Pub Date : 2026-01-08DOI: 10.1016/j.artd.2025.101946
Narayan Hulse FRCS (Tr&Orth), MCh, MRCS, MS, DNB
We report a robotic-assisted sliding medial epicondylar osteotomy along with a transosseous dual-fixation technique to balance severe varus deformities that are not amenable to medial release during total knee arthroplasty. A 60-year-old woman with bilateral knee osteoarthritis and a varus deformity of about 50° (hip–knee–ankle angle: Right 133°, left 127°) underwent staggered, bilateral robotic-assisted total knee arthroplasty. Despite excising osteophytes, performing a complete medial release, a reduction osteotomy, and reconstructing the medial tibial defect with a 10 mm modular metal augment, a significant imbalance with 9.5° of varus deformity remained uncorrected. Therefore, a medial epicondylar osteotomy was performed. The osteotomy fragment was displaced distally and posteriorly under real-time robotic control to achieve equal flexion and extension gaps. Robotic workflow is also used to monitor alignment and gaps during component cementation and osteotomy fixation. A dual-fixation technique is described using 2 interfragmentary cannulated screws and 2 transosseous nonabsorbable sutures to counter the deforming forces. The osteotomies healed bilaterally at 8 weeks. After 9 months of follow-up, the patient reports no pain, walks independently, has a range of motion of 0° to 115° bilaterally, and has a hip–knee–ankle angle of 178° on the right and 179° on the left.
{"title":"Robotic-Assisted Medial Epicondylar Osteotomy and Dual Fixation Technique During Total Knee Arthroplasty for Severe Varus Deformity","authors":"Narayan Hulse FRCS (Tr&Orth), MCh, MRCS, MS, DNB","doi":"10.1016/j.artd.2025.101946","DOIUrl":"10.1016/j.artd.2025.101946","url":null,"abstract":"<div><div>We report a robotic-assisted sliding medial epicondylar osteotomy along with a transosseous dual-fixation technique to balance severe varus deformities that are not amenable to medial release during total knee arthroplasty. A 60-year-old woman with bilateral knee osteoarthritis and a varus deformity of about 50° (hip–knee–ankle angle: Right 133°, left 127°) underwent staggered, bilateral robotic-assisted total knee arthroplasty. Despite excising osteophytes, performing a complete medial release, a reduction osteotomy, and reconstructing the medial tibial defect with a 10 mm modular metal augment, a significant imbalance with 9.5° of varus deformity remained uncorrected. Therefore, a medial epicondylar osteotomy was performed. The osteotomy fragment was displaced distally and posteriorly under real-time robotic control to achieve equal flexion and extension gaps. Robotic workflow is also used to monitor alignment and gaps during component cementation and osteotomy fixation. A dual-fixation technique is described using 2 interfragmentary cannulated screws and 2 transosseous nonabsorbable sutures to counter the deforming forces. The osteotomies healed bilaterally at 8 weeks. After 9 months of follow-up, the patient reports no pain, walks independently, has a range of motion of 0° to 115° bilaterally, and has a hip–knee–ankle angle of 178° on the right and 179° on the left.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101946"},"PeriodicalIF":2.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927003","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}
Robot-assisted unicompartmental knee arthroplasty (UKA) has been introduced to improve component positioning. The ROSA Knee System and Persona Partial Knee (Zimmer Biomet, Warsaw, IN, USA) constitute a relatively new robotic platform with limited data. We aimed to quantify tibial and femoral component alignment and evaluate short-term clinical outcomes.
Methods
We reviewed 64 consecutive medial UKAs performed with this system. Preoperative planning used computed tomography (CT)-based three-dimensional models. Postoperative component alignment was measured on radiographs and CT. Clinical outcomes were assessed with the 2011 Knee Society Score (KSS) preoperatively and at 1 year; paired analyses were performed in 34 knees with complete preoperative and postoperative KSS data.
Results
Tibial components were implanted in greater varus and with less posterior slope than planned. The planned tibial coronal angle was 0.0° ± 0.1°, whereas the postoperative CT-based angle was −2.7° ± 2.3°; posterior slope decreased from 7.8° ± 1.4° to 4.5° ± 2.4°. Femoral alignment showed minimal deviation. In the 34 knees with complete KSS data, mean symptom, satisfaction, and functional activity subscores improved from 7.4 ± 4.9, 16.1 ± 6.4, and 47.7 ± 17.2 to 19.4 ± 5.3, 29.8 ± 6.4, and 75.7 ± 14.5, respectively (all P < .0001).
Conclusions
Medial robot-assisted UKA with this system showed generally accurate component positioning but a consistent tendency toward approximately 2° greater tibial varus and reduced posterior slope relative to the plan. Awareness of this systematic deviation may help optimize tibial placement, and short-term clinical outcomes were favorable.
{"title":"Tendency of Tibial Component Placement and Short-Term Outcomes in ROSA-Assisted Unicompartmental Knee Arthroplasty Using the Persona Partial Knee System","authors":"Daichi Ishimaru MD, PhD, Kazuki Sohmiya MD, Nobuo Terabayashi MD, PhD, Kazu Matsumoto MD, PhD","doi":"10.1016/j.artd.2025.101938","DOIUrl":"10.1016/j.artd.2025.101938","url":null,"abstract":"<div><h3>Background</h3><div>Robot-assisted unicompartmental knee arthroplasty (UKA) has been introduced to improve component positioning. The ROSA Knee System and Persona Partial Knee (Zimmer Biomet, Warsaw, IN, USA) constitute a relatively new robotic platform with limited data. We aimed to quantify tibial and femoral component alignment and evaluate short-term clinical outcomes.</div></div><div><h3>Methods</h3><div>We reviewed 64 consecutive medial UKAs performed with this system. Preoperative planning used computed tomography (CT)-based three-dimensional models. Postoperative component alignment was measured on radiographs and CT. Clinical outcomes were assessed with the 2011 Knee Society Score (KSS) preoperatively and at 1 year; paired analyses were performed in 34 knees with complete preoperative and postoperative KSS data.</div></div><div><h3>Results</h3><div>Tibial components were implanted in greater varus and with less posterior slope than planned. The planned tibial coronal angle was 0.0° ± 0.1°, whereas the postoperative CT-based angle was −2.7° ± 2.3°; posterior slope decreased from 7.8° ± 1.4° to 4.5° ± 2.4°. Femoral alignment showed minimal deviation. In the 34 knees with complete KSS data, mean symptom, satisfaction, and functional activity subscores improved from 7.4 ± 4.9, 16.1 ± 6.4, and 47.7 ± 17.2 to 19.4 ± 5.3, 29.8 ± 6.4, and 75.7 ± 14.5, respectively (all <em>P</em> < .0001).</div></div><div><h3>Conclusions</h3><div>Medial robot-assisted UKA with this system showed generally accurate component positioning but a consistent tendency toward approximately 2° greater tibial varus and reduced posterior slope relative to the plan. Awareness of this systematic deviation may help optimize tibial placement, and short-term clinical outcomes were favorable.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101938"},"PeriodicalIF":2.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926990","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 : 2026-01-07DOI: 10.1016/j.artd.2025.101939
Lucas Ho MBChB (Hons) , Navnit S. Makaram MSc, MRCS (Ed) , Catherine James MBBCh, MRCS , Chryssa Neo MBChB, MSc, MRCS , Nick D. Clement MBBS, MD, PhD, FRCS Ed (Tr & Orth) , Chloe E.H. Scott MD, FRCSEd (Tr & Orth)
Background
Surgical management of native distal femoral fractures (DFFs) in elderly patients includes open reduction and internal fixation (ORIF) or distal femoral endoprosthetic replacement (DFR). When ORIF is complicated by nonunion or fixation failure, salvage DFR (sDFR) may be required. The comparative outcomes of primary DFR (pDFR) vs sDFR remain unclear. This systematic review and meta-analysis aimed to assess the quality of published literature and compared clinical and functional outcomes between pDFR and sDFR for native DFFs.
Methods
MEDLINE, Embase, and Cochrane databases were searched from inception to April 2024. Studies investigating outcomes of pDFR or sDFR following native DFFs were included. Studies evaluating periprosthetic fractures, oncologic indications, or primary arthritis were excluded. Twelve studies comprising 281 patients (230 pDFR, 51 sDFR) were included.
Results
Patients undergoing pDFR were significantly older (mean 79.3 vs 64.9 years; P < .001) and more comorbid (American Society of Anesthesiologists score: mean 2.99 vs 2.34; P < .001). Despite this, pDFR was associated with significantly lower reoperation (12.2% vs 23.5%; P = .04) and complication rates (15.7% vs 43.1%; P < .001) compared to sDFR. 1-year mortality rate was higher in the pDFR cohort (10.4% vs 2.0%). Functional outcomes were marginally lower in pDFR, although this was not statistically significant (76.3 vs 80.7%; P = .09).
Conclusions
sDFR following failed fixation of native DFFs was associated with nearly twice the risk of reoperation and postoperative complications compared to pDFR, despite being performed in a younger and less comorbid cohort. Elderly patients at risk of fixation failure may therefore benefit from pDFR.
背景：老年患者先天性股骨远端骨折（dff）的手术治疗包括切开复位内固定（ORIF）或股骨远端假体置换术（DFR）。当ORIF并发骨不连或固定失败时，可能需要补救性DFR （sDFR）。原发性DFR （pDFR）与sDFR的比较结果尚不清楚。本系统综述和荟萃分析旨在评估已发表文献的质量，并比较pDFR和sDFR治疗本地dff的临床和功能结果。方法检索medline、Embase和Cochrane数据库，检索时间为建库至2024年4月。纳入了调查本地dff后pDFR或sDFR结果的研究。评估假体周围骨折、肿瘤适应症或原发性关节炎的研究被排除在外。纳入了12项研究，共281例患者（230例pDFR， 51例sDFR）。结果接受pDFR的患者年龄明显增大（平均79.3岁vs 64.9岁；P < 0.001），合合症较多（美国麻醉医师学会评分：平均2.99岁vs 2.34岁；P < 0.001）。尽管如此，与sDFR相比，pDFR的再手术率（12.2% vs 23.5%, P = 0.04）和并发症发生率（15.7% vs 43.1%, P < 0.001）显著降低。pDFR组的1年死亡率更高（10.4% vs 2.0%）。功能结局在pDFR中略低，尽管这没有统计学意义（76.3 vs 80.7%; P = 0.09）。结论：与pDFR相比，原位dff固定失败后的dfr与再手术和术后并发症的风险接近两倍，尽管在更年轻且合并症较少的队列中进行。因此，有固定失败风险的老年患者可能受益于pDFR。
{"title":"Primary Versus Salvage Distal Femoral Endoprosthetic Replacement Following Native Distal Femur Fracture: A Systematic Review and Meta-Analysis","authors":"Lucas Ho MBChB (Hons) , Navnit S. Makaram MSc, MRCS (Ed) , Catherine James MBBCh, MRCS , Chryssa Neo MBChB, MSc, MRCS , Nick D. Clement MBBS, MD, PhD, FRCS Ed (Tr & Orth) , Chloe E.H. Scott MD, FRCSEd (Tr & Orth)","doi":"10.1016/j.artd.2025.101939","DOIUrl":"10.1016/j.artd.2025.101939","url":null,"abstract":"<div><h3>Background</h3><div>Surgical management of native distal femoral fractures (DFFs) in elderly patients includes open reduction and internal fixation (ORIF) or distal femoral endoprosthetic replacement (DFR). When ORIF is complicated by nonunion or fixation failure, salvage DFR (sDFR) may be required. The comparative outcomes of primary DFR (pDFR) vs sDFR remain unclear. This systematic review and meta-analysis aimed to assess the quality of published literature and compared clinical and functional outcomes between pDFR and sDFR for native DFFs.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, and Cochrane databases were searched from inception to April 2024. Studies investigating outcomes of pDFR or sDFR following native DFFs were included. Studies evaluating periprosthetic fractures, oncologic indications, or primary arthritis were excluded. Twelve studies comprising 281 patients (230 pDFR, 51 sDFR) were included.</div></div><div><h3>Results</h3><div>Patients undergoing pDFR were significantly older (mean 79.3 vs 64.9 years; <em>P</em> < .001) and more comorbid (American Society of Anesthesiologists score: mean 2.99 vs 2.34; <em>P</em> < .001). Despite this, pDFR was associated with significantly lower reoperation (12.2% vs 23.5%; <em>P</em> = .04) and complication rates (15.7% vs 43.1%; <em>P</em> < .001) compared to sDFR. 1-year mortality rate was higher in the pDFR cohort (10.4% vs 2.0%). Functional outcomes were marginally lower in pDFR, although this was not statistically significant (76.3 vs 80.7%; <em>P</em> = .09).</div></div><div><h3>Conclusions</h3><div>sDFR following failed fixation of native DFFs was associated with nearly twice the risk of reoperation and postoperative complications compared to pDFR, despite being performed in a younger and less comorbid cohort. Elderly patients at risk of fixation failure may therefore benefit from pDFR.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101939"},"PeriodicalIF":2.1,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927158","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 : 2026-01-07DOI: 10.1016/j.artd.2025.101941
Madeleine Orringer MD , Ioanna K. Bolia MD, MS, PhD , Cory K. Mayfield MD , Eric H. Lin BA , Cailan L. Feingold BS , Nathanael D. Heckmann MD , George F.Rick Hatch 3rd MD
Background
Arthritic progression after high tibial osteotomy (HTO) can require total knee arthroplasty (TKA). While primary TKA results are reliably favorable, there remains uncertainty regarding outcomes of TKA after HTO. We aimed to compare perioperative complication and revision rates for patients who converted to TKA after HTO (HTO-TKA) vs patients who underwent primary TKA.
Methods
Retrospective deidentified data were obtained from the PearlDiver Mariner Database from 2010 to 2022. Patients who underwent TKA following HTO were matched in a 1:3 ratio based on age, gender, and Charlson Comorbidity index to patients who underwent primary TKA. The incidence of revision surgery and postoperative complications were compared.
Results
After matching, 786 patients who underwent converted HTO-TKA were compared to 2356 patients who underwent primary TKA. Patients with TKA after HTO had nearly 4-fold increased incidence of postoperative infection (2.9% vs 0.64%, odds ratio (OR) = 4.7, 95% confidence interval [CI] 2.4-9.1, P < .0001) and wound disruption (6.0% vs 1.7%, OR = 3.7, 95% CI 2.4-5.7, P < .0001) compared to primary TKA patients. There was an increased incidence of aseptic loosening (1.8% vs 0.76%, OR = 2.4, 95% CI 1.2-4.8, P = .024). History of prior HTO was also associated with a 3-fold increase in incidence of revision TKA within 2 years (6.2% vs 2.3%, OR = 2.8, 95% CI 1.9-4.2, P < .0001).
Conclusions
Patients who undergo HTO before TKA have a higher incidence of perioperative complications and revision surgery compared to primary TKA patients. These data can be useful when counseling patients; however, further research should investigate whether recent advances in surgical techniques and contemporary changes in infection prophylaxis may enhance outcomes of TKA following HTO.
背景：高位胫骨截骨术（HTO）后关节炎进展可能需要全膝关节置换术（TKA）。虽然TKA的初步结果是可靠的，但HTO后TKA的结果仍然存在不确定性。我们的目的是比较HTO术后转TKA患者（HTO-TKA）与原发TKA患者的围手术期并发症和翻修率。方法从2010 - 2022年PearlDiver Mariner数据库中获得回顾性鉴定数据。根据年龄、性别和Charlson合并症指数，HTO后接受TKA的患者与接受原发性TKA的患者按1:3的比例进行匹配。比较翻修手术及术后并发症的发生率。结果匹配后，786例转行HTO-TKA患者与2356例原发TKA患者进行了比较。与原发TKA患者相比，HTO后TKA患者术后感染（2.9% vs 0.64%，优势比(OR) = 4.7, 95%可信区间[CI] 2.4-9.1, P < 0.0001）和伤口破裂（6.0% vs 1.7%, OR = 3.7, 95% CI 2.4-5.7, P < 0.0001）的发生率增加了近4倍。无菌性松动发生率增加（1.8% vs 0.76%, OR = 2.4, 95% CI 1.2-4.8, P = 0.024）。既往HTO病史也与2年内改版TKA发生率增加3倍相关（6.2% vs 2.3%, OR = 2.8, 95% CI 1.9-4.2, P < 0.0001）。结论TKA术前行HTO的患者围手术期并发症及翻修手术发生率高于原发性TKA患者。这些数据在为患者提供咨询时很有用；然而，进一步的研究应该调查手术技术的最新进展和当代感染预防的变化是否可以提高HTO后TKA的结果。
{"title":"Complications and Reoperation Rates of Total Knee Arthroplasty After High Tibial Osteotomy: A Matched Cohort Analysis From a Nationwide Database","authors":"Madeleine Orringer MD , Ioanna K. Bolia MD, MS, PhD , Cory K. Mayfield MD , Eric H. Lin BA , Cailan L. Feingold BS , Nathanael D. Heckmann MD , George F.Rick Hatch 3rd MD","doi":"10.1016/j.artd.2025.101941","DOIUrl":"10.1016/j.artd.2025.101941","url":null,"abstract":"<div><h3>Background</h3><div>Arthritic progression after high tibial osteotomy (HTO) can require total knee arthroplasty (TKA). While primary TKA results are reliably favorable, there remains uncertainty regarding outcomes of TKA after HTO. We aimed to compare perioperative complication and revision rates for patients who converted to TKA after HTO (HTO-TKA) vs patients who underwent primary TKA.</div></div><div><h3>Methods</h3><div>Retrospective deidentified data were obtained from the PearlDiver Mariner Database from 2010 to 2022. Patients who underwent TKA following HTO were matched in a 1:3 ratio based on age, gender, and Charlson Comorbidity index to patients who underwent primary TKA. The incidence of revision surgery and postoperative complications were compared.</div></div><div><h3>Results</h3><div>After matching, 786 patients who underwent converted HTO-TKA were compared to 2356 patients who underwent primary TKA. Patients with TKA after HTO had nearly 4-fold increased incidence of postoperative infection (2.9% vs 0.64%, odds ratio (OR) = 4.7, 95% confidence interval [CI] 2.4-9.1, <em>P</em> < .0001) and wound disruption (6.0% vs 1.7%, OR = 3.7, 95% CI 2.4-5.7, <em>P</em> < .0001) compared to primary TKA patients. There was an increased incidence of aseptic loosening (1.8% vs 0.76%, OR = 2.4, 95% CI 1.2-4.8, <em>P</em> = .024). History of prior HTO was also associated with a 3-fold increase in incidence of revision TKA within 2 years (6.2% vs 2.3%, OR = 2.8, 95% CI 1.9-4.2, <em>P</em> < .0001).</div></div><div><h3>Conclusions</h3><div>Patients who undergo HTO before TKA have a higher incidence of perioperative complications and revision surgery compared to primary TKA patients. These data can be useful when counseling patients; however, further research should investigate whether recent advances in surgical techniques and contemporary changes in infection prophylaxis may enhance outcomes of TKA following HTO.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101941"},"PeriodicalIF":2.1,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927002","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 : 2026-01-05DOI: 10.1016/j.artd.2025.101936
Margaret Hedeman BA , Jacie Lemos BS , Charles Guerra BS , Hadley Winslow BS , Arnav Sharma BS , William D. Werry MD , Phil Aurigemma MD , Brian Samuelsen MD , Mark J. Lemos MD
Background
Patellar Clunk Syndrome (PCS) is a known complication of total knee arthroplasty (TKA). Prior studies have identified multiple risk factors for PCS, including male sex, patellar size, and implant design. Previous literature suggests surgical intervention as the preferred treatment for PCS. No review to date has systematically assessed risk factors and treatment outcomes of PCS.
Methods
Following PRISMA protocol, 4 online databases were searched for English language studies published during or after the year 2000 that reported PCS as a primary outcome of TKA and identified (1) risk factors for developing PCS and/or (2) outcomes following treatment. The methodological quality of studies was assessed using the Newcastle-Ottawa Scale (NOS). The following outcomes were collected and reported: demographic information, overall PCS complication rate, risk factors, treatment plans, and treatment outcomes.
Results
The initial search yielded 699 articles. A total of 316 articles underwent full-text review; 24 articles were ultimately included and analyzed. Nineteen articles assessed risk factors, 2 assessed treatment outcomes, and 3 assessed both. Of the articles assessing risk factors, 9 (41%) reported specific implants, 3 (16%) reported mobile-bearing design, and 2 (9%) reported posterior stabilized (PS) design. Additional risk factors identified include retained patella, smaller patellar thickness, and higher postoperative knee flexion. Five articles assessed arthroscopic treatment for PCS, and all demonstrated satisfactory outcomes.
Conclusions
Risk factors for developing PCS include implant design, implant type, retained patella, patellar thickness, and higher postoperative flexion. Other risk factors were not supported by multiple studies. Arthroscopic treatment has strong evidence for improving functional outcomes in patients with symptomatic PCS.
{"title":"Patellar Clunk Syndrome: A Systematic Review of Risk Factors and Treatment","authors":"Margaret Hedeman BA , Jacie Lemos BS , Charles Guerra BS , Hadley Winslow BS , Arnav Sharma BS , William D. Werry MD , Phil Aurigemma MD , Brian Samuelsen MD , Mark J. Lemos MD","doi":"10.1016/j.artd.2025.101936","DOIUrl":"10.1016/j.artd.2025.101936","url":null,"abstract":"<div><h3>Background</h3><div>Patellar Clunk Syndrome (PCS) is a known complication of total knee arthroplasty (TKA). Prior studies have identified multiple risk factors for PCS, including male sex, patellar size, and implant design. Previous literature suggests surgical intervention as the preferred treatment for PCS. No review to date has systematically assessed risk factors and treatment outcomes of PCS.</div></div><div><h3>Methods</h3><div>Following PRISMA protocol, 4 online databases were searched for English language studies published during or after the year 2000 that reported PCS as a primary outcome of TKA and identified (1) risk factors for developing PCS and/or (2) outcomes following treatment. The methodological quality of studies was assessed using the Newcastle-Ottawa Scale (NOS). The following outcomes were collected and reported: demographic information, overall PCS complication rate, risk factors, treatment plans, and treatment outcomes.</div></div><div><h3>Results</h3><div>The initial search yielded 699 articles. A total of 316 articles underwent full-text review; 24 articles were ultimately included and analyzed. Nineteen articles assessed risk factors, 2 assessed treatment outcomes, and 3 assessed both. Of the articles assessing risk factors, 9 (41%) reported specific implants, 3 (16%) reported mobile-bearing design, and 2 (9%) reported posterior stabilized (PS) design. Additional risk factors identified include retained patella, smaller patellar thickness, and higher postoperative knee flexion. Five articles assessed arthroscopic treatment for PCS, and all demonstrated satisfactory outcomes.</div></div><div><h3>Conclusions</h3><div>Risk factors for developing PCS include implant design, implant type, retained patella, patellar thickness, and higher postoperative flexion. Other risk factors were not supported by multiple studies. Arthroscopic treatment has strong evidence for improving functional outcomes in patients with symptomatic PCS.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101936"},"PeriodicalIF":2.1,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927157","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 : 2026-01-03DOI: 10.1016/j.artd.2025.101937
Kevin C. Chang MD , Aleksandra Qilleri BS , Alexandra Echevarria BS , Jonathan R. Danoff MD
Background
This study compares short-term outcomes of robotic-assisted revision total knee arthroplasty (RA-rTKA) to conventional rTKA. We hypothesize that RA-rTKA will accelerate gains in range of motion and time to ambulation postoperatively.
Methods
This is a retrospective case-control study reviewing consecutive rTKA performed by a single surgeon between 2017 and 2024. rTKA cases performed prior to 2022 were compared to RA-rTKA performed from 2022 through present day. Revisions for periprosthetic joint infection or fracture were excluded. The primary outcome was hospital length of stay. Secondary outcomes included physical therapy (PT) metrics, blood loss, surgical time, and complications. Data collected included demographics, surgical and implant data, in-hospital PT progress, and outcomes through a minimum of 1 year.
Results
Sixty-six revision cases (42 rTKA and 24 RA-rTKA) were included with an average age of 67.7 years. Etiologies included loosening (42), second-stage reimplantation (12) after infection eradication, polyethylene wear (6), instability (6), and other etiologies (6). RA-rTKA case time averaged 27 minutes less than conventional; P = .18. The RA-rTKA cohort ambulated further on postoperative day 1 compared to the rTKA group (166.3 vs 87.2 feet; P = .01), was cleared by PT for discharge sooner (2.1 vs 3.1 days; P < .01), and had a shorter hospital length of stay (2.5 vs 3.6 days, P = .01). While all patients in both cohorts achieved at least 110° knee flexion by 6 weeks, RA-rTKA patients demonstrated significantly more knee flexion (119° vs 110°; P = .05). At a minimum of 1-year follow-up, no RA-rTKA patients required rerevisions, compared to 2 rTKA patients.
Conclusions
In this study, RA-rTKA showed improved ambulation in the immediate postoperative period, decreased hospital length of stay, and overall increased knee range of motion. These improvements were realized without increases in complications or operative time.
{"title":"Improved Perioperative Outcomes in Robotic-Assisted Revision Total Knee Arthroplasty","authors":"Kevin C. Chang MD , Aleksandra Qilleri BS , Alexandra Echevarria BS , Jonathan R. Danoff MD","doi":"10.1016/j.artd.2025.101937","DOIUrl":"10.1016/j.artd.2025.101937","url":null,"abstract":"<div><h3>Background</h3><div>This study compares short-term outcomes of robotic-assisted revision total knee arthroplasty (RA-rTKA) to conventional rTKA. We hypothesize that RA-rTKA will accelerate gains in range of motion and time to ambulation postoperatively.</div></div><div><h3>Methods</h3><div>This is a retrospective case-control study reviewing consecutive rTKA performed by a single surgeon between 2017 and 2024. rTKA cases performed prior to 2022 were compared to RA-rTKA performed from 2022 through present day. Revisions for periprosthetic joint infection or fracture were excluded. The primary outcome was hospital length of stay. Secondary outcomes included physical therapy (PT) metrics, blood loss, surgical time, and complications. Data collected included demographics, surgical and implant data, in-hospital PT progress, and outcomes through a minimum of 1 year.</div></div><div><h3>Results</h3><div>Sixty-six revision cases (42 rTKA and 24 RA-rTKA) were included with an average age of 67.7 years. Etiologies included loosening (42), second-stage reimplantation (12) after infection eradication, polyethylene wear (6), instability (6), and other etiologies (6). RA-rTKA case time averaged 27 minutes less than conventional; <em>P</em> = .18. The RA-rTKA cohort ambulated further on postoperative day 1 compared to the rTKA group (166.3 vs 87.2 feet; <em>P</em> = .01), was cleared by PT for discharge sooner (2.1 vs 3.1 days; <em>P</em> < .01), and had a shorter hospital length of stay (2.5 vs 3.6 days, <em>P</em> = .01). While all patients in both cohorts achieved at least 110° knee flexion by 6 weeks, RA-rTKA patients demonstrated significantly more knee flexion (119° vs 110°; <em>P</em> = .05). At a minimum of 1-year follow-up, no RA-rTKA patients required rerevisions, compared to 2 rTKA patients.</div></div><div><h3>Conclusions</h3><div>In this study, RA-rTKA showed improved ambulation in the immediate postoperative period, decreased hospital length of stay, and overall increased knee range of motion. These improvements were realized without increases in complications or operative time.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101937"},"PeriodicalIF":2.1,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885168","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}
Unstable intertrochanteric fractures in the elderly pose a significant treatment challenge due to poor bone quality, comminution, and associated comorbidities. Bipolar hemiarthroplasty offers the advantage of early mobilization and reduced fixation-related complications. This study evaluates short-term outcomes of bipolar hemiarthroplasty using an uncemented titanium fluted, tapered cone femoral prosthesis in such fractures.
Methods
A retrospective analysis was conducted on 43 consecutive elderly patients treated with uncemented bipolar hemiarthroplasty using a tapered, fluted cone stem between June 2023 and July 2024. Radiographic parameters—including stem subsidence, greater trochanter union, and limb-length discrepancy—were assessed at serial follow-ups. Functional outcomes were evaluated using the Harris Hip Score.
Results
Of the 43 patients operated on, 40 completed a minimum of 12 months follow-up. Greater trochanteric union was observed in 97.7% of cases, with one persistent nonunion causing abductor weakness and early dislocation. Mean stem subsidence was 3.5 mm (0.5–20 mm), with all settling occurring within the first 3 postoperative months; 4 patients (9.3%) experienced subsidence of 5 mm or more, including one requiring revision. The mean limb-length discrepancy was 4.7 mm (1–10 mm). At final follow-up, the mean Harris Hip Score among surviving patients was 91.28, with 29 patients (72.5%) achieving excellent outcomes and 11 patients (27.5%) achieving good outcomes.
Conclusions
Bipolar hemiarthroplasty using a tapered, fluted cone stem appears to be a reliable option for carefully selected elderly patients with unstable intertrochanteric fractures, offering predictable fixation, early weight-bearing, and favorable short-term functional results.
背景：老年人不稳定转子间骨折由于骨质量差、粉碎和相关合并症，给治疗带来了重大挑战。双相半关节置换术提供了早期活动和减少固定相关并发症的优势。本研究评估了在双极半关节置换术中使用非骨水泥钛槽锥形股骨假体治疗此类骨折的短期疗效。方法回顾性分析2023年6月至2024年7月连续43例老年患者行非骨水泥双极半关节置换术。在连续随访中评估影像学参数，包括椎体下沉、大转子愈合和肢体长度差异。使用Harris髋关节评分评估功能结果。结果43例手术患者中，40例完成了至少12个月的随访。97.7%的病例出现大转子愈合，其中一例持续不愈合导致外展肌无力和早期脱位。平均茎部下沉3.5 mm (0.5-20 mm)，所有下沉均发生在术后前3个月内；4例患者（9.3%）经历了5毫米或更多的下沉，包括1例需要翻修。平均肢长差异为4.7 mm （1-10 mm）。在最后的随访中，存活患者的Harris髋关节平均评分为91.28，其中29例（72.5%）患者获得了良好的结局，11例（27.5%）患者获得了良好的结局。结论：对于精心挑选的老年不稳定转子间骨折患者，双极半关节置换术采用锥形、槽状锥柄似乎是一种可靠的选择，可提供可预测的固定、早期负重和良好的短期功能效果。
{"title":"Stabilizing the Unstable: Cone Hemiarthroplasty in Geriatric Intertrochanteric Fractures","authors":"Arcot Reddy Vamsi Krishna, Babaji Sitaram thorat, Avtar Singh Kamboj, Abhijit das, Kshitij Srivastav, Arshid H. Wani","doi":"10.1016/j.artd.2025.101935","DOIUrl":"10.1016/j.artd.2025.101935","url":null,"abstract":"<div><h3>Background</h3><div>Unstable intertrochanteric fractures in the elderly pose a significant treatment challenge due to poor bone quality, comminution, and associated comorbidities. Bipolar hemiarthroplasty offers the advantage of early mobilization and reduced fixation-related complications. This study evaluates short-term outcomes of bipolar hemiarthroplasty using an uncemented titanium fluted, tapered cone femoral prosthesis in such fractures.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 43 consecutive elderly patients treated with uncemented bipolar hemiarthroplasty using a tapered, fluted cone stem between June 2023 and July 2024. Radiographic parameters—including stem subsidence, greater trochanter union, and limb-length discrepancy—were assessed at serial follow-ups. Functional outcomes were evaluated using the Harris Hip Score.</div></div><div><h3>Results</h3><div>Of the 43 patients operated on, 40 completed a minimum of 12 months follow-up. Greater trochanteric union was observed in 97.7% of cases, with one persistent nonunion causing abductor weakness and early dislocation. Mean stem subsidence was 3.5 mm (0.5–20 mm), with all settling occurring within the first 3 postoperative months; 4 patients (9.3%) experienced subsidence of 5 mm or more, including one requiring revision. The mean limb-length discrepancy was 4.7 mm (1–10 mm). At final follow-up, the mean Harris Hip Score among surviving patients was 91.28, with 29 patients (72.5%) achieving excellent outcomes and 11 patients (27.5%) achieving good outcomes.</div></div><div><h3>Conclusions</h3><div>Bipolar hemiarthroplasty using a tapered, fluted cone stem appears to be a reliable option for carefully selected elderly patients with unstable intertrochanteric fractures, offering predictable fixation, early weight-bearing, and favorable short-term functional results.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101935"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885167","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 : 2025-12-27DOI: 10.1016/j.artd.2025.101933
Davide De Leo PT , Federico Temporiti PT, PhD , Sofia Della Gatta PT , Davide Conti PT , Paola Adamo PT, MSc , Roberto Gatti PT, MSc
Background
Mobilization and walking after total hip arthroplasty (THA) are delivered as early as patients are able, but heterogeneity in administration timing has been reported. The study aimed to investigate the effects of very early (within 8 hours from surgery) vs early (between 12 and 24 hours from surgery) mobilization and walking on functional and psychosocial outcomes after THA.
Methods
In this prospective observational study, 237 patients with THA performed very early (n = 174) or early (n = 63) mobilization and walking. After collecting demographic (age, gender, body mass index) and clinical (osteoarthritis severity, preoperative functional status and comorbidities) characteristics at baseline, participants were assessed for mobility (Timed Up and Go) and pain (Numeric Pain Rating Scale) at baseline, first (T1) and third (T2) postoperative days. Fear of movement (Tampa Scale of Kinesiophobia) and anxiety (Visual Analog Scale for anxiety) were investigated at baseline and T2. Percentage of participants who achieved independent walking at T1, time to meet ambulatory discharge criteria, length of stay, adverse events and satisfaction (Visual Analog Patient Satisfaction Scale) were collected.
Results
No between-group differences were found for Timed Up and Go at T1 (MD -0.8s, CI95 -4.7 to 6.2) and T2 (MD -1.3s, CI95 -1.8 to 4.3). Numeric Pain Rating Scale, Tampa Scale of Kinesiophobia, walking independence at T1, time to meet ambulatory discharge criteria, length of stay, adverse events and Visual Analog Patient Satisfaction Scale showed no between-group differences (P > .05).
Conclusions
Very early mobilization and walking were not superior to early mobilization and walking on functional and psychosocial outcomes after THA.
{"title":"Effects of Very Early versus Early Mobilization and Walking on Functional and Psychosocial Outcomes in Acute Phase After Total Hip Arthroplasty: A Prospective Observational Study","authors":"Davide De Leo PT , Federico Temporiti PT, PhD , Sofia Della Gatta PT , Davide Conti PT , Paola Adamo PT, MSc , Roberto Gatti PT, MSc","doi":"10.1016/j.artd.2025.101933","DOIUrl":"10.1016/j.artd.2025.101933","url":null,"abstract":"<div><h3>Background</h3><div>Mobilization and walking after total hip arthroplasty (THA) are delivered as early as patients are able, but heterogeneity in administration timing has been reported. The study aimed to investigate the effects of very early (within 8 hours from surgery) vs early (between 12 and 24 hours from surgery) mobilization and walking on functional and psychosocial outcomes after THA.</div></div><div><h3>Methods</h3><div>In this prospective observational study, 237 patients with THA performed very early (n = 174) or early (n = 63) mobilization and walking. After collecting demographic (age, gender, body mass index) and clinical (osteoarthritis severity, preoperative functional status and comorbidities) characteristics at baseline, participants were assessed for mobility (Timed Up and Go) and pain (Numeric Pain Rating Scale) at baseline, first (T1) and third (T2) postoperative days. Fear of movement (Tampa Scale of Kinesiophobia) and anxiety (Visual Analog Scale for anxiety) were investigated at baseline and T2. Percentage of participants who achieved independent walking at T1, time to meet ambulatory discharge criteria, length of stay, adverse events and satisfaction (Visual Analog Patient Satisfaction Scale) were collected.</div></div><div><h3>Results</h3><div>No between-group differences were found for Timed Up and Go at T1 (MD -0.8s, CI<sub>95</sub> -4.7 to 6.2) and T2 (MD -1.3s, CI<sub>95</sub> -1.8 to 4.3). Numeric Pain Rating Scale, Tampa Scale of Kinesiophobia, walking independence at T1, time to meet ambulatory discharge criteria, length of stay, adverse events and Visual Analog Patient Satisfaction Scale showed no between-group differences (<em>P</em> > .05).</div></div><div><h3>Conclusions</h3><div>Very early mobilization and walking were not superior to early mobilization and walking on functional and psychosocial outcomes after THA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101933"},"PeriodicalIF":2.1,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885188","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}
Postoperative pain in total knee arthroplasty (TKA) can hinder rehabilitation and impair functional outcomes. Periarticular injection (PAI) is commonly used method to mitigate postoperative pain. However, the optimal injection sites and volumes remain inconclusive. Genicular nerve infiltration (GNI), targeting 3 of the 6 primary genicular nerve branches, has shown promise in nonoperative osteoarthritis treatment. This study aimed to evaluate the efficacy of intraoperative PAI with GNI in reducing postoperative pain following TKA.
Methods
This single-center, double-blinded, 3-arm randomized controlled trial enrolled 78 patients undergoing unilateral TKA (n = 26 per group). Patients were randomized to receive no injection (control), traditional PAI, or PAI with GNI targeting 3 genicular nerves. Bupivacaine was used in both injection groups. Primary outcomes included visual analog scale pain scores at rest and during motion. Secondary outcomes were opioid consumption, range of motion, modified Western Ontario and McMaster Universities Osteoarthritis scores, and adverse events. Outcomes were assessed at 24 and 48 hours and at 2 and 6 weeks postoperatively.
Results
Baseline characteristics were comparable among groups. Both PAI and GNI groups had significantly better outcomes than the control group regarding pain scores at rest and motion, opioid consumption, and active knee extension at 24 and 48 hours (P < .05). Outcomes between the PAI and GNI groups were comparable.
Conclusions
Intraoperative GNI as part of PAI may be effective in reducing postoperative knee pain, opioid use, and improving knee extension following TKA. GNI offers a targeted, consistent, and potentially simplified alternative to conventional PAI techniques.
{"title":"Intraoperative Genicular Nerve Infiltration Offers Comparable Pain Control to Traditional Periarticular Injection After Total Knee Arthroplasty: A Randomized Controlled Trial","authors":"Jirayu Phaliphot MD , Apisit Aoimoon MD , Chidchanok Ruengorn PhD , Kamolsak Sukhonthamarn MD","doi":"10.1016/j.artd.2025.101927","DOIUrl":"10.1016/j.artd.2025.101927","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pain in total knee arthroplasty (TKA) can hinder rehabilitation and impair functional outcomes. Periarticular injection (PAI) is commonly used method to mitigate postoperative pain. However, the optimal injection sites and volumes remain inconclusive. Genicular nerve infiltration (GNI), targeting 3 of the 6 primary genicular nerve branches, has shown promise in nonoperative osteoarthritis treatment. This study aimed to evaluate the efficacy of intraoperative PAI with GNI in reducing postoperative pain following TKA.</div></div><div><h3>Methods</h3><div>This single-center, double-blinded, 3-arm randomized controlled trial enrolled 78 patients undergoing unilateral TKA (n = 26 per group). Patients were randomized to receive no injection (control), traditional PAI, or PAI with GNI targeting 3 genicular nerves. Bupivacaine was used in both injection groups. Primary outcomes included visual analog scale pain scores at rest and during motion. Secondary outcomes were opioid consumption, range of motion, modified Western Ontario and McMaster Universities Osteoarthritis scores, and adverse events. Outcomes were assessed at 24 and 48 hours and at 2 and 6 weeks postoperatively.</div></div><div><h3>Results</h3><div>Baseline characteristics were comparable among groups. Both PAI and GNI groups had significantly better outcomes than the control group regarding pain scores at rest and motion, opioid consumption, and active knee extension at 24 and 48 hours (<em>P</em> < .05). Outcomes between the PAI and GNI groups were comparable.</div></div><div><h3>Conclusions</h3><div>Intraoperative GNI as part of PAI may be effective in reducing postoperative knee pain, opioid use, and improving knee extension following TKA. GNI offers a targeted, consistent, and potentially simplified alternative to conventional PAI techniques.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101927"},"PeriodicalIF":2.1,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841412","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 : 2025-12-26DOI: 10.1016/j.artd.2025.101930
Stephen M. Howell MD , Ahmed Zabiba BS , Alexander J. Nedopil MD , Maury L. Hull PhD
Background
In kinematically aligned (KA) total knee arthroplasty (TKA) using a femoral component with the traditional 6° valgus prosthetic trochlear groove (PTG), patients reported a lower Forgotten Joint Score (FJS) when the quadriceps line of pull was laterally misaligned to the groove, with an incidence of 89%. It remains unclear whether switching to a KA-optimized femoral component with a 20° valgus PTG, which properly aligns the quadriceps line of pull, can improve the FJS and the Oxford Knee Score (OKS).
Methods
The analysis of single-surgeon series of KA TKAs included 145 cases with a KA-optimized 20° valgus PTG and 292 cases with a 6° valgus PTG. Each participant reported their FJS and OKS at 2 years and underwent a postoperative coronal long-leg scan.
Results
The 20° group had a 6-point higher FJS (79) and a 16% lower incidence of poor FJS (<40) (8%) compared to the 6° group. Additionally, 73% and 22% achieved an excellent (48-42) or good (41-34) OKS, compared to 64% and 20% with a 6° valgus PTG. The FJS in the 20° group was 7 and 20 points higher in the coronal plane alignment of the knee (CPAK) types 2 and 3.
Conclusions
Surgeons performing KA TKA should consider switching to a KA-optimized femoral component with a 20° valgus PTG, as this option improves the FJS and OKS, lowers the risk of a poor FJS, and is especially useful for CPAK 2 and 3, with no apparent disadvantages in CPAK 1, 4, and 5.
{"title":"Switching From a 6° to a 20° Valgus Prosthetic Trochlear Groove Improved the Forgotten Joint and Oxford Knee Scores After Kinematically Aligned Total Knee Arthroplasty","authors":"Stephen M. Howell MD , Ahmed Zabiba BS , Alexander J. Nedopil MD , Maury L. Hull PhD","doi":"10.1016/j.artd.2025.101930","DOIUrl":"10.1016/j.artd.2025.101930","url":null,"abstract":"<div><h3>Background</h3><div>In kinematically aligned (KA) total knee arthroplasty (TKA) using a femoral component with the traditional 6° valgus prosthetic trochlear groove (PTG), patients reported a lower Forgotten Joint Score (FJS) when the quadriceps line of pull was laterally misaligned to the groove, with an incidence of 89%. It remains unclear whether switching to a KA-optimized femoral component with a 20° valgus PTG, which properly aligns the quadriceps line of pull, can improve the FJS and the Oxford Knee Score (OKS).</div></div><div><h3>Methods</h3><div>The analysis of single-surgeon series of KA TKAs included 145 cases with a KA-optimized 20° valgus PTG and 292 cases with a 6° valgus PTG. Each participant reported their FJS and OKS at 2 years and underwent a postoperative coronal long-leg scan.</div></div><div><h3>Results</h3><div>The 20° group had a 6-point higher FJS (79) and a 16% lower incidence of poor FJS (<40) (8%) compared to the 6° group. Additionally, 73% and 22% achieved an excellent (48-42) or good (41-34) OKS, compared to 64% and 20% with a 6° valgus PTG. The FJS in the 20° group was 7 and 20 points higher in the coronal plane alignment of the knee (CPAK) types 2 and 3.</div></div><div><h3>Conclusions</h3><div>Surgeons performing KA TKA should consider switching to a KA-optimized femoral component with a 20° valgus PTG, as this option improves the FJS and OKS, lowers the risk of a poor FJS, and is especially useful for CPAK 2 and 3, with no apparent disadvantages in CPAK 1, 4, and 5.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101930"},"PeriodicalIF":2.1,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841411","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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