Functional alignment is associated with increased incidence of pre-balance, reduced soft-tissue release, and post-operative pain compared to mechanical alignment in patients undergoing simultaneous bilateral robotic-assisted TKA.

This study aimed to compare two alignment strategies in the same patient undergoing simultaneous bilateral robotic-assisted TKA (SB-RATKA): mechanical alignment (MA), the gold-standard, and functional alignment (FA), a balance-driven, personalized alignment strategy. The outcome measures included quantitative assessment of soft-tissue release, incidence of knee balance, and post-operative pain. This was a prospective, self-controlled, randomized-controlled trial involving 72 patients who underwent SB-RATKA using the MAKO® robotic system with comparable grades of deformity and pain in both knees. 65 patients were finally included with one alignment strategy done per knee, with the patients blinded to the strategy used. The study recorded the additional soft-tissue releases required, incidence of pre-balance, and daily post-operative VAS pain scores. The mean age of the study population was 57.95 years, with a female preponderance (N = 53, 81.6%). MA group had significantly more medial compartment tightness in both flexion (MA-15.6 ± 1.8; FA-17 ± 1.3) and extension (MA-14.9 ± 1.9; FA-17 ± 1.1) (p < 0.0001) compared to the FA group after dynamic balancing. 66% of knees in the FA group (N = 43) achieved pre-balance compared to 32.3% in the MA group (N = 21) (p < 0.0001). VAS scores showed a significant reduction in pain in the FA group up to 72 h post-surgery (p < 0.0001). The requirement for posteromedial release (PM), posterior capsular (PC) release, tibial reduction osteotomy (TRO), and superficial MCL pie crusting (sMCL) were significantly lower in FA (PM-22, PC-13, TRO-8, sMCL-2) compared to MA (PM-44, PC-29, TRO-18, sMCL-8). Functional alignment strategy consistently resulted in a higher incidence of knee balance with a significant reduction in soft-tissue releases and immediate post-operative pain when compared to MA in the same patient undergoing SB-RATKA. Therapeutic Level 1.

Patella non-resurfacing in primary total knee arthroplasty provides good functional results-a retrospective review of nine thousand three hundred forty six knees.

PURPOSE: Patellar resurfacing has long been a contentious subject in TKA with no consensus and the literature yielding disparate results. The aim of this study was to evaluate the long-term functional outcomes and complications of patients undergoing primary TKA without patellar resurfacing (non-resurfacing). METHODS: This study retrospectively analysed 9346 patients who underwent primary manual jig-based TKA without patellar resurfacing at a single high-volume arthroplasty centre between 2010 and 2018. Patients with a minimum three year follow-up irrespective of disease etiology and implant manufacturer were included in the study. Primary outcome was measured using Oxford knee score and patellofemoral Feller score. Secondary outcomes included determining the incidence of patellofemoral complications and re-operation rates following TKA. RESULTS: A total of 8695 knees were eligible for final evaluation having a mean follow-up of 6.6 years. Mean age of the patients was 62.6 (SD-7.5) years with female predominance of (N-6619, 70.8%). The majority of the patients had primary OA (N-8792, 94.1%) with varus deformity (N-8642, 92.46%). Depuy was the most used manufacturer (n = 2592, 26.4%) with the posterior stabilised (N-4127, 44.2%) design being the most predominant. The mean Feller score of the study population was 24.5 (SD = 3) with a majority of patients having good to excellent outcomes (86.95%, N-8424) and mean Oxford knee score was 36.9 (SD-6.9) with a majority of the patients having an OKS greater than 30 (87.1%, N-8133) with anterior knee pain (AKP) reported in only 4.8% patients (N-418). Most common complications included patellar clunk (N-56, 0.7%), traumatic patellar fractures (N-62, 0.8%), quadriceps tendon tear (N-54, 0.7%) and patellar dislocation (N-4, 0.05%) CONCLUSION: Patellar non-resurfacing has no detrimental impact on functional outcomes and incidence of AKP. We conclude that it is a safe, cost-effective and satisfactory approach in primary TKA with no significant complications.

Avoiding Lateral Laxity in Robotic Arm-Assisted Total Knee Arthroplasty-A Surgical Technique Describing a New Method of Gap Capture and Balancing Strategy.

INTRODUCTION: Optimal flexion-extension gap balancing is an important factor in outcomes after total knee arthroplasty. Knees with varus deformities are commonly associated with a greater degree of lateral laxity both in extension and flexion. Residual lateral laxity could be encountered by surgeons during component trialling after robotic-assisted total knee arthroplasty (RATKA), necessitating additional medial soft tissue release for a thicker insert. This study describes a new technique of gap assessment during RATKA and we propose a functional alignment based balancing strategy to avoid residual lateral laxity. MATERIALS AND METHODS: This surgical technique was prospectively employed in 105 patients undergoing primary MAKO® (Stryker, Kalamazoo, Michigan) RATKA for osteoarthritis of the knee with varus deformity, between January 2021 and July 2021. Patients included had an initial lateral extension laxity of more than 24mm. Surgical data points collected consisted of characterization of the laxity profile of the knee using the medial and lateral extension and flexion initial gap captures, final gap captures after dynamic balancing with a functional alignment strategy, and residual lateral extension gap laxity in millimeters at the end of implantation. RESULTS: The mean initial lateral extension gap was 25.76mm (standard deviation [SD]=1.47) and the mean lateral flexion gap was 24.4mm (SD=1.94). Balance was achieved in all the patients with a 9 or 11mm insert, with a mean residual lateral laxity of 0.51mm (SD=0.73, range 0-2mm). The majority of patients (n=66, 62.85%) had zero lateral laxity at the end of final implantation while 24 patients (22.8%) had 1mm of residual lateral laxity. CONCLUSION: Residual lateral joint laxity can be avoided consistently and predictably in RATKA cases with initial gap capture of up to 30mm in lateral extension and flexion with this new technique of gap capture and employing various steps of balancing strategy described.

Effect of Intra-articular Injection of Corticosteroid in the Patients with Osteoarthritis of the Knee - A Hospital-Based Cross-Sectional Study.

BACKGROUND: Osteoarthritis (OA) of the peripheral joints is frequently related with physical disability and decline in health-related quality of life, deciphering into a significant burden on people and humankind. Although IA corticosteroid injections are being in clinical use, their long-term effects on knee OA are least studied and documented. Hence, the study was done with the aim of assessing the effect of intra-articular (IA) injection of corticosteroid in patients with OA of the knee. METHODS: This prospective observational study was conducted over a period of 6 months between 40 years and 75 years with Grade I and II OA of the knee admitted under the Department of Orthopaedics, Tertiary Care Hospital, Belgaum. Patients' affected knee was injected with 80 mg of triamcinolone after the examination, and follow-ups had done at 2 weeks, 6 weeks, 3 months, and 6 months. The standard pro forma used were Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS: The mean age of the participants was 58.96 ± 9.58, ranging from 40 to 75 years, with a slightly higher proportion of females. The proportion of Grade 1 and Grade II OA was 24% and 76%, respectively, and 54.7% had right-sided involvement. The difference between pre Rx: Pre intervention VAS score VAS score and follow-up periods at 2 weeks, 6 weeks, 3 months, and 6 months was statistically significant with respect to VAS scale, KOOS scale, and WOMAC scale (P < 0.001). CONCLUSION: there was no major adverse effect of corticosteroid injections, and it showed significant improvement in patients. There is a need to conduct large-scale well-controlled clinical trials with an appropriate control group, to be able to document the relative efficacy and safety of IA steroid injection.