[The combination of partial knee arthroplasties in knee osteoarthritis with an intact anterior cruciate ligament - a future model?] / Kombination von Knieteilprothesen bei intaktem vorderem Kreuzband ­ ein Zukunftsmodell?

BACKGROUND: Preserving both cruciate ligaments in knee prosthetics enables approximately physiological joint kinematics. In this way, faster rehabilitation and a higher return-to-sports rate can be achieved. Accordingly, there are considerations to preserve both cruciate ligaments by combining two partial prostheses in the case of symptomatic bicompartmental (BiCom) knee osteoarthritis. METHODS: This article summarizes the literature on BiCom arthroplasty and describes our own experiences from 54 consecutive cases with robotic-assisted technology. RESULTS: According to current data, BiCom arthroplasty shows good clinical results, without being able to demonstrate a clear advantage over conventional TKA. The revision risk is slightly increased in the short-term interval, which could be positively addressed with robotic-assistance. The disadvantages are the increased implant costs and the risk of subsequent osteoarthritis. Accordingly, patients who may potentially take advantage of this treatment must be critically selected.

[Evolving indications for partial knee replacement : New aspects]. / Update Indikation Teilprothese : Neue Aspekte.

BACKGROUND: Partial knee replacement has proven to be an effective therapy for advanced unicompartmental arthrosis of the knee. Despite continuous advancements in implants and surgical techniques over the past decades, the global preference for total knee arthroplasty still persists for historical reasons. OBJECTIVES: This report aims to illuminate advantages and disadvantages of partial knee replacement considering long-term results, the evolution of indication criteria over recent decades and new aspects in patient selection with potential improvements through emerging technologies. MATERIAL AND METHODS: The analysis involves the examination of long-term results from clinical studies and registry data, highlighting the risk factors for potential failures and their influence on the development of indication criteria. RESULTS: Present-day long-term results demonstrate excellent prosthetic survival, aligning with outcomes from total knee arthroplasty. New perspectives for expanding indication criteria are discussed, including the possible application of partial knee replacement in cases of severe varus deformity > 15°, anterior cruciate ligament insufficiency, young active patients, anterior knee pain, and/or patellofemoral arthritis, as well as mild radiographic arthritis with degenerative medial meniscus root tear and meniscal extrusion. DISCUSSION: Indication criteria have consistently expanded in recent years, taking into account modern insights, and the application of advanced technologies can enhance precision and minimize surgical errors. Furthermore, this report emphasizes that revision rates are not the sole criterion for success and underscores the necessity for a comprehensive examination of clinical results.

Maintaining the Physiological Lateral Flexion Gap in the Kinematically Aligned TKA Does Not Compromise Clinical Outcomes at One-Year Follow-Up.

Background: Instability is a common cause of (total knee arthroplasty) TKA failure, which can be prevented by achieving proper gap balance during surgery. There is no consensus on the ideal gap balance in TKA, and different alignment philosophies result in varying soft-tissue tightness. Traditional TKA aims for symmetric compartment balance, while kinematic alignment (KA) restores anatomy and accepts asymmetric flexion gaps. This study evaluated the impact of these philosophies on the flexion gap balance and clinical outcomes. Methods: A retrospective review of 167 patients who received true or restricted KA robotic-assisted TKA with at least one year of follow-up was conducted. The groups were based on intraoperative flexion gap differences: symmetric (0-1 mm) (n = 94) and asymmetric (2-5 mm) (n = 73). Results: Preoperative demographics and postoperative clinical and functional scores were compared. Both groups were similar in demographics and preoperative scores. True KA alignment was more likely to result in an asymmetric flexion gap, while restricted KA produced symmetric gaps. Conclusions: The study found no adverse effects from the physiological asymmetric flexion gap, with clinical and functional outcomes comparable to symmetric gaps. A 5 mm difference between the medial and lateral gap width did not negatively impact the outcomes. True KA more frequently results in a physiological asymmetric flexion gap.

How Is the Spectrum of Sarcoma Surgery Assessed?

PURPOSE: To meet the challenges of the precision medicine era, quality assessment of shared sarcoma care becomes pivotal. The MDT approach is the most important parameter for a successful outcome. Of all MDT disciplines, surgery is the key step to rendering sarcoma patients disease free; therefore, defining its spectrum is critical. To the best of the authors' knowledge, a comprehensive interoperable digital platform to assess the scope of sarcoma surgery in its full complexity is lacking. METHODS: An interoperable digital platform on sarcoma surgery has been created to assess the clinical exposure, tumor characteristics, and surgical settings and techniques applied for both resections and reconstructions of sarcomas. RESULTS: The surgical exposure of an individual surgeon over time served as a pilot. Over the study period of 10 years, there were 723 sarcoma board/MDT meetings discussing 3130 patients. A total of 1094 patients underwent 1250 surgical interventions on mesenchymal tumors by one single sarcoma surgeon. These included 615 deep soft tissue tumors (197 benign, 102 intermediate, 281 malignant, 27 simulator, 7 metastasis, 1 blood); 116 superficial soft tissue tumors (45 benign, 12 intermediate, 40 malignant, 18 simulator, 1 blood); and 519 bone tumors (129 benign, 112 intermediate, 182 malignant, 18 simulator, 46 metastasis, 14 blood, and 18 sequelae of first treatment). Detailed types of resections and reconstructions were analyzed. CONCLUSIONS: An interoperable digital data platform on sarcoma surgery with transparent real-time descriptive analytics is feasible and enables large-scale definition of the spectrum of sarcoma surgery to meet the challenges of sarcoma precision care in the future.