Centrally sensitized patients undergoing total knee arthroplasty have higher expectations than do non-centrally sensitized patients.

PURPOSE: The goal of this retrospective observational study is to determine whether patients with and without central sensitization (CS) undergoing total knee arthroplasty (TKA) have similar preoperative expectations. It was hypothesized that the degree of preoperative expectations is higher in patients with CS than in those without. METHODS: The data of 324 patients who underwent primary unilateral TKA for knee osteoarthritis were reviewed and CS was measured using the Central Sensitization Inventory (CSI), which is a validated self-reported questionnaire consisting of a total of 25 questions. CS was defined as a CSI score of 40 or more. Patient expectations were investigated using the Hospital for Special Surgery Knee Replacement Expectations Survey (HSS-KRES) comprising five categories including pain relief, baseline activity, high flexion activity, social activity, and psychological well-being. The expectations of patients, the Western Ontario and McMaster Universities arthritis index (WOMAC) and American Society of Anesthesiologists (ASA) classification scores were compared between the CS and non-CS groups. RESULTS: The top three patient expectations in both groups were pain relief, psychological well-being, and walking ability. The total score for the expectations was 55.0 ± 8.3 in the CS group and 52.3 ± 10.4 in the non-CS group, indicating that the expectations of the CS group were higher than the non-CS group before TKA (p < 0.05). When the items on the HSS-KRES scale and the five categories were compared, the CS group had significantly higher expectations for pain relief and psychological well-being than did the non-CS group (all p < 0.05). CONCLUSION: The expectations of patients with CS before TKA were higher than those without CS. Given the limited improvement in patient-reported outcome measures of patients with CS undergoing TKA, they should be counseled to be realistic especially with their preoperative expectations of pain relief and psychological well-being. LEVEL OF EVIDENCE: III.

Past, present, and future of cartilage restoration: from localized defect to arthritis.

BACKGROUND: Osteoarthritis, one of the most common joint diseases, is characterized by the loss of joint function due to articular cartilage destruction. Herein, we review current and previous research involving the clinical applications of arthritis therapy and suggest potential therapeutic options for osteoarthritis in the future. PAST, PRESENT, AND FUTURE TREATMENT: The arthroscopic cartilage regeneration procedure or realignment osteotomy has been performed as a joint-conserving procedure in cases where conservative treatment for damaged articular cartilage and early osteoarthritis failed. If cartilage regeneration is ineffective or if the joint damage progresses, arthroplasty is the main treatment option. The need for biological arthritis treatment has expanded as the healthy lifespan of the global population has increased. Accordingly, minimally invasive surgical treatment has been developed for the treatment of damaged cartilage and early osteoarthritis. However, patients generally prefer to avoid all types of surgery, including minimally invasive surgery. Therefore, in the future, the treatment of osteoarthritis will likely involve injection or medication. CONCLUSION: Currently, arthritis management primarily involves the surgical application of therapeutic agents to the joints. However, nonsurgical or prophylactic methods are expected to become mainstream arthritis therapies in the future.

Anterior Dens Screw Fixation for Traumatic C1-2 Lateral Subluxation With 3-Part Fractures of the C2 Axis (Dens, Lateral Mass, and Hangman Fractures): A Case Report.

INTRODUCTION: To report the first case of traumatic C1-2 lateral subluxation with three-part fractures of the C2 axis (dens, lateral mass, and hangman fractures) that was successfully treated with only anterior dens screw fixation. METHODS: A 56-year-old man was admitted to the hospital complaining of neck and left arm pains caused by a pedestrian traffic accident. Radiologic examination revealed traumatic C1-2 lateral subluxation, type 3 dens fracture (Anderson and D'Alonzo classification), fracture of both C2 lateral masses, and type 1 hangman fracture (Levine and Edwards classification). RESULTS: Preoperative closed reduction of the C1-2 lateral subluxation was successfully achieved by skull traction using a Gardner-Wells tong. The patient underwent anterior dens screw fixation for type 3 dens fracture with posterior angulation. At the 2-year follow-up visit, good reduction of traumatic C1-2 lateral subluxation and solid fusion of all three-part fractures of the C2 axis were achieved with full range of motion and stability at the C1-2 joint. In addition, notable improvement of neck and left arm pains was achieved. DISCUSSION: Preoperative closed reduction and anterior dens screw fixation can be considered as a less invasive and motion-preserving surgery for traumatic C1-2 lateral subluxation with three-part fractures of the C2 axis.