Journal of Knee Surgery最新文献

Purpose To determine whether robotic-assisted total knee arthroplasty (TKA) represents a viable and cost-effective strategy for managing complex knees in the setting of extra-articular deformity. Methods We reviewed a consecutive series of 12 robotic-assisted TKAs performed in patients with a spectrum of femoral and tibial deformities, including retained hardware and post-traumatic malalignment. All procedures were completed as single-stage primary arthroplasties using the MAKO robotic platform. Patients were followed for two years post-operatively with radiographic evaluation and validated functional outcome measures. Cost-effectiveness analysis was performed in seven selected cases, comparing the actual cost of the robotic single-stage procedure with the projected cost of a two-stage conventional pathway. Results All 12 patients underwent successful arthroplasty without the need for revision at latest follow-up. Radiographically, a mean mechanical axis correction of 8.7° was achieved. Significant improvements in functional scores and quality-of-life measures were observed at two years. In the seven cases evaluated for cost-effectiveness analysis, the robotic approach demonstrated net cost savings when compared with a staged conventional strategy Conclusion Robotic-assisted TKA enables precise deformity management through enhanced pre-operative planning and intra-operative guidance, allowing complex cases to be addressed in a single stage with favourable functional and economic outcomes.

Introduction: This study was planned to reveal the relationship between coronal alignment parameters and patient reported outcome (PROM) in the first year postoperatively after Total Knee Arthroplasty(TKA).

Materials and methods: TKA for knee osteoarthritis between February 2019 and March 2023 were identified as potential candidates for the study.Patients who underwent THA between February 2019 and March 2023 were retrospectively scanned.The exclusion criteria included ipsilateral total hip arthroplasty,history of surgery around the knee,preoperative tibial or femoral fracture,osteoarthritis due to rheumatic or traumatic causes,osteoarthritis due to valgus malalignment,bilateral THA and leg long-leg standing x-rays not taken with the appropriate acquisition technique.All patients were measured on full wight bearing long leg x-rays taken 1 day before preoperatively and 1 year postoperatively.Hip-Knee-Angle (HKA), Lateral distal femoral angle(LDFA) and medial proximal tibial angle(MPTA) were measured in all patients.Preoperative and 1 year measurements of the patients.The relationship between changes in radiographic measurements and Knee Injury and Osteoarthritis Outcome Score (KOOS),Visual Analogue Score (VAS) and Oxford Knee Score was statistically evaluated.

Results: 153 patients were included in the study.137(89.5%) of these patients were female and 16(10.5%) were male.The mean age of the patients was 66.7±5.12 years.Statistically significant improvement was found in all clinical scores in the post- operative period.A statistically significant negative correlation was found between pre-operative HKA and pre-operative Oxford score.The analysis of the relationship between changes in radiologic parameters and changes in clinical scores revealed no statistically significant correlation.

Conclusion: There is no relationship between coronal plane parameters and postoperative 1st year PROM in TKA patients.

Peripheral nerve blockade is commonly employed as perioperative pain management for posterolateral corner (PLC) knee reconstructions. However, common peroneal nerve (CPN) analgesia limits immediate postoperative assessment (within 0.5-2 hours of surgery) for iatrogenic injury and may further cause a "second hit" injury in cases of preoperative CPN trauma. Meanwhile, lack of lateral knee analgesia may result in intractable pain and the need for postoperative "rescue block." The incidence of iatrogenic peroneal nerve injury (from nerve block and/or surgical exploration) and frequency of "rescue blockade" remains unknown after PLC reconstruction. This study aims to identify the incidence of these events to inform the ideal perioperative anesthesia protocol. Patients who underwent PLC reconstruction at a single Level 1 academic institution were identified over a 4-year period. Medical records were queried for demographics, injury patterns, nerve blockade, surgical interventions, and perioperative nerve injury. Fifty knees were identified: 30 (60%) underwent preoperative CPN block, and 20 (40%) underwent CPN-sparing analgesia. Preoperative CPN injury was present in 20% of the cohort. Forty percent of these neurological injuries experienced improvement of symptoms shortly after neurolysis, while another 40% required further intervention. Factors determining avoidance of CPN analgesia were preoperative CPN injury (p = 0.030) and low-energy injury mechanism (p = 0.038). Of the CPN-sparing cohort, nine (45%) underwent a postoperative rescue block. Risk factors for rescue block were younger age (25.3 years vs. 39.8 years; p = 0.007) and lower BMI (26.5 kg/m² vs. 33.0 kg/m²; p = 0.035). Incidence of iatrogenic CPN palsy following PLC reconstruction was 6%, all of which were incomplete and did not require operative intervention. Incidence of iatrogenic CPN injury was low, with only incomplete nerve palsies that did not necessitate operative intervention. Avoidance of preoperative CPN blockade allowed for immediate postoperative neurologic evaluation. However, nearly half of the CPN-sparing cohort did require a postoperative "rescue block." This risk was higher among younger patients with lower BMIs.

Background Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) maintain distinct roles in the operative management of unicompartmental knee osteoarthritis. Whilst both procedures have traditionally been approached with caution in patients with obesity, the rising prevalence of obesity has led to increasing numbers of these patients undergoing surgical management. Despite this, limited evidence directly compares short-term complication profiles between HTO and UKA in obese populations. This study aims to evaluate 30-day outcomes in patients with obesity undergoing HTO versus UKA. Methods A national surgical repository was queried for patients with obesity undergoing HTOs and UKAs from 2008 to 2020. Patient demographics, medical comorbidities, and thirty-day outcomes were compared. Data were analyzed using Chi-Squared tests and binary logistic regression. 3,424 UKAs and 86 HTOs were included. The HTO cohort had a greater proportion of male (67.4% vs 44.2%, p<0.001) and Black (10.5% vs. 6.9%, p<0.001) patients compared to the UKA cohort. The UKA cohort had a greater proportion of patients with diabetes mellitus (14.0% vs 4.7%, p=0.010), hypertension (50.3% vs 29.1%, p<0.001), and American Society of Anesthesiologists (ASA) Class of 3 or 4 (39.5% vs 19.8%, p<0.001). Results Postoperative complications were higher in HTO patients. Wound infections (5.8% vs. 1.1%, p=0.003) and cumulative complication rates (7.0% vs. 2.0%, p=0.010) were higher in HTO compared to UKA. HTO was similarly associated with higher odds of wound infections (OR 6.6; 95% CI 2.5-18.0; p<0.001) and any-cause complication (OR 4.8; 95% CI 2.0-11.7; p=0.001). Conclusion While complication rates are overall low after HTO and UKA, obese patients undergoing HTO maintain higher odds of 30-day complications relative to their UKA counterparts. Assuming both procedures could be indicated for the patient's deformity and pattern of arthritis, obese patients may be better suited for UKA to minimize complications.

This study explores the top 100 most-cited articles on anterior cruciate ligament (ACL) injuries from the past decade to summarize the current state of research and identify emerging trends. The goal is to provide a theoretical basis for future research directions in this field.Using CiteSpace and VOSviewer, we analyzed the 100 most-cited ACL papers, identifying key contributors, research trends, and evolving focus areas.The analysis included a total of 100 highly cited articles on ACL injury published over the past decade. The articles spanned 23 countries. Geographical distribution: The United States, Australia, and the United Kingdom. Key institutions: Ohio State University (United States) and La Trobe University (Australia). Leading authors: Timothy E. Hewett from Marshall University and Kate E. Webster from La Trobe University. Journals: The American Journal of Sports Medicine and the British Journal of Sports Medicine.This study identifies key trends in ACL injury research, including personalized rehabilitation, psychological factor integration, osteoarthritis prevention, dynamic assessment standardization, and surgical improvements. By analyzing the most-cited studies from the past decade, we provide a focused understanding of current priorities and actionable insights into enhancing ACL injury prevention, treatment, and long-term recovery outcomes.

This study aimed to evaluate the progression of medial meniscus (MM) extrusion (MME) volume (MMEV) at knee joint extension/flexion up to 3 years after pullout repair of MM posterior root tears (MMPRT) and to assess its relationship with clinical outcomes. A retrospective analysis was conducted in 15 patients who underwent pullout repair of unilateral MMPRT and open magnetic resonance imaging (MRI) examination preoperatively and at 1 and 3 years postoperatively. An open MRI was performed at knee joint extension and flexion. MME and MMEV at knee joint extension, MM posterior extrusion (MMPE), and MMEV at knee joint flexion were evaluated. Clinical scores were recorded preoperatively and at 1 and 3 years postoperatively. The correlations between changes in MME, MMPE, and MMEV from the preoperative period to 3 years postoperatively (ΔMMEV) and clinical scores from the preoperative period to 3 years postoperatively were evaluated. MME and MMEV at knee joint extension increased significantly from preoperatively to 1 year (p = 0.001 and p = 0.016) and to 3 years (p < 0.001 and p = 0.010), with no significant change from 1 to 3 years (p = 0.319 and p = 0.840). MMPE at knee joint flexion decreased significantly from preoperatively to 1 year (p = 0.007) and to 3 years (p = 0.002), whereas no difference was observed from 1 to 3 years (p = 0.672). MMEV at knee joint flexion showed no significant longitudinal changes (all p > 0.644). After false discovery rate (FDR) adjustment, all clinical outcomes, except the pain visual analog scale, demonstrated significant time effects. No significant correlation was observed between ΔMME, ΔMMPE, and ΔMMEV at knee joint extension and clinical outcomes before/after FDR adjustment. Although moderate correlations between ΔMMEV at knee joint flexion and clinical outcomes were observed before adjustment, none remained significant after FDR correction. Three years after transtibial pullout repair for MMPRT, MMPE at knee joint flexion significantly improved, maintaining MMEV at knee joint flexion without deterioration. ΔMMEV at knee joint flexion may correlate with clinical score improvement; however, further research is required.

The aim of this study was to investigate the effect of neuromuscular exercise program on knee functions in the late period after the surgery and to develop a new injury prevention exercise program. The participants were evaluated twice before and after the protocol and between the tests they were subjected to a neuromuscular exercise program for a total of 6 weeks and 18 sessions. The Lysholm Knee Scoring Scale and Tampa Scale for Kinesiophobia were completed in a face-to-face environment, LESS test, knee strength and active/passive proprioception tests with isokinetic dynamometer, vertical jump height, lower extremity Y balance test, single leg and cross-over hop distance measurements were performed before and after the protocol. The study was completed with 19 male participants aged 18-50 who had undergone ACL reconstruction (9 to 48 months post-op). The mean body mass index 25.18±2.33 kg/m2, post-operative time 22 (13-42) months, time from injury to operation 7 (2-24) months, post-operative professional rehabilitation time 41.05±25.30 days and Tegner Activity Scale score 5.32±1.2. Post-protocol measurements demonstrated significantly better results than pre-protocol values in all parameters, except for the knee flexion-to-extension strength ratio. As a result of the study, it was revealed that the neuromuscular exercise protocol applied for 6 weeks in the late period after anterior cruciate ligament reconstructions is a method that can be used to adapt the parameters examined in the study. It should be considered as a viable rehabilitation program, particularly for individuals who fail to meet RTP criteria even nine months after surgery.

Introduction: As inflation, new technology, and rising costs continue to strain healthcare in the United States, it is important to understand the trends in insurance reimbursement. We evaluated commercial insurance reimbursement for patients undergoing inpatient primary total knee arthroplasty (TKA) based on the technology utilized and over time.

Methods: We retrospectively reviewed a commercial claims database for 33,157 inpatient primary TKA performed with cemented or uncemented components between 1/1/2016 and 12/31/2021. All patients had private commercial insurance and procedure codes for both the hospital and physician were present. Records were reviewed for technology used and financial reimbursement, without adjusting for inflation. Independent-samples t-test and analysis of variance were performed.

Results: Hospital reimbursement increased from $25,207.65 per TKA in 2016 to $28,291.10 in 2021 (p<0.001). Physician reimbursement remained similar, from $2,368.25 per TKA in 2016 to $2,279.70 in 2021 (p=0.1). Cemented TKA was associated with increased hospital reimbursement compared to uncemented TKA ($26,658.98 versus $25,854.92, p<0.001), but similar physician reimbursement ($2,358.03 versus $2,329.60, p=0.6). Robotic assisted (RA) cemented TKA had the higher hospital reimbursement ($28,910.19) than manual cemented TKA ($26,342.29), manual uncemented ($25,566.31), and RA uncemented ($26,378.05, p<0.001). Physician reimbursement was similar in each of the four categories: manual cemented ($2,359.34), manual uncemented ($2,282.62), RA cemented ($2,348.66), and RA uncemented ($2,414.75, p=0.5).

Conclusion: Physician reimbursement has remained similar for primary TKA from 2016 to 2021, despite hospital reimbursement increasing. We believe that physician reimbursement should increase each year to reflect the increased cost of living caused by inflation. In addition, RA cemented primary TKA provides the highest reimbursement for both hospitals, but physicians are reimbursed similarly, independent of the technology used.

Introduction: Functional alignment (FA) in total knee arthroplasty (TKA) aims to restore native limb alignment and soft-tissue balance, but the safety of wider coronal alignment boundaries in elderly patients with potentially reduced bone quality remains uncertain, particularly with cementless fixation. This study evaluated early clinical and radiographic outcomes of robot-assisted FA-TKA with cementless implants in elderly Japanese patients, focusing on the safety of allowing tibial varus up to 6° within an overall ±6° limb alignment boundary.

Materials and methods: This retrospective cohort study analyzed 99 cementless primary TKAs in 66 patients (mean age 74.3 ± 8.1 years) performed between July 2023 and July 2024 using a single-radius implant and a robot-assisted FA protocol. Preoperative computed tomography-based planning and intra-operative gap assessment were used to individualize component positioning within predefined coronal boundaries while minimizing soft-tissue release. Clinical outcomes, including the 2011 Knee Society Score (KSS) and Forgotten Joint Score-12 (FJS-12), range of motion, radiographic alignment, and complications were assessed at 12 months.

Results: All 99 knees were available at 1 year. Extension and flexion range of motion, KSS domains, and FJS-12 improved significantly from preoperative to 12-month follow-up. Postoperative radiographs demonstrated alignment within the intended FA boundaries, with more horizontal joint-line obliquity and a shift toward Coronal Plane Alignment of the Knee (CPAK) Type I phenotypes. No progressive radiolucent lines or loosening were observed in 98 knees. One valgus knee treated with a lateral parapatellar approach developed medial tibial baseplate subsidence after lateralized tibial placement and required revision. Among 42 knees implanted with 6° tibial varus, no subsidence or revision occurred. Other complications included one patellar tendon rupture and two atraumatic patellar fractures.

Discussion: Robot-assisted FA-TKA with cementless implants provided favorable early clinical and radiographic outcomes in elderly Japanese patients. Within 1 year, tibial varus up to 6° and overall limb alignment within ±6° were not associated with early tibial subsidence in varus knees, although meticulous planning and implantation remain essential, particularly in valgus knees.

The ability to predict component sizes that shall be required during total knee arthroplasty (TKA) helps ensure their availability and increase operating room efficiency. Some literature on bilateral conventional manual TKA indicates the existence of inherent prosthetic size asymmetry, whereas other research correlates component size variations with asymmetric postoperative outcomes. Given the precision offered by robotic technology, we hypothesized that bilateral robot-assisted TKA (ra-TKA) would result in near-perfect component size symmetry and provide for a reliable means of predicting prosthetic sizes that shall be required for surgery of the second knee. Overall, 102 patients who underwent staged bilateral cruciate-retaining image-free ra-TKA for primary osteoarthritis between January 2023 and November 2024 were studied. The proportions of patients with all-component symmetry and asymmetry of one or more components were assessed. The agreement between component sizes of contralateral knees was analyzed. The study cohort comprised 66 women and 36 men with a mean age of 63.1 ± 7.1 years. All modes of isolated and multicomponent size asymmetry were noted. Excellent bilateral agreement for exact femoral (77.5% symmetry, ƙw  = 0.83) and tibial (71.6% symmetry, ƙw  = 0.80) component sizes, but poor agreement for exact insert sizes (68.6% symmetry, intraclass correlation coefficient = 0.164) was noted. When an error margin of ± 1 size was permitted, however, the predictive potential increased to over 95% for all component sizes. Patients with all-component symmetry and those with asymmetry of isolated components were comparable in terms of age, sex, and preoperative coronal deformity, range of knee flexion, and Knee Society scores. Prosthetic size asymmetry during bilateral TKA seems inherent to an extent and may result from morphological variations or differences in component positioning requirements for attaining optimal gap balance. Ensuring the availability of all insert sizes and exact as well as ± 1 sizes of femoral and tibial components in relation to those used for the first knee surgery seems adequate for the second knee surgery for most patients.