Journal of Knee Surgery最新文献

The impact of cementless trabecular metal (TM) implants on implant survivorship are not well delineated. This study compares primary total knee arthroplasty (TKA) revision rates of cemented knee replacements with two cementless knee replacement designs-cementless TM and a non-TM cementless design. Data from a national registry queried TKA procedures performed for osteoarthritis from 1999 to 2020. The risk of revision of Zimmer NexGen TKA using cementless TM, cementless non-TM, and cemented non-TM were compared. Analyses included Kaplan-Meier estimates of survivorship and Cox hazard ratios (HR), stratified by age and gender. Cementless TM components had higher risks of revision compared with cementless non-TM implants (HR = 1.49; p ≤ 0.001). Cementless TM implants showed higher risks of revision compared with cemented non-TM prostheses for the first 2 years (HR = 1.75, p < 0.001). Non-TM prostheses posed equal risk of revision for cementless and cemented fixations (HR = 0.95, p = 0.522). Patients aged 55 to 64 years and 65 to 74 years had a higher risk of revision for cementless TM compared with cementless non-TM (HR = 1.40, p = 0.033 and HR = 1.79, p < 0.001, respectively) and cemented non-TM implants (HR = 1.51, p < 0.001 and HR = 1.54, p < 0.001, respectively). The study shows there is an increased risk of revision with TM cementless implants for patients aged 55 to 74 years. These results do not support the use of TM tibial implants for patients of this age group for primary TKA.

The objective of this study was to determine relationships between intraoperative posterior cruciate ligament (PCL) sacrificing posterior stabilized (PS) total knee arthroplasty (TKA) laxity measurements throughout flexion and patient outcomes at 2 years post-TKA and to define clinically relevant laxity thresholds to optimize patient outcomes.In a single-surgeon study, PCL sacrificing TKA using a robotics-assisted platform with a digital joint tensioning device was performed in 115 knees in 115 patients. Final intraoperative joint laxity was recorded, and 2-year Knee Injury and Osteoarthritis Outcome Scores (KOOSs) were obtained. A Simulated Annealing optimization algorithm was used to identify medial and lateral laxity windows which maximized the 2-year KOOS pain score. Wilcoxon nonparametric tests were used to compare outcomes between groups.Significant associations were found between intraoperative joint laxity and 2-year KOOS pain outcomes throughout flexion. Clinically relevant laxity windows were defined medially and laterally in mid-flexion and flexion for improved outcomes, whereas only a lateral laxity window could be defined in extension. When all laxity windows were satisfied, a 14.5-KOOS point improvement was found (97.2 vs. 77.8, p = 0.0060) compared to knees which did not satisfy any window. Improvements in Activities of Daily Living (Δ8.8, p = 0.0143), Sports (Δ22.5, p = 0.0108), and Quality of Life (Δ18.7, p = 0.0011) KOOS subscores were also found in knees which satisfied all windows versus 0-1 window.Intraoperative joint laxity is associated with postoperative outcomes in a PS knee design, wherein patients balanced within identified laxity targets reported improved outcomes over those that did not. Clinically significant thresholds were defined and were predominately found in mid-flexion and flexion for medial and lateral laxity. When target windows were combined further improved outcomes were identified.

The purpose of this study was to investigate factors that influence clinical outcomes after anterior cruciate ligament (ACL) reconstruction in patients aged ≥40 years. We studied 264 patients aged ≥40 and 154 patients aged ≤20 years who underwent ACL reconstruction at several surgical centers. A logistic regression analysis was conducted to identify factors that influenced the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 1 year post-ACL reconstruction. In the older patient group, cartilage damage in the patellofemoral compartment at surgery was a significant risk factor for poor postoperative KOOS subscores (pain, activities of daily living [ADL], sports, and quality of life [QOL]). Articular cartilage damage in the lateral compartment also significantly influenced one of the postoperative KOOS subscores (symptoms). In the younger patient group, articular cartilage damage in any compartments did not influence the postoperative KOOS subscores; only two preoperative KOOS subscores (symptoms and QOL) significantly influenced their postoperative KOOS subscores. We concluded that the articular cartilage damage in the patellofemoral compartment at ACL reconstruction predicts poor KOOS subscores at the 1-year follow-up in patients aged ≥40 years. STUDY DESIGN:  Cohort study (Prevalence); Level of evidence, 2.

Meniscus repair has increased in frequency, especially among surgeons who focus on youth sports injuries. The aim of this study was to determine current trends in meniscus repair among a specific subset of meniscus repair surgeons. A cross-sectional survey utilizing several clinical vignettes was administered to orthopaedic surgeon members of the Pediatric Research in Sports Medicine (PRiSM) Society to investigate surgeon experience and training, number of meniscus repair procedures performed, and surgical and rehabilitation preferences. A statistical analysis of the responses was performed to determine associations between years in practice or type of fellowship training and the number of meniscus repair procedures performed, surgical indications, and rehabilitation preferences. The response rate to various questions ranged from 61.5 (59/96) to 63.5% (61/96). In all vignettes, a majority favored repair as well as some degree of weight-bearing and range-of-motion restrictions. Surgeons who had been in practice for 6 to 10 years performed significantly more meniscus repairs per year than those who had been in practice for greater than 20 years (p = 0.009) and those who had been in practice for 0 to 5 years (p = 0.05). Surgeons who had been in practice for greater than 20 years performed a significantly higher percentage of meniscectomies relative to meniscus repairs, compared with those in practice for 0 to 5 years (p = 0.002) or 6 to 10 years (p = 0.0003). When surgeons were grouped into those with less than 10 years of experience and those with greater than 10 years of experience, the former group performed a significantly higher number of meniscus repairs relative to meniscectomies than the latter group of surgeons (p < 0.0001). Less experienced surgeons are more likely to perform meniscus repair than meniscectomy, but all surgeons surveyed had a general preference for repair in all clinical vignettes. Repair technique preferences as well as rehabilitation protocols varied widely among surgeons.

Total knee arthroplasty (TKA) is the most common joint arthroplasty procedure and is shown to be a reliable and efficacious way to improve quality of life. Individuals with interatrial wall abnormalities (IAWAs), such as atrial septal defect or patent foramen ovale (PFO), are at increased baseline risk for stroke and overall lifetime morbidity. The purpose of our study was to elucidate the association between IAWAs and perioperative TKA outcomes.We performed a retrospective cohort study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample database. Admissions for TKA between 2010 and 2019 were identified using the international classification of disease (ICD)-9 and ICD-10 procedure codes. Patients with ICD-9-clinical modification (CM) diagnosis code 7455 or ICD-10-CM diagnosis code Q211 were assigned to the IAWA cohort, the primary exposure. Confounding variables included basic demographics, baseline health status, and surgical facility characteristics. The primary outcomes studied were medical complications, implant-related complications, and admission mortality. Univariate and adjusted multivariable regression analyses were used to identify associations.Compared to patients in the non-IAWA cohort, those in the IAWA cohort had significant risks for same-admission medical complications (odds ratio [OR] 5.77, 95% confidence interval [CI] 4.59-7.15; p < 0.001), implant-related complications (OR 1.55, 95% CI 1.09-2.12; p = 0.009), stroke (OR 77.46, 95% CI 58.4-101.2; p < 0.001), venous thromboembolism (VTE; OR 3.78 95% CI 2.47-5.51; p < 0.001), and mortality (OR 8.36, 95% CI 3.54-16.52; p < 0.001) following TKA.Compared to patients without IAWAs, those with IAWAs who undergo TKA have higher risks for same-admission medical and implant-related complications as well as same-admission mortality. Similarly, these patients have higher risks for same-admission stroke and VTE. Further research on perioperative TKA management in patients with IAWAs is needed.Level of Evidence is III: retrospective cohort study.

The medial unicompartmental knee arthroplasty (mUKA) has been recognized as an excellent treatment for medial knee osteoarthritis. The posterior tibial slope (PTS) is measured radiographically with the intramedullary axis (IMA) to the tibial baseplate on the sagittal plane radiograph. However, in most computer-navigated or robotic mUKAs, the PTS is set from a transmalleolar axis (TMA).The PTS difference was evaluatedbetween the sagittal TMA and the sagittal IMA of patients undergoing a CT-based primary robotic-assisted mUKA.We retrospectively reviewed the preoperative computed tomography (CT) scans taken according to the MAKO system protocol (Stryker) of 67 patients undergoing mUKAs. We measured the angular difference between the IMA and the TMA in the sagittal plane.Using the TMA to set the PTS the estimation of the slope of the medial tibial plateau would increase by an average of 1.9 ± 3.2 degreescompared to the IMA. Furthermore, in nineknees, PTS was decreased.Tibial components implanted with the help of a CT scan-based preoperative planning MAKO will show an average of 1.9 degrees more than those measured on sagittal radiographs potentially of concern for knee kinematics. A universal language is needed to standardize the slope calculation and the respective reference axis used.

Literature on revision osteosynthesis for failed patella fracture fixation is extremely limited. This study reviews the treatment options and outcomes for revision and re-revision osteosynthesis at a Level 1 trauma center. All patella revision osteosynthesis cases between January 2021 and March 2024 were identified using Current Procedural Terminology codes at a single tertiary care academic center. Medical records, operative reports, and radiographs were reviewed to collect details regarding patient demographics, initial injury and fracture management, indications for revision surgery, revision construct, postoperative weight bearing and range-of-motion restrictions, and outcomes. The primary outcome was major failure defined as loss of fixation or further surgery for nonunion or infection. Ten patients underwent revision osteosynthesis for failed fixation. All fractures were initially comminuted fracture patterns (AO/OTA 34-C3), with nine (90%) initially treated with a 2.7-mm patella-specific variable angle locking plate (Synthes, Paoli, PA). Half (n = 5) of the patients were revised with the same patella-specific plate and half with an all suture transosseous fibertape tension band (Arthrex, Naples, FL). Additional fixation in the form of bony augmentation was performed in 20% (n = 2) of cases and soft tissue augmentation in 70% (n = 7). There was a 70% (n = 7) major failure rate, mostly due to loss of inferior pole fixation. There were four re-revision procedures performed with surgical fixation. Two of these subsequently developed infection, one united and the other had no radiographic signs of union and was lost to follow-up, but was without complication. Regardless of the chosen fixation construct, revision osteosynthesis for failed fixation of initial comminuted fracture patterns has an extremely high rate of failure. Complications increase with further revision surgery. Level of evidence: therapeutic level 3.

Introduction The benefit of patellar resurfacing in total knee arthroplasty (TKA) remains uncertain, with conflicting evidence regarding associated revision rates and clinical outcomes. Although initial studies have reported higher revision rates associated with unresurfaced patellae, recent evidence questions the necessity of routine patellar resurfacing. This study aimed to evaluate the risk of revision following TKA performed with and without patellar resurfacing using data from the American Joint Replacement Registry (AJRR). Material and methods The AJRR was queried for all patients aged 65 and older undergoing elective TKA between January 2012 and March 2020 with a minimum 2-year follow-up. Cases were linked using supplemental Centers for Medicare and Medicaid data. Cases with hybrid fixation, highly constrained implants, and revision components were excluded. Patients were categorized into two groups: those with a resurfaced patella and those without. Cumulative incidence function (CIF) curves and cause-specific Cox models were utilized to assess all-cause revision risk, adjusting for sex, age, femoral design (cruciate retaining vs posterior stabilized), fixation type (cemented vs cementless), and Charlson Comorbidity Index (CCI). Results Of the 390,304 TKAs with minimum two-year follow-up in our cohort, 22,829 had no patellar resurfacing performed. Adjusted Hazard Ratios (HR) revealed no significant difference in all-cause revision (HR=0.96, 95% CI 0.81-1.13, p=0.656), revision for mechanical loosening (HR=1.61 [0.88, 2.93], p=0.122), or revision for infection (HR=1.02 [0.79, 1.33], p=0.860) associated with patellar resurfacing status. Conclusion Our study found that patients with an unresurfaced patella do not face an increased short-term revision risk following TKA. These findings challenge the necessity of routine patellar resurfacing and underscore the importance of considering other factors, such as femoral design, patient comorbidities, and implant-related variables in revision risk stratification.

Robotic-assisted devices help provide precise component positioning in conversion of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA). A few studies offer surgical techniques for computed tomography (CT) based robotic-assisted conversion of UKA to TKA; however, no studies to date detail this procedure utilizing a non-CT-based robotic-assisted device. This article introduces a novel technique employing a non-CT-based robotic-assisted device (ROSA Knee System, Zimmer Biomet, Warsaw, IN) for converting UKA to TKA with a focus on its efficacy in gap balancing. We present three patients (ages 46-66 years) who were evaluated for conversion of UKA to TKA for aseptic loosening, stress fracture, and progressive osteoarthritis. Each patient underwent robotic-assisted conversion to TKA. Postoperative assessments at 6 months revealed improved pain, function, and radiographic stability. Preoperative planning included biplanar long leg radiographs to determine the anatomic and mechanical axis of the leg. After arthrotomy with a standard medial parapatellar approach, infrared reflectors were pinned into the femur and tibia, followed by topographical mapping of the knee with the UKA in situ. The intraoperative software was utilized to evaluate flexion and extension balancing and plan bony resections. Then, the robotic arm guided placement of the femoral and tibial guide pins and the UKA components were removed. After bony resection of the distal femur and proximal tibia, the intraoperative software was used to reassess the extension gap, and plan posterior condylar resection to have the flexion gap match the extension gap. The use of a non-CT-based robotic-assisted device in conversion of UKA to TKA is a novel technique and a good option for surgeons familiar with robotic-assisted arthroplasty, resulting in excellent outcomes at 6 months.

There is continued debate about the efficacy and indications for patellar resurfacing in total knee arthroplasty (TKA), especially with the emergence of patella-friendly designs. This study aimed to compare the postoperative outcomes in patients undergoing TKA with or without patellar resurfacing using the same implant design. This is a retrospective cohort study of patients who underwent TKA including those with patellar resurfacing (PR group) and those without (NPR group). Demographic data included age, gender, side of surgery, operative time, and body mass index (BMI). Outcomes included preoperative, 2-week, 6-week, and 1-year postoperative Knee Injury and Osteoarthritis Outcome Score and Joint Replacement (KOOS, JR) values along with knee range of motion (ROM). Postoperative complications were recorded. The power analysis with a large effect size indicated that a minimum sample size of 54 was required for Student's t-test and 34 for the paired t-test. A total of 90 medial pivot (MP) TKA were included in this study. There were 30 knees in the PR group and 60 in the NPR group. There was no significant difference between the groups for all demographic data, preoperative and postoperative ROM, and KOOS, JR values at all time points (p > 0.05 for all variables). The KOOS, JR significantly improved in the NPR groups at 2 weeks, 6 weeks, and 1 year postoperatively when compared with the preoperative score and at 6 weeks and 1 year postoperatively in the PR group (p < 0.01). No revisions related to the patellofemoral joint were observed in patients initially undergoing patellar resurfacing. One patient in the NPR group required secondary patellar resurfacing. The patella-friendly MP TKA yielded favorable postoperative outcomes, with or without patellar resurfacing. Improvements in KOOS, JR were observed earlier in the NPR group when compared with the PR group, suggesting that patellar resurfacing may not always be necessary for modern TKA designs. LEVEL OF EVIDENCE:  Retrospective cohort study, Level III.