequencing (WGS) was performed to determine the genetic relatedness of LRSE isolates. RESULTS: In the pre-intervention period, LRSE were isolated from 31 patients (17 in blood cultures). The average consumption of linezolid and daptomycin decreased from 7.5 DDD/100 PD and 12.3 DDD/100 PD per month in the pre-intervention period to 2.5 DDD/100 PD and 5.7 DDD/100 PD per month in the post-intervention period (p = 0.0022 and 0.0205), respectively. Conversely, vancomycin consumption increased from 0.2 DDD/100 PD per month to 4.7 DDD/100 PD per month (p < 0.0001). In the post-intervention period, LRSE were detected in 6 patients (4 in blood cultures) (p = 0.0065). WGS revealed the predominance of one single clone. CONCLUSIONS: Complementing infection control measures by targeted antibiotic stewardship interventions was beneficial in containing the spread of LRSE in an ICU.
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Gestão de Antimicrobianos , Farmacorresistência Bacteriana , Controle de Infecções/métodos , Linezolida/farmacologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus epidermidis/efeitos dos fármacos , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Alemanha , Humanos , Unidades de Terapia Intensiva , Staphylococcus epidermidis/genética , Sequenciamento Completo do GenomaRESUMO
BACKGROUND: The purpose of this prospective consecutive multicenter study was to investigate whether the type of surgical approach (medial parapatellar (MPA) or lateral parapatellar with tibial tubercle osteotomy (TubOT)) influences the early clinical and radiological outcomes of primary total knee arthroplasty (TKA). METHODS: Ligament balancing primary TKA with a rotating platform was performed in 143 knees (m:w = 1:1.6; mean age 69 +/- 8 years). The TKA was done by a lateral parapatellar subvastus approach with stepcut osteotomy of the tibial tubercle (53%; n = 76, group A) or medial parapatellar approach (47%; n = 67, group B). The outcome was assessed at 1 and 2 years postoperatively by the American Knee Society score (KSS) and the knee society total knee arthroplasty roentgenographic evaluation and scoring system (TKA-RESS). The patient's pain level and satisfaction was noted by a visual analogue scale (VAS). Data were analyzed by an independent statistician with a level of significance of p < 0.05. The Wilcoxon two sample test (two-sided) was used to investigate differences of patients between group A and B pre- and postoperatively. The paired t-test was used to evaluate differences over course of time within each group. For comparison of radiological alignment a Chi(2)-test was performed. RESULTS: Although having a lower degree of preoperative flexion (112 degrees +/- 15 degrees versus 115 degrees +/- 15 degrees) patients in group A showed a significantly (p = 0.027) higher degree of flexion (118 degrees +/- 10 degrees) at their last follow-up than patients in group B (114 degrees +/- 10 degrees). Patients in group A showed a significantly better mean VAS pain (p = 0.0001) and satisfaction (p = 0.0058) at 2 years follow-up. The pain free walking distance was significantly (p = 0.036) longer for group A than group B. Patients treated with a lateral approach were significantly more stable in terms of valgus stress (p = 0.049). The Knee society score was significantly (p = 0.0009) higher at two years follow up in group A compared to group B. The postoperative mechanical alignment and positioning of the prosthesis were not significantly different. Patients in group B presented with significantly (p = 0.0017) more tibial radiolucencies (> 2 mm) at their last follow-up than patients in group A. There was no prosthesis related revision in either group. The revision rate in group A (4%) was higher than in group B (1.5%), which was mainly due to two cases of traumatic secondary displacement of the tibial tubercle and need for refixation. CONCLUSIONS: The TubOT led to slightly better functional results and less pain two years after primary TKA. It is however not clear if the improved outcome can outweigh the longer operation time and higher risk of early complications and revisions. Long-term studies are necessary to show whether there is any difference in prosthesis longevity between both types of approach.