Journal of Joint Surgery and Research最新文献_第4页

Functional knee positioning in total knee arthroplasty: Rationale and current evidence 全膝关节置换术中功能性膝关节定位：基本原理和当前证据

Journal of Joint Surgery and Research

Pub Date : 2025-07-04 DOI: 10.1016/j.jjoisr.2025.06.005

Hannes Vermue , Luca Andriollo , Elvire Servien , Cécile Batailler , Sébastien Lustig

Purpose

This narrative review aimed to evaluate the principles and outcomes of functional knee positioning (FKP) in total knee arthroplasty (TKA), a modern, patient-specific, robot-assisted technique designed to restore native limb alignment while preserving soft tissue balance.

Methods

A systematic literature search was conducted on March 22, 2025 across PubMed, Embase, and the Cochrane Library using the terms “functional alignment”, “functional knee positioning”, and “total knee arthroplasty.” A total of 1533 articles were identified, with relevant studies selected based on their contribution to understanding FKP principles, soft tissue balance, component positioning, and clinical outcomes.

Results

FKP employs a six-step, image-based planning strategy to reconstruct individual three-dimensional alignment and achieve ligament balance without soft tissue releases. Compared with mechanical and kinematic alignment, FKP more reliably achieves intra-operative balance, especially in the sagittal plane, and minimizes coronal and axial malalignment. FKP has shown consistent implant positioning accuracy and significantly low rates of soft tissue release. Clinical studies report high early post-operative scores, with some studies demonstrating superior outcomes in KOOS, WOMAC, and patient satisfaction compared with conventional strategies. FKP maintains outcomes across deformity types, implant designs, and Coronal Plane Alignment of the Knee (CPAK) phenotypes.

Conclusions

FKP represents a reproducible, anatomy-respecting alignment technique in TKA, with excellent early to midterm functional results and high patient satisfaction. By integrating robotic planning and intra-operative soft tissue assessment, FKP enables a highly personalized and biomechanically optimized alternative to conventional alignment strategies. Standardization of techniques and long-term outcome studies are needed to fully establish its role in routine clinical practice.

目的：本综述旨在评估全膝关节置换术（TKA）中功能性膝关节定位（FKP）的原理和结果。全膝关节置换术是一种现代的、患者特异性的、机器人辅助的技术，旨在恢复肢体对齐，同时保持软组织平衡。方法系统检索PubMed、Embase和Cochrane图书馆于2025年3月22日检索的相关文献，检索词为“功能对齐”、“功能性膝关节定位”和“全膝关节置换术”。共有1533篇文章被确定，根据对FKP原理、软组织平衡、部件定位和临床结果的贡献选择相关研究。结果fkp采用六步，基于图像的规划策略来重建个人三维对齐并实现韧带平衡而不释放软组织。与机械对齐和运动对齐相比，FKP更可靠地实现术中平衡，特别是在矢状面，并最大限度地减少冠状面和轴向对齐偏差。FKP显示出一致的植入物定位准确性和显著低的软组织释放率。临床研究报告了较高的早期术后评分，一些研究表明，与传统策略相比，kos、WOMAC和患者满意度的结果更好。FKP维持了畸形类型、植入物设计和膝关节冠状面对齐（CPAK）表型的结果。结论sfkp是一种可重复的、尊重解剖结构的TKA对准技术，具有良好的早期到中期功能效果和较高的患者满意度。通过整合机器人规划和术中软组织评估，FKP提供了高度个性化和生物力学优化的替代方案，取代了传统的对齐策略。需要标准化的技术和长期的结果研究，以充分确立其在常规临床实践中的作用。

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引用次数: 0

Tranexamic acid in total hip arthroplasty: Nationwide evidence for reducing blood transfusions and post-operative complications 全髋关节置换术中的氨甲环酸：全国范围内减少输血和术后并发症的证据

Journal of Joint Surgery and Research

Pub Date : 2025-07-01 DOI: 10.1016/j.jjoisr.2025.06.004

Hidetatsu Tanaka , Kunio Tarasawa , Yu Mori , Kazuyoshi Baba , Ryuichi Kanabuchi , Yasuaki Kuriyama , Hiroaki Kurishima , Hideki Fukuchi , Hiroki Kawamata , Kiyohide Fushimi , Toshimi Aizawa , Kenji Fujimori

Purpose

Total hip arthroplasty (THA) is an effective treatment for hip degenerative diseases; however, peri-operative blood loss often necessitates blood transfusion. Tranexamic acid (TXA) is widely used to reduce bleeding, although limited real-world evidence exists from Japanese populations. This study assessed the association between peri-operative TXA use and transfusion requirements and complications using nationwide data.

Methods

THA cases in the Japanese Diagnosis Procedure Combination (DPC) database from December 2011 to March 2023 were retrospectively analyzed. Patients undergoing primary THA for osteoarthritis, osteonecrosis, or rheumatoid arthritis were included. One-to-one propensity score (PS) matching was performed between patients who received TXA and those who did not. Logistic regression was used to evaluate outcomes including allogenic and autologous transfusion rate, infection, deep vein thrombosis (DVT), pulmonary embolism (PE), and death. A subgroup analysis of TXA dosage (≥2000 mg vs. <2000 mg) was performed.

Results

After PS matching, 134,653 patients were included in each group. TXA use significantly reduced allogeneic transfusion on post-operative Day 0 [odds ratio (OR) 0478], Day 1 (OR 0.377), and Day 2 (OR 0.339). Similarly, TXA use significantly reduced autologous transfusion rates on Day 0 (OR 0.555), Day 1 (OR 0.486), and Day 2 (OR 0.533). Higher TXA doses (≥2000 mg) further reduced Day 0 allogeneic and autologous transfusions, but increased autologous transfusion risk on Day 1. While no statistically significant differences were found in infection, PE, or death, TXA was associated with a slightly higher DVT risk.

Conclusions

Peri-operative TXA use in THA reduced transfusion needs without increasing PE or mortality risks, although careful monitoring for DVT is warranted. Future studies should clarify optimal dosing strategies tailored to Japanese populations.

目的全髋关节置换术是治疗髋关节退行性疾病的有效方法；然而，围手术期失血往往需要输血。氨甲环酸（TXA）被广泛用于减少出血，尽管在日本人群中存在有限的真实证据。本研究利用全国数据评估围手术期TXA使用与输血需求和并发症之间的关系。方法回顾性分析2011年12月至2023年3月日本诊断程序组合（DPC）数据库中的tha病例。因骨关节炎、骨坏死或类风湿关节炎而接受原发性THA治疗的患者也包括在内。在接受TXA治疗的患者和未接受TXA治疗的患者之间进行一对一倾向评分（PS）匹配。采用Logistic回归评估结果，包括异体和自体输血率、感染、深静脉血栓形成（DVT）、肺栓塞（PE）和死亡。对TXA剂量（≥2000 mg vs.≤2000 mg）进行亚组分析。结果经PS匹配后，两组共纳入134,653例患者。使用TXA可显著减少术后第0天、第1天（OR 0.377）和第2天（OR 0.339）的异体输血[比值比（OR） 0478]。同样，TXA的使用显著降低了第0天（OR 0.555）、第1天（OR 0.486）和第2天（OR 0.533）的自体输血率。较高的TXA剂量（≥2000 mg）进一步降低了第0天的异体和自体输血，但增加了第1天的自体输血风险。虽然在感染、PE或死亡方面没有发现统计学上的显著差异，但TXA与稍高的DVT风险相关。结论：在THA手术中使用TXA减少了输血需求，但没有增加PE或死亡风险，尽管有必要仔细监测DVT。未来的研究应阐明适合日本人群的最佳给药策略。

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引用次数: 0

Is selective hospitalist–orthopedic surgeon co-management based on the Charlson comorbidity index useful in peri-operative care of total hip arthroplasty? 基于Charlson合并症指数的选择性医院-骨科医生共同管理在全髋关节置换术围手术期护理中有用吗？

Journal of Joint Surgery and Research

Pub Date : 2025-06-30 DOI: 10.1016/j.jjoisr.2025.06.003

Kazuhiko Sonoda , Yusuke Kubo , Sanshiro Inoue , Toshihiko Hara

Purpose

Total hip arthroplasty (THA) is an effective treatment for hip diseases, but peri-operative management of patients with multiple comorbidities is challenging due to an increased risk of medical complications. Hospitalist–orthopedic surgeon co-management (HOC) has been reported to improve peri-operative care, but its effectiveness and impact on healthcare resources remain uncertain. This prospective, single-center study evaluated the utility of selective HOC based on the Charlson comorbidity index (CCI) in THA peri-operative management.

Methods

This study included 90 consecutive cases with primary THA by a single orthopedic surgeon. Based on CCI, patients were divided into an HOC group (CCI score ≥2) and non-HOC group (CCI score <2). The HOC group received peri-operative care from a hospitalist and orthopedic surgeon, while non-HOC group was managed by an orthopedic surgeon alone. Medical and surgery-related complications, hospital length of stay, 30-day mortality, and costs were evaluated.

Results

There were 17 cases (19%) in the HOC group and 73 (81%) in non-HOC group. The mean CCI score was 3.1 ± 1.3 in the HOC group and 0.4 ± 0.5 in the non-HOC group. Medical complications were more frequent in the HOC group (35% vs. 4%), while surgery-related complications were comparable. No statistically significant difference was observed in length of stay, 30-day mortality, and costs.

Conclusions

Selective indication for HOC based on CCI effectively identified high-risk patients, enabling timely intervention for medical complications without prolonging hospital stay. This strategy may mitigate peri-operative medical risks while optimizing resource use.

目的全髋关节置换术（THA）是髋关节疾病的有效治疗方法，但由于并发症的风险增加，有多种合并症的患者的围手术期管理具有挑战性。据报道，医院-骨科医生共同管理（HOC）可以改善围手术期护理，但其有效性和对医疗资源的影响仍不确定。这项前瞻性单中心研究评估了基于Charlson合并症指数（CCI）的选择性HOC在THA围手术期管理中的应用。方法本研究纳入由同一位骨科医生连续施行的90例原发性全髋关节置换术。根据CCI分为HOC组（CCI评分≥2）和非HOC组（CCI评分<；2）。HOC组接受住院医师和骨科医生的围手术期护理，而非HOC组由骨科医生单独管理。评估了医疗和手术相关并发症、住院时间、30天死亡率和费用。结果HOC组17例（19%），非HOC组73例（81%）。HOC组CCI平均评分为3.1±1.3分，非HOC组CCI平均评分为0.4±0.5分。医学并发症在HOC组更常见（35% vs. 4%），而手术相关并发症是相当的。在住院时间、30天死亡率和费用方面没有观察到统计学上的显著差异。结论基于CCI的HOC选择性适应证可有效识别高危患者，及时干预医疗并发症而不延长住院时间。该策略可在优化资源利用的同时降低围手术期医疗风险。

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引用次数: 0

Proximal tibia bone mineral density correlates more closely with hip density in men with knee osteoarthritis 在患有膝骨关节炎的男性中，胫骨近端骨密度与髋关节密度的相关性更密切

Journal of Joint Surgery and Research

Pub Date : 2025-06-22 DOI: 10.1016/j.jjoisr.2025.06.001

Junya Itou , Ayano Kuwasawa , Kotaro Nihei , Ken Okazaki

Purpose

Achieving biological fixation of the often loosened tibia is increasingly important for total knee arthroplasty (TKA), with one key factor being the bone density of the proximal tibia. This study examined whether hip bone mineral density (BMD), the most common diagnostic tool for osteoporosis, can estimate tibial BMD in both sexes.

Methods

This retrospective study included patients who underwent primary TKA with hip and tibial BMD measurement. Tibial BMD was measured 10 mm distal to the lateral tibial articular surface, separately for the medial (BMD_m) and lateral (BMD_l) sides. Additionally, the association between BMD and lower limb alignment was evaluated.

Results

In total, 1012 knees were included (79.3% in women). The mean patient age at surgery was 73.3 ± 7.5 years. The mean total hip BMD for women and men was 0.79 ± 0.13 g/cm² and 0.95 ± 0.16 g/cm², respectively. The mean BMD_m and BMD_l was, respectively, 0.75 ± 0.16 g/cm² and 0.63 ± 0.13 g/cm² in women and 0.92 ± 0.18 g/cm² and 0.89 ± 0.18 g/cm² in men. Both BMD_m and BMD_l showed a moderate correlation with hip BMD (r = 0.67 and 0.66, respectively) in men. In women, BMD_m showed a weak correlation (r = 0.47). Regarding lower limb alignment, BMD_m was significantly higher in varus alignment than in neutral or valgus alignment. BMD_l did not change with lower limb alignment.

Conclusions

BMD_m and BMD_l were moderately correlated with hip BMD in men, while BMD_m showed a low correlation in women.

目的在全膝关节置换术（TKA）中，实现经常松动的胫骨的生物固定越来越重要，其中一个关键因素是胫骨近端骨密度。本研究考察了髋部骨密度（BMD）——骨质疏松症最常见的诊断工具——是否可以估计两性胫骨骨密度。方法本回顾性研究纳入了原发性全髋关节置换术并测量髋关节和胫骨骨密度的患者。胫骨骨密度在胫骨外侧关节面远端10mm处测量，分别测量内侧（BMDm）和外侧（BMDl）侧。此外，还评估了骨密度与下肢直线之间的关系。结果共纳入1012个膝关节，其中女性占79.3%。手术时患者平均年龄为73.3±7.5岁。女性和男性的平均髋总骨密度分别为0.79±0.13 g/cm2和0.95±0.16 g/cm2。女性平均BMDm和BMDl分别为0.75±0.16 g/cm2和0.63±0.13 g/cm2，男性平均BMDm和BMDl分别为0.92±0.18 g/cm2和0.89±0.18 g/cm2。男性BMDm和BMDl与髋部BMD均有中度相关性（r分别为0.67和0.66）。在女性中，BMDm呈弱相关性（r = 0.47）。在下肢对齐方面，内翻对齐组的BMDm明显高于中性或外翻对齐组。BMDl不随下肢对齐而改变。结论男性sbmdm和BMDm与髋部骨密度呈中等相关性，女性BMDm与髋部骨密度呈低相关性。

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引用次数: 0

Is anterosuperior cup overhang a risk factor for iliopsoas impingement after total hip arthroplasty? A radar chart analysis 前上杯悬垂是全髋关节置换术后髂腰肌撞击的危险因素吗？雷达图分析

Journal of Joint Surgery and Research

Pub Date : 2025-05-15 DOI: 10.1016/j.jjoisr.2025.04.004

Sakura Kuniyoshi , Satoshi Nakasone , Mika Takaesu , Takahiro Igei , Fumiyuki Washizaki , Masamichi Onaga , Masato Ishihara , Kotaro Nishida

Purpose

Groin pain is an occasional complication of total hip arthroplasty (THA), with iliopsoas impingement (IPI) often associated with irritation between the iliopsoas tendon and an overhanging acetabular cup. Although cup overhang is typically assessed using radiography or computed tomography (CT), a more precise evaluation of cup positioning within the acetabulum may improve IPI diagnosis. This study aimed to investigate the association between IPI and circumferential cup overhang using the radar chart method to determine the precise amount of cup overhang without being affected by the metal artifacts.

Methods

A total of 128 patients who underwent primary THA via the direct anterior approach between 2014 and 2023 were analyzed. Patients were divided into IPI and non-IPI groups. To eliminate the influence of metal artifacts, pre-operative CT with a computer-aided design model of the acetabulum cup was generated using image matching. Radial CT planes were created at 15° intervals, and the angles of edge of the acetabular cup (ACA) and acetabular rim (ARA) were measured in each plane. The acetabular rim was represented as a clock, and radar charts were generated for each group. Cup overhang was defined as locations where the ACA exceeded the ARA.

Results

The radar chart of the IPI group demonstrated significant cup overhang in the 1:30 location.

Conclusions

These result suggests that cup overhang in the anterosuperior region, particularly in the 1:30 location, is a risk factor for IPI following THA. The radar chart method provides a comprehensive evaluation of cup positioning and may serve as a valid evaluation tool for assisting IPI diagnosis.

目的腹股沟疼痛是全髋关节置换术（THA）的偶发并发症，髂腰肌撞击（IPI）通常与髂腰肌肌腱和髋臼杯悬垂之间的刺激有关。虽然髋臼杯悬垂通常是通过x线摄影或计算机断层扫描（CT）来评估的，但髋臼内髋臼杯定位的更精确评估可能会提高IPI的诊断。本研究旨在探讨IPI与环向杯外伸之间的关系，使用雷达图方法确定杯外伸的精确量，而不受金属伪影的影响。方法分析2014 ~ 2023年128例经直接前路行原发性THA手术的患者资料。患者分为IPI组和非IPI组。为了消除金属伪影的影响，采用图像匹配的方法生成了髋臼杯计算机辅助设计模型的术前CT。以15°间隔创建径向CT平面，在每个平面上测量髋臼杯（ACA）边缘和髋臼缘（ARA）的角度。将髋臼边缘表示为时钟，并为每组生成雷达图。杯型悬垂被定义为ACA超过ARA的位置。结果IPI组的雷达图显示在1:30位置有明显的杯部悬垂。结论上述结果提示前上区，特别是1:30位置的杯部悬垂是THA术后IPI的危险因素。雷达图方法提供了杯子定位的全面评估，可以作为一个有效的评估工具，协助IPI诊断。

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引用次数: 0

Updates in the management of lateral patellar instability

Journal of Joint Surgery and Research

Pub Date : 2025-05-14 DOI: 10.1016/j.jjoisr.2025.04.001

Amber M. Parker , Naofumi Hashiguchi , Miho J. Tanaka

Purpose

The purpose of this study was to review current concepts in the evaluation and management of lateral patellar instability, focusing on anatomical risk factors, diagnostic approaches, and treatment strategies.

Methods

A comprehensive review of the literature examining anatomical considerations, risk factors, diagnostic methods, and treatment options for patellar instability was conducted. The review focused on the medial patellofemoral complex (MPFC) anatomy, various imaging modalities, and conservative and surgical management approaches.

Results

Patellar instability involves multiple anatomical risk factors, including abnormalities in dynamic/static stabilizers, osseous restraints, and lower extremity alignment. The MPFC, consisting of the medial patellofemoral ligament (MPFL) and medial quadriceps tendon–femoral ligament, provides primary restraint against lateral instability in early knee flexion. While 94–100% of first-time dislocations involve MPFL injury and can be managed conservatively, patients with multiple risk factors show 70–90% recurrence rates. Surgical treatment through MPFC reconstruction shows low redislocation rates (1.8–4.5%) and may be combined with additional procedures such as tibial tubercle osteotomy, trochleoplasty, or alignment correction based on individual pathoanatomy.

Conclusions

Successful management of patellar instability requires a comprehensive evaluation of anatomical risk factors and individualized treatment approaches. While conservative management is appropriate for first-time dislocations without significant risk factors, surgical intervention through MPFC reconstruction and associated procedures shows promising outcomes in preventing recurrence and improving function in high-risk patients.

目的本研究的目的是回顾目前评估和治疗外侧髌骨不稳的概念，重点是解剖危险因素、诊断方法和治疗策略。方法对有关髌骨不稳的解剖学考虑、危险因素、诊断方法和治疗方案的文献进行全面回顾。本文综述了内侧髌股复合体（MPFC）的解剖、各种成像方式以及保守和手术治疗方法。结果髌骨不稳涉及多种解剖学危险因素，包括动/静态稳定器、骨约束和下肢对齐异常。MPFC由内侧髌股韧带（MPFL）和内侧股四头肌肌腱-股韧带组成，对早期膝关节屈曲的外侧不稳定起到主要的抑制作用。虽然94-100%的首次脱位涉及MPFL损伤，可以保守处理，但有多种危险因素的患者复发率为70-90%。通过MPFC重建的手术治疗显示出较低的再脱位率（1.8-4.5%），并可结合其他手术，如胫骨结节截骨、滑车成形术或基于个体病理解剖的对齐矫正。结论成功治疗髌骨不稳需要综合评估解剖危险因素和个体化治疗方法。对于没有明显危险因素的首次脱位，保守治疗是合适的，通过MPFC重建和相关手术干预在预防复发和改善高危患者的功能方面显示出良好的结果。

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引用次数: 0

Temporal changes in synovitis and chronic pain after total knee arthroplasty: A two-year longitudinal study 全膝关节置换术后滑膜炎和慢性疼痛的时间变化：一项为期两年的纵向研究

Journal of Joint Surgery and Research

Pub Date : 2025-05-08 DOI: 10.1016/j.jjoisr.2025.04.002

Natsuki Sugimura, Koji Aso, Hiroyuki Wada, Masashi Izumi, Masahiko Ikeuchi

Purpose

Chronic post-surgical pain (CPSP) following total knee arthroplasty (TKA) leads to significant patient dissatisfaction post-operatively. Previous cross-sectional research has identified post-TKA synovitis as a key factor influencing CPSP, but there is a lack of longitudinal data. This study aimed to analyze risk factors for post-TKA pain and synovitis, including pre-operative elements, to better understand their roles in CPSP.

Methods

A cohort of 49 knees from 42 patients undergoing TKA for osteoarthritis was assessed. Demographic data, pre-operative and post-operative radiographic findings, pre-operative magnetic resonance imaging, intra-operative blood loss, and post-operative C-reactive protein levels were documented. Chronic pain, measured using the WOMAC pain subscale, and synovitis, quantified by our original “total PD score” using power Doppler (PD) ultrasonography, were recorded pre-operatively and at six months, one year, and two years post-operatively. Multivariable analysis was used to identify factors contributing to chronic pain and synovitis at these time points.

Results

Multivariable analysis showed that the total PD score was significantly associated with chronic pain at one and two years post-TKA. Pre-operative WOMAC pain subscale scores were also significantly associated with chronic pain at one year. For synovitis, the pre-operative total PD score was associated at the two year mark, and body mass index (BMI) was found to be a contributing factor at six months, one year, and two years.

Conclusions

Greater overall synovitis on PD ultrasonography was significantly associated with chronic pain post-TKA. Greater pre-operative synovitis and lower BMI were identified as contributing factors to post-TKA synovitis on PD ultrasonography. Further research is warranted to explore additional unassessed factors influencing post-TKA synovitis and to enhance imaging assessments.

目的全膝关节置换术（TKA）术后慢性疼痛（CPSP）导致患者术后明显的不满意。以前的横断面研究已经确定tka后滑膜炎是影响CPSP的关键因素，但缺乏纵向数据。本研究旨在分析tka后疼痛和滑膜炎的危险因素，包括术前因素，以更好地了解它们在CPSP中的作用。方法对42例接受全膝关节置换术治疗的骨关节炎患者的49个膝关节进行队列分析。记录了人口统计数据、术前和术后x线检查结果、术前磁共振成像、术中出血量和术后c反应蛋白水平。术前、术后6个月、1年和2年分别记录慢性疼痛（采用WOMAC疼痛亚量表测量）和滑膜炎（采用功率多普勒（power Doppler， PD）超声原始“PD总评分”量化）。多变量分析用于确定在这些时间点导致慢性疼痛和滑膜炎的因素。结果多变量分析显示，tka后1年和2年PD总分与慢性疼痛显著相关。术前WOMAC疼痛亚量表评分与一年后的慢性疼痛也显著相关。对于滑膜炎，术前总PD评分在两年时是相关的，而体重指数（BMI）在6个月、1年和2年时是一个影响因素。结论PD超声显示整体滑膜炎加重与tka后慢性疼痛显著相关。PD超声检查发现术前滑膜炎加重和BMI降低是tka术后滑膜炎的因素。有必要进一步研究其他未评估的影响tka后滑膜炎的因素，并加强影像学评估。

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引用次数: 0

Robotic-assisted total knee arthroplasty: Systematic review of surgical assist robotic systems available in Japan 机器人辅助全膝关节置换术：日本手术辅助机器人系统的系统回顾

Journal of Joint Surgery and Research

Pub Date : 2025-05-08 DOI: 10.1016/j.jjoisr.2025.04.003

Keizo Wada , Daisuke Hamada , Yasuaki Tamaki , Shota Shigekiyo , Koichi Sairyo

Purpose

Surgical assistant robots are now available for total knee arthroplasty (TKA). This review aimed to clarify the characteristics, accuracy, learning curve, and clinical results of robotic-assisted (RA) TKA performed using systems that are currently available in Japan (MAKO, ROSA, NAVIO/CORI, and VELYS).

Methods

The PubMed database was searched to identify studies on RA-TKA.

Results

MAKO is a semi-active robot using an oscillating saw. It is a computed tomography-based platform capable of determining the size and location of an implant pre-operatively. ROSA offers both imageless and image-based options using two-dimensional radiographs that are transformed into a three-dimensional model of the knee. NAVIO and CORI are handheld robotic platforms that support image-free anatomic data collection and streamlined intra-operative surgical planning with dynamic gap balancing. VELYS is an image-free, operating room bedrail-mounted, RA system that positions an oscillating saw for the surgeon to perform bone resection with real-time cut-plane tracking to compensate for any leg movement. Although there are some characteristic differences among the surgical assistant robots, the present review reveals that robot-controlled osteotomy may be more accurate than conventional techniques using a conventional guide and bone saw, with favorable short-term outcomes after RA-TKA.

Conclusions

This review found that the robotic systems recently made available in Japan demonstrate a high level of accuracy and show favorable short-term outcomes.

目的：手术辅助机器人现在可用于全膝关节置换术（TKA）。本综述旨在阐明使用日本现有系统（MAKO、ROSA、NAVIO/CORI和VELYS）进行的机器人辅助（RA） TKA的特点、准确性、学习曲线和临床结果。方法检索PubMed数据库，筛选RA-TKA相关研究。结果smako是一种使用摆动锯的半主动机器人。它是一种基于计算机层析成像的平台，能够在术前确定植入物的大小和位置。ROSA提供无图像和基于图像的选择，使用二维x线片转换成三维膝盖模型。NAVIO和CORI是手持式机器人平台，支持无图像解剖数据收集，并通过动态间隙平衡简化术中手术计划。VELYS是一种无图像的、安装在手术室床轨上的RA系统，它为外科医生定位一个振荡锯，通过实时切割平面跟踪来补偿任何腿部运动。尽管手术辅助机器人之间存在一些特征差异，但本综述表明，机器人控制的截骨术可能比使用传统导骨器和骨锯的传统技术更准确，RA-TKA术后短期效果良好。本综述发现，最近在日本推出的机器人系统显示出高水平的准确性，并显示出良好的短期效果。

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引用次数: 0

Development of a wearable system to estimate knee adduction moment of patients with knee osteoarthritis during gait using a single inertial measurement unit 一种可穿戴系统的开发，以估计膝关节骨性关节炎患者的膝关节内收力矩在步态中使用一个单一的惯性测量单元

Journal of Joint Surgery and Research

Pub Date : 2025-03-24 DOI: 10.1016/j.jjoisr.2025.02.005

Ayako Akiba , Kengo Harato , Hiroshi Yoshihara , Yu Iwama , Kohei Nishizawa , Takeo Nagura , Masaya Nakamura

Purpose

The external knee adduction moment (KAM) during gait is an important mechanical factor for knee osteoarthritis (KOA). Three-dimensional motion capture (MoCap) has been used to measure KAM, but it has limitations including cost, measuring time, and space. The purpose of this study was to develop a simple and wearable system to estimate KAM.

Methods

Thirty-nine female and seven male subjects diagnosed with KOA were included. Simultaneous measurements of 5 m walk using MoCap and inertial measurement unit (IMU) attached to the knee were performed, and a deep learning algorithm based on a gait phase detection algorithm and one-dimensional convolutional neural network model was used to estimate KAM. In addition, the reliability of the artificial intelligence system was also evaluated.

Results

The mean absolute percent error (MAPE) and mean absolute error (MAE) of estimated KAM peak of the training data and test datasets were 13.0% and 0.0428 Nm.s/(BW∗Ht) and 17.3% and 0.0505 Nm.s/(BW∗Ht), respectively, and those of estimated KAM impulse were 20.4% and 0.0214 Nm.s/(BW∗Ht) and 21.4% and 0.0212 Nm.s/(BW∗Ht), respectively. The Pearson correlation coefficients between estimated KAM (peak, impulse) and MoCap KAM (peak, impulse) were 0.870 and 0.975 in the training dataset and 0.591 and 0.690 in the test dataset. The intraclass correlation coefficients (ICCs) of estimated KAM impulse were 0.83, 0.94, 0.70, and 0.82 for ICCs (1.1), (1,k), (2,1), and (2,k) respectively.

Conclusions

The wearable system showed reasonable accuracy and reliability in estimating KAM of KOA during gait. The simple equipment in the system enables the measurement of KAM during daily practice in the clinic or hospital if there is available space to walk 5 m.

目的步态中膝关节外内收力矩（KAM）是膝关节骨性关节炎（KOA）的重要力学因素。三维运动捕捉（MoCap）已被用于测量KAM，但它存在成本、测量时间和空间等限制。本研究的目的是开发一个简单的可穿戴系统来估计KAM。方法选取确诊为KOA的女性39例，男性7例。使用动作捕捉和附着在膝盖上的惯性测量单元（IMU）同时测量5 m步行，并使用基于步态相位检测算法和一维卷积神经网络模型的深度学习算法来估计KAM。此外，还对人工智能系统的可靠性进行了评估。结果训练数据和测试数据估计KAM峰的平均绝对百分比误差（MAPE）和平均绝对误差（MAE）分别为13.0%和0.0428 Nm.s/(BW∗Ht)， 17.3%和0.0505 Nm.s/(BW∗Ht)， KAM冲量估计分别为20.4%和0.0214 Nm.s/(BW∗Ht)和21.4%和0.0212 Nm.s/(BW∗Ht)。估计的KAM（峰值、脉冲）和MoCap KAM（峰值、脉冲）之间的Pearson相关系数在训练数据集中分别为0.870和0.975，在测试数据集中分别为0.591和0.690。估计KAM冲量的类内相关系数（ICCs）在ICCs（1.1）、（1,k）、（2,1）和（2,k）分别为0.83、0.94、0.70和0.82。结论该可穿戴系统对步态中KOA的KAM估计具有一定的准确性和可靠性。系统中的简单设备可以在诊所或医院的日常练习中测量KAM，如果有5米的可用空间。

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引用次数: 0

Evaluation of early implant failure in Japanese patients undergoing unrestricted kinematic alignment total knee arthroplasty 日本无限制运动对齐全膝关节置换术患者早期假体失败的评估

Journal of Joint Surgery and Research

Pub Date : 2025-03-20 DOI: 10.1016/j.jjoisr.2025.02.004

Shuji Toyono , Shigenobu Fukushima , Takao Yamamoto , Takashi Ito , Takahiro Miyaji , Akemi Suzuki , Michiaki Takagi

Purpose

Total knee arthroplasty (TKA) traditionally involves mechanical alignment with a target range of ±3°. However, unrestricted kinematic alignment (urKA) has emerged as a viable alternative, potentially maintaining a favorable implant survival rate without the constraints of neutral alignment. Japanese people have more pronounced tibial varus than other populations. This study evaluated early implant failures in Japanese patients with osteoarthritis who underwent urKA-TKA.

Methods

In this study, 557 knees of 460 patients who underwent urKA-TKA between June 2019 and September 2021 were retrospectively analyzed. Surgeries were conducted by four surgeons using standardized urKA techniques, ensuring consistent ligament balancing and component positioning. The primary outcome was the rate of revision for aseptic loosening over at least 2 years, with secondary outcomes focusing on post-operative alignment.

Results

The follow-up rate was 95%, with a mean of 3.0 years. The implant survival rate was 100% considering implant revision as the endpoint, and 99% when re-operation was included. Post-operative alignment revealed that 60.3% of tibial components and 39.3% of limbs had varus alignment exceeding 3°; however, this did not compromise implant survival during the follow-up period.

Conclusions

The follow-up of at least 2 years for urKA-TKA in a Japanese cohort demonstrated no early implant failures with no significant effect on outcomes from deviations in varus alignment. These results support the use of urKA-TKA and underscore the need for long-term studies to further substantiate these findings in the Japanese population.

目的：传统的全膝关节置换术（TKA）需要机械对齐，目标范围为±3°。然而，无限制运动对齐（urKA）已经成为一种可行的替代方法，可以在没有中性对齐限制的情况下保持良好的种植体存活率。日本人的胫骨内翻比其他国家的人更明显。本研究评估了日本骨关节炎患者行urKA-TKA的早期种植失败。方法回顾性分析2019年6月至2021年9月期间460例urKA-TKA患者的557个膝关节。手术由四名外科医生使用标准化的urKA技术进行，确保一致的韧带平衡和部件定位。主要结果是至少2年内无菌性松动的翻修率，次要结果集中于术后对齐。结果随访率95%，平均3.0年。以种植体翻修为终点，种植体成活率为100%，包括再次手术后，成活率为99%。术后对准显示60.3%的胫骨部件和39.3%的四肢内翻对准超过3°；然而，在随访期间，这并不影响种植体的存活。结论：对日本一组urKA-TKA患者进行了至少2年的随访，发现早期植入失败，内翻对准偏差对结果没有显著影响。这些结果支持urKA-TKA的使用，并强调需要在日本人群中进行长期研究以进一步证实这些发现。

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引用次数: 0