The in vivo kinematics after combined total ankle arthroplasty (TAA) remains unknown. This study evaluated and compared the three-dimensional kinematics of the talar component between standard TAA, using the talar component where only the surface of the talar dome was replaced, and combined TAA, using the iterative closest point algorithm and computed tomography (CT).
Methods
The combined TAA and standard TAA groups comprised 17 and 9 ankles, respectively. CT was performed with patients in active dorsiflexed and plantarflexed ankle positions at least 3 months post-operatively.
Results
From non-weight-bearing dorsiflexion to plantarflexion, a significant medial translation of the total talar prosthesis was observed in the combined TAA group compared with the standard TAA group. Rotation of the x-axis (inversion) and translation of the z-axis (lateral translation) were negatively correlated.
Conclusions
Combined TAA results in greater inversion of the ankle joint during plantarflexion than standard TAA.
{"title":"Early post-operative in vivo kinematics after total ankle arthroplasty using a total talar prosthesis: Three-dimensional analysis using the iterative closest point algorithm","authors":"Hiroaki Kurokawa , Yasuhito Tanaka , Shinichi Kosugi , Rea Ikeda , Tatsuya Fukuda , Norihiro Tsujimoto , Yoshiyuki Kamatani , Yinghao Li , Nan Mei , Yuki Ueno , Takuma Miyamoto , Kiyonori Tomiwa , Akira Taniguchi , Shinichi Nakagawa , Hiroshi Takemura , Yoshinori Takakura","doi":"10.1016/j.jjoisr.2025.09.003","DOIUrl":"10.1016/j.jjoisr.2025.09.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The <em>in vivo</em> kinematics after combined total ankle arthroplasty (TAA) remains unknown. This study evaluated and compared the three-dimensional kinematics of the talar component between standard TAA, using the talar component where only the surface of the talar dome was replaced, and combined TAA, using the iterative closest point algorithm and computed tomography (CT).</div></div><div><h3>Methods</h3><div>The combined TAA and standard TAA groups comprised 17 and 9 ankles, respectively. CT was performed with patients in active dorsiflexed and plantarflexed ankle positions at least 3 months post-operatively.</div></div><div><h3>Results</h3><div>From non-weight-bearing dorsiflexion to plantarflexion, a significant medial translation of the total talar prosthesis was observed in the combined TAA group compared with the standard TAA group. Rotation of the x-axis (inversion) and translation of the z-axis (lateral translation) were negatively correlated.</div></div><div><h3>Conclusions</h3><div>Combined TAA results in greater inversion of the ankle joint during plantarflexion than standard TAA.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 4","pages":"Pages 207-213"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-24DOI: 10.1016/j.jjoisr.2025.09.002
Umito Kuwashima, Masafumi Itoh, Junya Itou, Ken Okazaki
Purpose
This study compared post-operative kneeling abilities following unicompartmental knee arthroplasty (UKA) and open-wedge high tibial osteotomy (OWHTO) for varus knee osteoarthritis.
Methods
This retrospective cohort study included 127 knees that underwent UKA and 100 knees that underwent OWHTO between 2018 and 2022. Clinical data, including Knee injury and Osteoarthritis Outcome Score (KOOS) and the University of California, Los Angeles (UCLA) activity score, were collected pre-operatively and at a minimum 12 month follow-up. Kneeling ability was defined using the KOOS Sp5 subscore. Factors influencing post-operative kneeling, including age, pre- and post-operative knee flexion angle, pre-operative UCLA activity score, degree of osteoarthritis, femorotibial angle, pre-operative kneeling ability, and surgical procedure, were evaluated using multiple linear regression analysis.
Results
OWHTO demonstrated significantly better post-operative kneeling ability than UKA. Pre-operative kneeling ability and surgical procedure statistically significantly influenced post-operative outcomes (regression coefficient −0.50, 95% confidence interval −0.003–0.99; p = 0.049).
Conclusions
OWHTO was significantly associated with better Sp5 scores and improved post-operative kneeling ability, emphasizing the importance of choosing the appropriate surgical technique for better post-operative kneeling ability.
{"title":"Comparison of post-operative kneeling ability in patients with varus knee osteoarthritis: unicompartmental knee arthroplasty versus open-wedge high tibial osteotomy","authors":"Umito Kuwashima, Masafumi Itoh, Junya Itou, Ken Okazaki","doi":"10.1016/j.jjoisr.2025.09.002","DOIUrl":"10.1016/j.jjoisr.2025.09.002","url":null,"abstract":"<div><h3>Purpose</h3><div>This study compared post-operative kneeling abilities following unicompartmental knee arthroplasty (UKA) and open-wedge high tibial osteotomy (OWHTO) for varus knee osteoarthritis.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 127 knees that underwent UKA and 100 knees that underwent OWHTO between 2018 and 2022. Clinical data, including Knee injury and Osteoarthritis Outcome Score (KOOS) and the University of California, Los Angeles (UCLA) activity score, were collected pre-operatively and at a minimum 12 month follow-up. Kneeling ability was defined using the KOOS Sp5 subscore. Factors influencing post-operative kneeling, including age, pre- and post-operative knee flexion angle, pre-operative UCLA activity score, degree of osteoarthritis, femorotibial angle, pre-operative kneeling ability, and surgical procedure, were evaluated using multiple linear regression analysis.</div></div><div><h3>Results</h3><div>OWHTO demonstrated significantly better post-operative kneeling ability than UKA. Pre-operative kneeling ability and surgical procedure statistically significantly influenced post-operative outcomes (regression coefficient −0.50, 95% confidence interval −0.003–0.99; <em>p</em> = 0.049).</div></div><div><h3>Conclusions</h3><div>OWHTO was significantly associated with better Sp5 scores and improved post-operative kneeling ability, emphasizing the importance of choosing the appropriate surgical technique for better post-operative kneeling ability.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 4","pages":"Pages 201-206"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Promontory stem, a newly developed Zweymüller cementless femoral stem with a proximal fixation-enhancing fin, was introduced in Japan in 2022. This study aimed to evaluate its early clinical and radiological outcomes.
Methods
This retrospective cohort study included 56 patients who underwent primary total hip arthroplasty using the Promontory stem between August 2022 and October 2023. Clinical scores (JOA, EQ-VAS, HOOS-JR, FJS-12) and radiographic findings (stem alignment, stress shielding, radiolucent lines, cortical hypertrophy) were assessed at a mean follow-up of 22.8 months. Multivariate logistic regression was used to identify predictors of stress shielding around the stem.
Results
The mean patient age was 66.0 years and 71.4% were female. JOA scores improved significantly from pre-to post-operative time points in all domains; the total score increased from 42.9 to 82.3 at 2 years (p < 0.001). Mean EQ-VAS, HOOS-JR, and FJS-12 scores at final follow-up averaged 77.3 ± 17.6, 79.8 ± 15.7, and 63.5 ± 25.6, respectively. Radiologically, stress shielding was observed in 66.1%, with 17.9% having grade 2 or higher. Radiolucent lines were noted in 69.6% and cortical hypertrophy in 17.9%. No cases of aseptic loosening occurred. Complications included stem subsidence (3.6%), dislocation (3.6%), and periprosthetic fracture (1.8%). The 2 year implant survival rate was 98.2%. Multivariate logistic regression identified older age, female sex, and pre-operative lower bone mineral density of femoral neck as predictors of stress shielding.
Conclusions
The Promontory stem showed favorable early outcomes with no major complications and high survivorship, despite frequent stress shielding and proximal radiolucent lines.
Promontory柄是一种新开发的带有近端固定增强鳍的zweym骨水泥股骨柄，于2022年在日本推出。本研究旨在评估其早期临床和放射学结果。方法：本回顾性队列研究包括56例于2022年8月至2023年10月期间使用Promontory柄行原发性全髋关节置换术的患者。临床评分（JOA, iq - vas, HOOS-JR, FJS-12）和影像学表现（椎体对中，应力屏蔽，放射性透光线，皮质肥大）在平均22.8个月的随访中进行评估。多变量逻辑回归用于识别茎周围应力屏蔽的预测因子。结果患者平均年龄66.0岁，女性占71.4%。JOA评分从术前到术后各时间点均有显著改善；2年后总分由42.9分上升至82.3分（p < 0.001）。最终随访时EQ-VAS、HOOS-JR和FJS-12的平均评分分别为77.3±17.6、79.8±15.7和63.5±25.6。放射学上，66.1%观察到应力屏蔽，17.9%为2级或以上。69.6%为透光线，17.9%为皮质肥大。未发生无菌性松动。并发症包括骨干下沉（3.6%）、脱位（3.6%）和假体周围骨折（1.8%）。2年种植体成活率为98.2%。多因素logistic回归发现，年龄较大、女性和术前股骨颈较低的骨密度是应力屏蔽的预测因素。结论尽管有频繁的应力屏蔽和近端放射线线，但海角干的早期预后良好，无重大并发症，生存率高。
{"title":"Early clinical outcomes of a newly designed Zweymüller cementless stem in total hip arthroplasty: a retrospective cohort study","authors":"Hideki Ueyama, Ryo Sugama, Yukihide Minoda, Sho Masuda, Yohei Ohyama, Ryosuke Kirihigashi, Yuichi Miura, Hidetomi Terai","doi":"10.1016/j.jjoisr.2025.09.001","DOIUrl":"10.1016/j.jjoisr.2025.09.001","url":null,"abstract":"<div><h3>Purpose</h3><div>The Promontory stem, a newly developed Zweymüller cementless femoral stem with a proximal fixation-enhancing fin, was introduced in Japan in 2022. This study aimed to evaluate its early clinical and radiological outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 56 patients who underwent primary total hip arthroplasty using the Promontory stem between August 2022 and October 2023. Clinical scores (JOA, EQ-VAS, HOOS-JR, FJS-12) and radiographic findings (stem alignment, stress shielding, radiolucent lines, cortical hypertrophy) were assessed at a mean follow-up of 22.8 months. Multivariate logistic regression was used to identify predictors of stress shielding around the stem.</div></div><div><h3>Results</h3><div>The mean patient age was 66.0 years and 71.4% were female. JOA scores improved significantly from pre-to post-operative time points in all domains; the total score increased from 42.9 to 82.3 at 2 years (<em>p</em> < 0.001). Mean EQ-VAS, HOOS-JR, and FJS-12 scores at final follow-up averaged 77.3 ± 17.6, 79.8 ± 15.7, and 63.5 ± 25.6, respectively. Radiologically, stress shielding was observed in 66.1%, with 17.9% having grade 2 or higher. Radiolucent lines were noted in 69.6% and cortical hypertrophy in 17.9%. No cases of aseptic loosening occurred. Complications included stem subsidence (3.6%), dislocation (3.6%), and periprosthetic fracture (1.8%). The 2 year implant survival rate was 98.2%. Multivariate logistic regression identified older age, female sex, and pre-operative lower bone mineral density of femoral neck as predictors of stress shielding.</div></div><div><h3>Conclusions</h3><div>The Promontory stem showed favorable early outcomes with no major complications and high survivorship, despite frequent stress shielding and proximal radiolucent lines.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 4","pages":"Pages 194-200"},"PeriodicalIF":0.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-18DOI: 10.1016/j.jjoisr.2025.08.004
Henry Somerby , Allina Nocon , Ananya Alleyne , David Mayman , Thomas Sculco , Stephen Lyman
Purpose
The Hip Disability and Osteoarthritis Outcome Score – Joint Replacement (HOOS-JR) and the Knee Injury and Osteoarthritis Outcome Score – Joint Replacement (KOOS-JR) are validated, short-form versions of the HOOS and KOOS patient reported outcome measures (PROMs) that are used to assess “joint health.” Developed in response to the Centers for Medicare & Medicare's (CMS) pay-for-performance policy, HOOS-JR and KOOS-JR evaluate patients before in-office visits. New mandatory CMS reporting requirements raise challenges for collecting PROMs. Telephone administration of PROMs may reduce reliability issues and increase collection rates. This study aimed to evaluate the reliability of telephone-administered HOOS-JR and KOOS-JR compared with in-person administration. It was hypothesized that telephone administration of PROMs will be a reliable modality for collection.
Methods
Phone interviews were conducted for new patients seeking care for hip- or knee-related disabilities (66 hips, 66 knees). Patients answered demographic questions and either the HOOS-JR or KOOS-JR. At their in-office visit, patients completed the same PROM via self-administration. To reduce recall bias, a minimum of 7 days between phone interview and self-administration was ensured. Test–retest reliability, using an intraclass correlation coefficient (ICC), was calculated.
Results
The overall cohort had a mean age of 65 ± 10.7 years and was primarily female (60.6%) having less than a postgraduate degree (63.6%). The HOOS-JR telephone interview showed good reliability compared with self-administration [ICC 0.80, 95% confidence interval (CI) 0.70–0.87], while KOOS-JR showed moderate agreement (ICC 0.70, 95% CI 0.55–0.81). Patients preferred to self-administer HOOS-JR or KOOS-JR (78.0%). Within self-administration, patients preferred email administration (65%), followed by paper (25%), and tablet (10%).
Conclusion
Telephone administration of HOOS-JR and KOOS-JR is a reliable alternative to self-administration. Incorporating phone interviews into clinical practice may enhance care delivery and increase required PROM capture rates.
{"title":"Validation of telephone administration of the HOOS-JR and KOOS-JR joint replacement specific patient reported outcomes measures","authors":"Henry Somerby , Allina Nocon , Ananya Alleyne , David Mayman , Thomas Sculco , Stephen Lyman","doi":"10.1016/j.jjoisr.2025.08.004","DOIUrl":"10.1016/j.jjoisr.2025.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>The Hip Disability and Osteoarthritis Outcome Score – Joint Replacement (HOOS-JR) and the Knee Injury and Osteoarthritis Outcome Score – Joint Replacement (KOOS-JR) are validated, short-form versions of the HOOS and KOOS patient reported outcome measures (PROMs) that are used to assess “joint health.” Developed in response to the Centers for Medicare & Medicare's (CMS) pay-for-performance policy, HOOS-JR and KOOS-JR evaluate patients before in-office visits. New mandatory CMS reporting requirements raise challenges for collecting PROMs. Telephone administration of PROMs may reduce reliability issues and increase collection rates. This study aimed to evaluate the reliability of telephone-administered HOOS-JR and KOOS-JR compared with in-person administration. It was hypothesized that telephone administration of PROMs will be a reliable modality for collection.</div></div><div><h3>Methods</h3><div>Phone interviews were conducted for new patients seeking care for hip- or knee-related disabilities (66 hips, 66 knees). Patients answered demographic questions and either the HOOS-JR or KOOS-JR. At their in-office visit, patients completed the same PROM via self-administration. To reduce recall bias, a minimum of 7 days between phone interview and self-administration was ensured. Test–retest reliability, using an intraclass correlation coefficient (ICC), was calculated.</div></div><div><h3>Results</h3><div>The overall cohort had a mean age of 65 ± 10.7 years and was primarily female (60.6%) having less than a postgraduate degree (63.6%). The HOOS-JR telephone interview showed good reliability compared with self-administration [ICC 0.80, 95% confidence interval (CI) 0.70–0.87], while KOOS-JR showed moderate agreement (ICC 0.70, 95% CI 0.55–0.81). Patients preferred to self-administer HOOS-JR or KOOS-JR (78.0%). Within self-administration, patients preferred email administration (65%), followed by paper (25%), and tablet (10%).</div></div><div><h3>Conclusion</h3><div>Telephone administration of HOOS-JR and KOOS-JR is a reliable alternative to self-administration. Incorporating phone interviews into clinical practice may enhance care delivery and increase required PROM capture rates.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 4","pages":"Pages 188-193"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Some patients experience anxiety or dissatisfaction shortly after total knee arthroplasty (TKA) regarding pain relief and the resumption of normal activities. The aim of this study was to clarify the longitudinal changes in clinical outcomes up to 12 months after TKA.
Methods
This study included 230 Japanese patients (39 males and 191 females) who underwent TKA for varus knee osteoarthritis by the same surgical team using the same implant. Clinical evaluations were performed pre-operatively and at 3, 6, and 12 months after TKA. The following patient reported outcome measures were used: Japanese Knee Osteoarthritis Measure (JKOM); visual analog scale for pain; and patient satisfaction. The Knee Society Score, Timed Up and Go test score, and range of motion were also evaluated.
Results
The evaluated scores showed statistically significant improvements at all three post-operative evaluation points compared with pre-operation, except for knee flexion angle. Improvements in almost all evaluated clinical outcomes persisted up to 12 months. Among the 60 unsatisfied patients at 3 months, 31 were satisfied while 29 remained unsatisfied at 12 months. Multivariable logistic regression analysis revealed that the pain and stiffness subscale of the JKOM and flexion contracture influenced satisfaction at 12 months.
Conclusions
Almost all clinical outcomes improved by 12 months after TKA. These findings can be used to encourage patients who are concerned about their outcomes shortly after this procedure. The pain and stiffness subscale of the JKOM and flexion contracture influenced satisfaction at 12 months.
{"title":"One year longitudinal changes in clinical outcomes after total knee arthroplasty: Implications for early dissatisfaction","authors":"Shunsuke Utsumi , Takehiko Sugita , Naohisa Miyatake , Akira Sasaki , Seiya Miyamoto , Ikuo Maeda , Takashi Aki , Masayuki Kamimura , Toshimi Aizawa","doi":"10.1016/j.jjoisr.2025.08.002","DOIUrl":"10.1016/j.jjoisr.2025.08.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Some patients experience anxiety or dissatisfaction shortly after total knee arthroplasty (TKA) regarding pain relief and the resumption of normal activities. The aim of this study was to clarify the longitudinal changes in clinical outcomes up to 12 months after TKA.</div></div><div><h3>Methods</h3><div>This study included 230 Japanese patients (39 males and 191 females) who underwent TKA for varus knee osteoarthritis by the same surgical team using the same implant. Clinical evaluations were performed pre-operatively and at 3, 6, and 12 months after TKA. The following patient reported outcome measures were used: Japanese Knee Osteoarthritis Measure (JKOM); visual analog scale for pain; and patient satisfaction. The Knee Society Score, Timed Up and Go test score, and range of motion were also evaluated.</div></div><div><h3>Results</h3><div>The evaluated scores showed statistically significant improvements at all three post-operative evaluation points compared with pre-operation, except for knee flexion angle. Improvements in almost all evaluated clinical outcomes persisted up to 12 months. Among the 60 unsatisfied patients at 3 months, 31 were satisfied while 29 remained unsatisfied at 12 months. Multivariable logistic regression analysis revealed that the pain and stiffness subscale of the JKOM and flexion contracture influenced satisfaction at 12 months.</div></div><div><h3>Conclusions</h3><div>Almost all clinical outcomes improved by 12 months after TKA. These findings can be used to encourage patients who are concerned about their outcomes shortly after this procedure. The pain and stiffness subscale of the JKOM and flexion contracture influenced satisfaction at 12 months.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 4","pages":"Pages 182-187"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to compare the clinical outcomes of high tibial osteotomy (HTO) and total knee arthroplasty (TKA) in early elderly patients with severe knee osteoarthritis (OA).
Methods
This retrospective study included patients aged 65–74 years with Kellgren–Lawrence grade 4 medial knee OA who underwent either HTO or TKA. All patients had a minimum post-operative follow-up of 2 years. Propensity score matching was performed to balance baseline characteristics between the groups. Clinical outcomes were evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS), along with the achievement rates of minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) for each KOOS subscale at final follow-up. Statistical comparisons were made using the unpaired t-test, paired t-test, and Fisher's exact test, with statistical significance set at p < 0.05.
Results
A total of 27 matched pairs were analyzed. Pre-operatively, there were no statistically significant differences in KOOS subscale scores between the groups. At the final follow-up, KOOS symptoms and pain scores, as well as the MCID achievement rate for KOOS symptoms, were statistically significantly better in the TKA group than in the HTO group. PASS achievement rates did not differ statistically significantly between the groups.
Conclusion
At a mean follow-up of 60.8 months, TKA resulted in better KOOS symptoms and pain scores and higher MCID achievement rate for KOOS symptoms than HTO. These findings suggest that TKA may offer more favorable outcomes than HTO for early elderly patients with severe medial knee OA.
目的比较老年早期重度膝骨性关节炎（OA）患者高位胫骨截骨术（HTO）与全膝关节置换术（TKA）的临床疗效。方法本回顾性研究纳入年龄65-74岁的kelgren - lawrence 4级膝关节内侧OA患者，接受HTO或TKA治疗。所有患者术后随访至少2年。进行倾向评分匹配以平衡各组之间的基线特征。临床结果采用膝关节损伤和骨关节炎结局评分（oos），以及最终随访时每个oos亚量表的最小临床重要差异（MCID）和患者可接受症状状态（PASS）的完成率进行评估。采用非配对t检验、配对t检验和Fisher精确检验进行统计学比较，p <； 0.05为统计学显著性。结果共分析27对配对。术前，两组间kos亚量表评分差异无统计学意义。最后随访时，TKA组的oos症状、疼痛评分以及oos症状的MCID完成率均优于HTO组，差异有统计学意义。两组学生的及格率没有统计学上的显著差异。结论平均随访60.8个月时，TKA患者的KOOS症状和疼痛评分均优于HTO， KOOS症状的MCID完成率高于HTO。这些发现表明，对于老年早期严重膝关节内侧OA患者，TKA可能比HTO提供更有利的结果。
{"title":"Comparison of clinical outcomes between high tibial osteotomy and total knee arthroplasty in early elderly patients with severe osteoarthritis","authors":"Kodai Hamaoka , Shinichiro Okimura , Kazushi Horita , Yasutoshi Ikeda , Yohei Okada , Tomoaki Kamiya , Atsushi Teramoto","doi":"10.1016/j.jjoisr.2025.08.001","DOIUrl":"10.1016/j.jjoisr.2025.08.001","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to compare the clinical outcomes of high tibial osteotomy (HTO) and total knee arthroplasty (TKA) in early elderly patients with severe knee osteoarthritis (OA).</div></div><div><h3>Methods</h3><div>This retrospective study included patients aged 65–74 years with Kellgren–Lawrence grade 4 medial knee OA who underwent either HTO or TKA. All patients had a minimum post-operative follow-up of 2 years. Propensity score matching was performed to balance baseline characteristics between the groups. Clinical outcomes were evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS), along with the achievement rates of minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) for each KOOS subscale at final follow-up. Statistical comparisons were made using the unpaired <em>t</em>-test, paired <em>t</em>-test, and Fisher's exact test, with statistical significance set at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>A total of 27 matched pairs were analyzed. Pre-operatively, there were no statistically significant differences in KOOS subscale scores between the groups. At the final follow-up, KOOS symptoms and pain scores, as well as the MCID achievement rate for KOOS symptoms, were statistically significantly better in the TKA group than in the HTO group. PASS achievement rates did not differ statistically significantly between the groups.</div></div><div><h3>Conclusion</h3><div>At a mean follow-up of 60.8 months, TKA resulted in better KOOS symptoms and pain scores and higher MCID achievement rate for KOOS symptoms than HTO. These findings suggest that TKA may offer more favorable outcomes than HTO for early elderly patients with severe medial knee OA.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 4","pages":"Pages 177-181"},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Successful total knee arthroplasty (TKA) relies on proper ligament balancing with a focus on medial stability. Intra-operative evaluation of the medial flexion gap must account for the relative femur–tibia positioning after implant placement. This study investigated whether intra-operative fine-tuning of the medial gap, enabled by a simple, reproducible spacer block for precise flexion gap measurement, could achieve consistent medial gap matching in both extension and flexion.
Methods
Forty-seven patients (9 men, 38 women) with knee osteoarthritis underwent JOURNEY II bicruciate stabilized TKA. A spacer block simulating post-cam engagement was designed to accurately assess the medial flexion gap. Intra-operative fine-tuning of the medial flexion gap was performed using spacer blocks and a stepless femoral cutting guide. Gaps were measured during the component trial using a tension device and at 1 year post-operatively via stress radiographs.
Results
Initially, 29% of knees exhibited a flexion–extension gap difference ≥2 mm after posterior cruciate ligament resection and tibial osteotomy. Spacer block fine-tuning reduced this to 8% and this improvement persisted at 1 year. At 4 years follow-up, Knee Society Scores were favorable, with significant gains in extension and flexion angles.
Conclusion
The developed spacer block technique, which replicates the post-cam engaging position, provided consistent and accurate flexion gap measurements and reduced flexion–extension discrepancies. This approach enhanced knee stability and patient outcome post-TKA.
{"title":"Appropriate flexion gap evaluation for fine-tuning of medial stabilizing technique in JOURNEY II bicruciate stabilized total knee arthroplasty","authors":"Yukio Akasaki, Satoshi Hamai, Shinya Kawahara, Ichiro Kurakazu, Kenji Kitamura, Yasuharu Nakashima","doi":"10.1016/j.jjoisr.2025.07.004","DOIUrl":"10.1016/j.jjoisr.2025.07.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Successful total knee arthroplasty (TKA) relies on proper ligament balancing with a focus on medial stability. Intra-operative evaluation of the medial flexion gap must account for the relative femur–tibia positioning after implant placement. This study investigated whether intra-operative fine-tuning of the medial gap, enabled by a simple, reproducible spacer block for precise flexion gap measurement, could achieve consistent medial gap matching in both extension and flexion.</div></div><div><h3>Methods</h3><div>Forty-seven patients (9 men, 38 women) with knee osteoarthritis underwent JOURNEY II bicruciate stabilized TKA. A spacer block simulating post-cam engagement was designed to accurately assess the medial flexion gap. Intra-operative fine-tuning of the medial flexion gap was performed using spacer blocks and a stepless femoral cutting guide. Gaps were measured during the component trial using a tension device and at 1 year post-operatively via stress radiographs.</div></div><div><h3>Results</h3><div>Initially, 29% of knees exhibited a flexion–extension gap difference ≥2 mm after posterior cruciate ligament resection and tibial osteotomy. Spacer block fine-tuning reduced this to 8% and this improvement persisted at 1 year. At 4 years follow-up, Knee Society Scores were favorable, with significant gains in extension and flexion angles.</div></div><div><h3>Conclusion</h3><div>The developed spacer block technique, which replicates the post-cam engaging position, provided consistent and accurate flexion gap measurements and reduced flexion–extension discrepancies. This approach enhanced knee stability and patient outcome post-TKA.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 3","pages":"Pages 170-175"},"PeriodicalIF":0.0,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study was to investigate chronic post-surgical pain (CPSP) in patients in the 6 months after total hip arthroplasty (THA), focusing on its prevalence, contributing factors, and duration.
Methods
Study subjects were 257 women who underwent THA at a single hospital. The following measures were evaluated pre-operatively and at 1, 2, and 6 months post-operatively: motion pain measured using a visual analog scale (VAS); central sensitization syndrome; pain catastrophizing; fear of movement; self-efficacy; anxiety; and depression scale. CPSP was defined as VAS ≥30 mm at 6 months post-operatively, and patients were dichotomized into CPSP and non-CPSP groups. The results were compared in a two-way analysis of variance (ANOVA) with presence and timing of CPSP as factors.
Results
The incidence of CPSP was 5.1%, and the CPSP group was significantly older than the non-CPSP group. ANOVA showed that the VAS was significantly higher in the CPSP group at 1, 2, and 6 months post-operatively compared with the non-CPSP group. Furthermore, the VAS of the CPSP group was significantly higher, and it was worse at 6 months than at 1 month post-operatively.
Conclusions
In this Japanese cohort, the incidence of CPSP after THA was lower than that reported in international studies. Although initial pain relief was observed, some patients experienced worsening pain from around 1 month post-operatively. This finding suggests the importance of timely interventions during this subacute period to help prevent the progression of CPSP.
{"title":"Worsening pain patterns and chronic post-surgical pain following total hip arthroplasty: A 6-month retrospective cohort study","authors":"Yusuke Suzuki , So Tanaka , Ryota Imai , Takeshi Chiba","doi":"10.1016/j.jjoisr.2025.07.001","DOIUrl":"10.1016/j.jjoisr.2025.07.001","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to investigate chronic post-surgical pain (CPSP) in patients in the 6 months after total hip arthroplasty (THA), focusing on its prevalence, contributing factors, and duration.</div></div><div><h3>Methods</h3><div>Study subjects were 257 women who underwent THA at a single hospital. The following measures were evaluated pre-operatively and at 1, 2, and 6 months post-operatively: motion pain measured using a visual analog scale (VAS); central sensitization syndrome; pain catastrophizing; fear of movement; self-efficacy; anxiety; and depression scale. CPSP was defined as VAS ≥30 mm at 6 months post-operatively, and patients were dichotomized into CPSP and non-CPSP groups. The results were compared in a two-way analysis of variance (ANOVA) with presence and timing of CPSP as factors.</div></div><div><h3>Results</h3><div>The incidence of CPSP was 5.1%, and the CPSP group was significantly older than the non-CPSP group. ANOVA showed that the VAS was significantly higher in the CPSP group at 1, 2, and 6 months post-operatively compared with the non-CPSP group. Furthermore, the VAS of the CPSP group was significantly higher, and it was worse at 6 months than at 1 month post-operatively.</div></div><div><h3>Conclusions</h3><div>In this Japanese cohort, the incidence of CPSP after THA was lower than that reported in international studies. Although initial pain relief was observed, some patients experienced worsening pain from around 1 month post-operatively. This finding suggests the importance of timely interventions during this subacute period to help prevent the progression of CPSP.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 3","pages":"Pages 151-158"},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Initial gaps in the tibial bone–tray interface may sometimes occur due to insufficient impaction, especially on hard tibial bone. The purpose of this study was to investigate the frequency of occurrence, characteristics, and natural history of initial gaps between the tibial bone–tray interface during surgery in a modern cementless total knee arthroplasty (TKA).
Methods
A retrospective review of a consecutive series of 273 cementless posterior stabilized mobile-bearing TKAs (Attune; DePuy Synthes, Warsaw, IN, USA) was performed. The incidence of gaps between the tibial bone and tibial tray that remained open during surgery was reviewed immediately after surgery and at 1 week, 1, 2, 4, and, 6 months, and 1 year post-operatively. The 273 TKAs were divided into two groups: TKAs with initial gaps (Group G) and those without gaps (Group N).
Results
Initial gaps appeared in 26 of the 273 TKAs (9.5%) on radiographs immediately after surgery. Four of 26 TKAs (15%) showed initial gaps that naturally disappeared due to weight-bearing at 1 week post-operatively, 16 of 26 TKAs (62%) within 1 month post-operatively, 20 of 26 TKAs (77%) within 2 months post-operatively, and all 26 TKAs (100%) within 4 months post-operatively. Group G included significantly younger patients (p < 0.01) with a higher body mass index (p < 0.01) than Group N. No patients required revision surgery.
Conclusion
The majority of initial gaps at the tibial bone–tray interface were resolved early during follow-up in a modern, cementless, posterior stabilized, mobile-bearing TKA.
{"title":"Early closure of initial gaps in the bone–tray interface of modern cementless total knee arthroplasty: A retrospective cohort study","authors":"Yoshinori Mikashima , Hitoshi Imamura , Koichiro Yano , Katsunori Ikari , Hiroshi Takagi , Ken Okazaki","doi":"10.1016/j.jjoisr.2025.06.006","DOIUrl":"10.1016/j.jjoisr.2025.06.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Initial gaps in the tibial bone–tray interface may sometimes occur due to insufficient impaction, especially on hard tibial bone. The purpose of this study was to investigate the frequency of occurrence, characteristics, and natural history of initial gaps between the tibial bone–tray interface during surgery in a modern cementless total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>A retrospective review of a consecutive series of 273 cementless posterior stabilized mobile-bearing TKAs (Attune; DePuy Synthes, Warsaw, IN, USA) was performed. The incidence of gaps between the tibial bone and tibial tray that remained open during surgery was reviewed immediately after surgery and at 1 week, 1, 2, 4, and, 6 months, and 1 year post-operatively. The 273 TKAs were divided into two groups: TKAs with initial gaps (Group G) and those without gaps (Group N).</div></div><div><h3>Results</h3><div>Initial gaps appeared in 26 of the 273 TKAs (9.5%) on radiographs immediately after surgery. Four of 26 TKAs (15%) showed initial gaps that naturally disappeared due to weight-bearing at 1 week post-operatively, 16 of 26 TKAs (62%) within 1 month post-operatively, 20 of 26 TKAs (77%) within 2 months post-operatively, and all 26 TKAs (100%) within 4 months post-operatively. Group G included significantly younger patients (<em>p</em> < 0.01) with a higher body mass index (<em>p</em> < 0.01) than Group N. No patients required revision surgery.</div></div><div><h3>Conclusion</h3><div>The majority of initial gaps at the tibial bone–tray interface were resolved early during follow-up in a modern, cementless, posterior stabilized, mobile-bearing TKA.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 3","pages":"Pages 145-150"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Like bone formation, porous tantalum (Ta) for total hip arthroplasty (THA) improves both initial stability and secondary biological fixation compared with porous titanium (Ti). The authors have occasionally observed new bone formation filling the cavity between the acetabular cup and acetabular bone in the supralateral part over time. This study aimed to investigate whether an improvement in bone coverage of the Ta cup was observed over time compared with that of the Ti cup.
Methods
This study included 223 patients (223 hips) with hip osteoarthritis who underwent primary THA using either a Ta or Ti cup. Host bone coverage of the acetabular cup was examined on radiographs using the cup center-edge (CE) angle and bone coverage index (BCI). Radiologically measured cup inclination (RI) was also measured.
Results
At 5 years, the mean cup CE angle was 35.3 ± 7.5° for Ti and 37.4 ± 7.1° for TA (p = 0.036), and the BCI was 90.8 ± 5.4% and 92.6 ± 6.6, respectively (p = 0.033). The improvement rates from 2 years to 5 years and from baseline to 5 years were statistically significantly greater in the Ta group than in the Ti group. In the multiple regression analysis, BCI at baseline (p < 0.0001), Ta (p = 0.018), and RI (p = 0.018) were significant predictors of BCI improvement 2–5 years later.
Conclusions
Filling the bone deficit in the lateral part of the cup without a bone graft over time had an advantage in the Ta cup over the Ti cup, which may enhance long-term survival. Additionally, RI and BCI were identified as important factors.
{"title":"Porous tantalum versus titanium-coated acetabular cups in total hip arthroplasty: Midterm radiological evidence of supralateral bone defect filling without grafting","authors":"Takuhei Kozaki , Satoru Yamazaki , Kimihide Murakami , Shigeki Sando , Koji Hashimoto , Akihiro Hoshino , Yuki Kuboi , Daisuke Nishiyama , Daisuke Fukui , Mamoru Kawakami","doi":"10.1016/j.jjoisr.2025.06.002","DOIUrl":"10.1016/j.jjoisr.2025.06.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Like bone formation, porous tantalum (Ta) for total hip arthroplasty (THA) improves both initial stability and secondary biological fixation compared with porous titanium (Ti). The authors have occasionally observed new bone formation filling the cavity between the acetabular cup and acetabular bone in the supralateral part over time. This study aimed to investigate whether an improvement in bone coverage of the Ta cup was observed over time compared with that of the Ti cup.</div></div><div><h3>Methods</h3><div>This study included 223 patients (223 hips) with hip osteoarthritis who underwent primary THA using either a Ta or Ti cup. Host bone coverage of the acetabular cup was examined on radiographs using the cup center-edge (CE) angle and bone coverage index (BCI). Radiologically measured cup inclination (RI) was also measured.</div></div><div><h3>Results</h3><div>At 5 years, the mean cup CE angle was 35.3 ± 7.5° for Ti and 37.4 ± 7.1° for TA (<em>p</em> = 0.036), and the BCI was 90.8 ± 5.4% and 92.6 ± 6.6, respectively (<em>p</em> = 0.033). The improvement rates from 2 years to 5 years and from baseline to 5 years were statistically significantly greater in the Ta group than in the Ti group. In the multiple regression analysis, BCI at baseline (<em>p</em> < 0.0001), Ta (<em>p</em> = 0.018), and RI (<em>p</em> = 0.018) were significant predictors of BCI improvement 2–5 years later.</div></div><div><h3>Conclusions</h3><div>Filling the bone deficit in the lateral part of the cup without a bone graft over time had an advantage in the Ta cup over the Ti cup, which may enhance long-term survival. Additionally, RI and BCI were identified as important factors.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 3","pages":"Pages 138-144"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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