Knee最新文献

{"title":"Elevated risks of pneumonia, cognitive dysfunction, and cerebrovascular disorder in super-elderly knee arthroplasty patients: insights from a nationwide Japanese database","authors":"Yu Mori ,&nbsp;Kunio Tarasawa ,&nbsp;Hidetatsu Tanaka ,&nbsp;Masayuki Kamimura ,&nbsp;Kento Harada ,&nbsp;Naoko Mori ,&nbsp;Kiyohide Fushimi ,&nbsp;Toshimi Aizawa ,&nbsp;Kenji Fujimori","doi":"10.1016/j.knee.2026.104351","DOIUrl":"10.1016/j.knee.2026.104351","url":null,"abstract":"<div><h3>Introduction</h3><div>Knee arthroplasty is an effective treatment option for managing advanced osteoarthritis and rheumatoid arthritis, even in elderly patients. However, super-elderly patients face increased risks of postoperative complications such as in-hospital mortality, deep vein thrombosis, pneumonia, cerebrovascular events, and cognitive dysfunction. This study aims to analyze postoperative complications in super-elderly patients (aged 85 years and older) and elderly patients (aged 70–84 years) who underwent total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) using Japan’s nationwide DPC database. The analysis was conducted after adjusting for confounding factors through propensity score matching.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of 200,925 patients who underwent TKA or UKA between 2016 and 2023. After propensity score matching (1:1) based on age, sex, body mass index, surgical method, and comorbidities, 21,117 patients were included in each group. Postoperative complications, including in-hospital mortality, deep vein thrombosis, pneumonia, cerebrovascular events, and cognitive dysfunction, were analyzed. Multivariate logistic regression identified independent risk factors for postoperative complications.</div></div><div><h3>Results</h3><div>The super-elderly group exhibited higher odds ratios for pneumonia (2.227, 95% CI: 1.494–3.319), cerebrovascular events (1.720, 95% CI: 1.305–2.266), and cognitive dysfunction (1.767, 95% CI: 1.485–2.103). They also had more extended hospital stays and higher blood transfusion requirements. However, no significant differences were observed for deep vein thrombosis, pulmonary embolism, or in-hospital mortality.</div></div><div><h3>Conclusion</h3><div>Super-elderly patients exhibit increased risks for certain complications, though not for mortality. When clinically appropriate, performing knee arthroplasty before the age of 85 may help reduce these risks.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104351"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One third of patients have articular cartilage thickness greater than three millimeters measured from femoral resections in kinematically aligned total knee arthroplasty","authors":"Alexander J. Nedopil ,&nbsp;Anand Singh Dhaliwal ,&nbsp;Stephen M. Howell ,&nbsp;Maury L. Hull","doi":"10.1016/j.knee.2026.104323","DOIUrl":"10.1016/j.knee.2026.104323","url":null,"abstract":"<div><h3>Background</h3><div>Kinematic alignment (KA) total knee arthroplasty (TKA) seeks to restore native limb and knee alignments regardless of the degree of preoperative deformity and/or flexion contracture. Hence, the thickness of each femoral resection should match the femoral component after adjusting for cartilage wear and sawblade kerf. Previously, the thickness of worn articular cartilage has been set at 2 mm. If the proportion of patients with thickness ≥3 mm is relatively large however, then adjusting resection thickness to reflect cartilage thickness is a refinement of interest. The objectives were to determine the proportion of patients undergoing KA TKA with cartilage thickness ≥3 mm in each resection.</div></div><div><h3>Method</h3><div>Using calibrated photographs, articular cartilage thickness was measured on 456 unworn resections (i.e. distal medial and lateral, posterior medial and lateral) from 201 patients undergoing KA TKA. The proportion of patients with cartilage thickness ≥3 mm was determined for each resection.</div></div><div><h3>Results</h3><div>The proportions of patients with cartilage thickness ≥3 mm were 29% and 34% for the distal medial and lateral resections, respectively, and 36% and 23% for the posterior medial and lateral resections, respectively.</div></div><div><h3>Conclusion</h3><div>The relatively large proportion of patients with cartilage thickness ≥3 mm motivates taking next steps to assess the clinical practicality of adjusting resection thickness to reflect cartilage thickness. One next step is to determine how accurately cartilage thicknesses of worn distal and posterior surfaces can be predicted by measuring thickness of the contralateral unworn distal surface.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104323"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An improved activation function for the recognition of knee osteoarthritis severity","authors":"Shuaishuai Chang ,&nbsp;Hongliang Duan ,&nbsp;QingE Wu","doi":"10.1016/j.knee.2026.104361","DOIUrl":"10.1016/j.knee.2026.104361","url":null,"abstract":"<div><h3>Background</h3><div>Existing knee osteoarthritis (KOA) severity classification methods typically rely on a combination of object detection algorithms and classification algorithms. However, this approach not only increases the computational burden and time costs but also reduces the efficiency of real-time diagnosis, which makes it difficult to meet the needs of practical applications. To address the performance limitations of KOA severity recognition models that operate without target detection algorithms, a deep transfer learning approach incorporating a novel activation function (AvRELU) was proposed. The goal was to improve classification performance, particularly for small sample datasets, while optimizing computational resources.</div></div><div><h3>Methods</h3><div>A dataset consisting of 3300 digital X-ray images of KOA patients was utilized. During model training and evaluation, five-fold cross-validation was used to assess robustness, and the dataset was divided into training, validation, and testing sets through a stratified sampling method at an 8:1:1 ratio. A transfer learning approach utilizing a pretrained Inception-v3 backbone was proposed, where Bayesian optimization automated both the fine-tuning process and downstream classifier construction. To improve the model performance, the activation function AvRELU was introduced in the network layer of the downstream model. Moreover, Kendall’s tau-b correlation analysis was employed to evaluate the statistical significance of differences in the predicted Kellgren–Lawrence grades among the different methods.</div></div><div><h3>Results</h3><div>Using five-fold cross-validation, the proposed method achieved an average test set performance of 95% accuracy, 95% F1-score, and 93% kappa. These results demonstrated the superior performance of the method in KOA severity recognition.</div></div><div><h3>Conclusions</h3><div>The method proposed here not only significantly improves model performance on small-sample datasets but also maintains the model’s lightweight and low-resource characteristics. Moreover, it achieves better performance in KOA severity recognition than most existing methods.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104361"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sciatic nerve compression as a cause of severe chronic pain after total knee replacement: a case report","authors":"Tim Philips ,&nbsp;Willem Goethals ,&nbsp;Francis De Neve ,&nbsp;Pieter-Bastiaan De Keyzer ,&nbsp;Jean F. Goubau ,&nbsp;Michiel Cromheecke","doi":"10.1016/j.knee.2026.104363","DOIUrl":"10.1016/j.knee.2026.104363","url":null,"abstract":"<div><h3>Background</h3><div>Persistent pain following total knee replacemnt (TKR) remains a challenging and often multifactorial issue. While common causes include infection, malalignment, or complex regional pain syndrome, less typical origins are easily overlooked. We report a unique case of chronic, disproportionate posterior thigh pain 1 year after TKR, caused by a complete proximal hamstring rupture leading to symptomatic sciatic nerve compression. To our knowledge, this is the first published case describing this specific postoperative complication and its successful surgical management.</div></div><div><h3>Case presentation</h3><div>A 66-year-old woman presented with severe, unbearable posterior thigh pain that began immediately after left TKR. The pain was continuous, worse at night, and aggravated by sitting, cycling, or stair climbing. Previous surgeons had attributed the symptoms to complex regional pain syndrome. Clinical examination revealed a Popeye-like deformity of the distal hamstring, a positive Tinel’s sign, and localized tenderness over the sciatic nerve. Imaging studies demonstrated a complete rupture of the common hamstring tendon, including the semimembranosus, with an 18.5-cm retraction and entrapment of the semitendinosus tendon against the sciatic nerve. Conservative management with ultrasound-guided perineural infiltrations provided only transient relief. Surgical exploration and neurolysis were therefore performed. Intraoperatively, the sciatic nerve was identified, released from adhesions, and decompressed along its bifurcation. The surrounding musculature appeared atrophic and infiltrated with fatty tissue. Postoperatively, the patient experienced immediate and sustained relief, with the pain score improving from 80/100 to 10/100 and complete functional recovery documented within 2 months. There were no neurological or vascular deficits, and the patient reported maximal satisfaction with the surgical outcome.</div></div><div><h3>Conclusions</h3><div>This case highlights an exceptionally rare etiology of chronic pain, which started immediately following TKR: a complete proximal hamstring rupture with secondary sciatic nerve compression. Recognition of this condition requires clinical suspicion when patients present with disproportionate posterior thigh pain unresponsive to standard treatment. Early magnetic resonance imaging is essential for accurate diagnosis. Timely surgical neurolysis can achieve excellent functional outcomes. Increased awareness among orthopedic surgeons and rehabilitation specialists may prevent delayed diagnosis and unnecessary patient suffering.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104363"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of Agilium Freestep ankle–foot orthosis on the kinetic and kinematic parameters of gait in patients with knee osteoarthritis","authors":"Mahsa Kavyani Boroujeni ,&nbsp;Mohammad Taghi Karimi ,&nbsp;Masoud Rafiaei ,&nbsp;Hossein Akbari Aghdam","doi":"10.1016/j.knee.2026.104353","DOIUrl":"10.1016/j.knee.2026.104353","url":null,"abstract":"<div><h3>Background</h3><div>There are several orthotic treatment options for knee osteoarthritis. Ankle–foot orthosis (AFO) is a new approach in this regard; it is designed to reduce knee joint loading and consequently reduce the joint cartilage degeneration process. Previous studies considered the knee adduction moment as a surrogate marker for knee joint loading and knee joint contact force was not measured precisely. Moreover, the effect of this orthosis on joint kinematic and ground reaction force was not evaluated in previous studies. Thus, the aim of this study was to evaluate the gait kinetic parameters including joint moment and joint contact force and kinematic parameters of patients with medial knee compartment osteoarthritis using AFO.</div></div><div><h3>Methods</h3><div>Ten women with knee osteoarthritis participated in this study. Patients were assessed in two conditions: walking with and without AFO (Agilium Freestep®, Ottobock, Duderstadt, Germany). Thirty-six reflective markers were attached on lower limb anatomical landmarks of patients and a motion analysis system and a Kistler force plate were used to monitor the markers’ motion and collect the forces applied on the legs, respectively. OpenSim software was used to measure knee joint kinematic, moments and estimate knee joint contact force.</div></div><div><h3>Results</h3><div>The current study showed that immediately after wearing AFO, stride length significantly decreased (1.141 ± 0.103 vs. 1.101 ± 0.095 m, <em>P</em> = 0.02). Moreover, the second peak of vertical ground reaction force decreased significantly (1.034 ± 0.035 vs. 1.013 ± 0.030, <em>P</em> = 0.02). Immediately after wearing the AFO, no statistically significant changes were observed in the knee joint contact force components or in the ankle and knee ranges of motion.</div></div><div><h3>Conclusion</h3><div>No statistically significant difference was observed immediately after wearing Agilium AFO regarding its effect on reducing knee joint contact force and sagittal knee moment. It is important to note that due to the small sample size and the short-term nature of this study, the generalizability of these findings is limited. Further research with larger cohorts and longer follow up periods is recommended to clarify and confirm these preliminary findings. However, therapists could consider recommending this AFO for osteoarthritic knee patients to potentially decrease knee joint loading, especially for those who cannot tolerate knee orthoses.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104353"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The re-infection rate over time following two-stage revision knee arthroplasty for peri-prosthetic joint infection: A retrospective review of 130 knees at minimum 4-year follow-up","authors":"Cameron Brown ,&nbsp;Duncan Renton ,&nbsp;Bruce McLintock ,&nbsp;James Doonan ,&nbsp;Rahul Battyhcharya ,&nbsp;Michael Murphy ,&nbsp;Bryn G. Jones ,&nbsp;Mark J.G. Blyth","doi":"10.1016/j.knee.2026.104368","DOIUrl":"10.1016/j.knee.2026.104368","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to identify the risk of reinfection, the risk factors associated with reinfection and the microbiological, surgical, and patient factors associated with failure in two-stage revision surgery for prosthetic joint infection.</div></div><div><h3>Methods</h3><div>130 knees undergoing two-stage revision arthroplasty for prosthetic joint infection between 2004–20 from a single centre with a minimum four-year follow-up (range 4–21 years) were identified. Re-infection, the risk of prosthesis explanation and mortality were analysed using Kaplan-Meier survivorship graphs. Univariant and multivariate analyses were performed to identify any association between re-infection and patient, microbiological or surgical factors. Reinfection rates were compared for knees undergoing two-stage revision surgery for infection in patients following simple primary arthroplasty and those following revision arthroplasty surgery or where a complex primary had been carried out following fracture fixation.</div></div><div><h3>Results</h3><div>There was a 17% reinfection rate with reinfection occurring up to 10 years after the two-stage revision surgery. Of the re-infected knees, 77% underwent prosthesis explantation. The 5 and 10-year mortality rates were 5.4% and 24.1% respectively. The Charlson Co-morbidity Index, number or type of organisms, growth of organisms at second-stage, degree of bony defect or need for soft tissue flap coverage had no association with the risk of re-infection.</div></div><div><h3>Conclusion</h3><div>Two-stage revision arthroplasty remains an effective surgical option to treat PJI. Reinfection, however, can occur up to 10 years following apparent successful eradication surgery.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104368"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of a clinical score to predict persistent anterior knee pain after anterior cruciate ligament reconstruction","authors":"Horacio Rivarola ,&nbsp;Camilo Helito ,&nbsp;Cristian Collazo ,&nbsp;Marcos Palanconi ,&nbsp;Marcos Meninato ,&nbsp;Edgar Barros ,&nbsp;Gonzalo Arteaga ,&nbsp;Francisco Endara Urresta ,&nbsp;Carlos Peñaherrera-Carillo ,&nbsp;Alejandro Barros Castro","doi":"10.1016/j.knee.2026.104366","DOIUrl":"10.1016/j.knee.2026.104366","url":null,"abstract":"<div><h3>Background</h3><div>Persistent anterior knee pain remains one of the most frequent causes of postoperative dissatisfaction after anterior cruciate ligament reconstruction (ACLR). Despite extensive literature on potential etiologic factors, no validated clinical tool currently exists to predict which patients are at greatest risk.</div></div><div><h3>Methods</h3><div>A retrospective cohort of 450 consecutive primary ACLR procedures was analyzed. Patients with revision surgery, multiligament injury, or previous osteotomy were excluded. The primary outcome was persistent anterior knee pain at 12 months, defined as a visual analogue scale (VAS) score &gt;3/10 or Kujala score &lt;80. Candidate predictors included demographic factors, graft type, posterior tibial slope, notchplasty, meniscal injury, injury chronicity, and early quadriceps activation. Multivariable logistic regression with backward elimination was performed. Model discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC-ROC) and Hosmer–Lemeshow (HL) test, with internal validation by 1000 bootstrap replications.</div></div><div><h3>Results</h3><div>Five independent predictors were identified: use of bone–patellar-tendon–bone graft (odds ratio (OR) 2.8, <em>P</em> &lt; 0.01), female sex (OR 1.9, <em>P</em> = 0.03), posterior tibial slope &gt;12° (OR 2.2, <em>P</em> = 0.01), absence of notchplasty (OR 1.7, <em>P</em> = 0.04), and delayed quadriceps activation &gt;2 weeks (OR 2.4, <em>P</em> &lt; 0.01). The model showed excellent discrimination (AUC = 0.82, 95% confidence interval 0.78–0.87) and good calibration (HL <em>P</em> = 0.46). The simplified 0- to 10-point Anterior Knee Pain Score (AKPS-ACL) identified patients at high risk with a cutoff ≥6 (sensitivity 80%, specificity 75%, negative predictive value 91%).</div></div><div><h3>Conclusion</h3><div>The AKPS-ACL represents an internally validated clinical score for predicting persistent anterior knee pain after ACLR, integrating anatomical, technical, and rehabilitation factors into a practical risk-stratification tool.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104366"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which factors correlate with muscle strength capacity in people with patellofemoral pain? A systematic review with meta-analysis","authors":"Guilherme S. Nunes ,&nbsp;Maitê M. Pellenz ,&nbsp;Júlia Bianchin Piussi ,&nbsp;Bruna Wageck ,&nbsp;Luis Ulisses Signori ,&nbsp;Matheus Weide Solner ,&nbsp;Anna Julia Meireles Dangui","doi":"10.1016/j.knee.2026.104358","DOIUrl":"10.1016/j.knee.2026.104358","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with patellofemoral pain (PFP) commonly exhibit muscle weakness; however, the relationship between muscle strength deficits and other factors in this population remains unclear. The present systematic review aimed to identify factors correlated with muscle strength capacity in individuals with PFP.</div></div><div><h3>Method</h3><div>A systematic search was conducted in Medline, Embase, CINAHL, SPORTDiscus, and Web of Science from their inception to September 2025. Correlational studies that included individuals with PFP and reported quantitative measures of muscle strength correlated with other quantitative variables were eligible for inclusion.</div></div><div><h3>Results</h3><div>Out of 9370 records screened, 57 studies met the inclusion criteria, and 37 were included in the meta-analyses. The findings indicated that knee extensor strength is trivially to moderately correlated with functionality, pain, pain duration, and kinesiophobia; knee flexor strength is weakly to moderately correlated with functionality and pain; hip abductor strength is trivially to moderately correlated with function, hip frontal and transverse plane movements; hip extensor strength is weakly correlated with function; hip external rotation strength is weakly correlated with function; hip posterolateral strength is moderately correlated with function; and trunk lateral flexion strength is weakly correlated with knee frontal plane movement.</div></div><div><h3>Conclusion</h3><div>Despite the generally weak correlations observed, muscle strength capacity in individuals with PFP presents significant associations with key factors such as pain, function, kinesiophobia, and lower limb movement patterns.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104358"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liposomal bupivacaine reduced postoperative analgesia in patients undergoing knee arthroplasty","authors":"Jad Mansour ,&nbsp;Mohammad Daher ,&nbsp;Matthew Nakouzi ,&nbsp;Jonathan Liu ,&nbsp;Michel Estephan ,&nbsp;Amer Sebaaly ,&nbsp;Alan H. Daniels ,&nbsp;Mouhanad M. El-Othmani","doi":"10.1016/j.knee.2026.104346","DOIUrl":"10.1016/j.knee.2026.104346","url":null,"abstract":"<div><h3>Background</h3><div>Liposomal bupivacaine (LB), a sustained-release formulation, is designed to prolong regional analgesia, and has been investigated as a solution for perioperative pain management. This meta-analysis of randomized controlled trials (RCTs) assessed the benefits of LB in patients undergoing knee arthroplasty.</div></div><div><h3>Methods</h3><div>Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar were accessed and explored until November 2025. The extracted data consisted of the risk of nausea/vomiting (N/V), length of stay (LOS), and postoperative pain and opioid consumption at 1, 2, and 3 days postoperatively.</div></div><div><h3>Results</h3><div>Six RCTs were included, consisting of 311 in the LB group and 318 in the control group. There was no difference between the two groups in N/V or LOS. However, patients receiving LB had less pain compared with patients receiving ropivacaine at 1 day postoperatively (standardized mean difference = −0.69, <em>P</em> = 0.03), and less pain compared with the control groups as a whole 2 days postoperatively (standardized mean difference = −0.44, <em>P</em> &lt; 0.001). Opioid consumption was lower in the LB group compared with the group receiving standard bupivacaine at 1, 2, and 3 days postoperatively (mean difference = −11.52 morphine milligram equivalents (MME), mean difference = −9.02 MME, mean difference = −4.58 MME, <em>P</em> &lt; 0.001 respectively). Similarly, Opioid consumption was lower in the LB group compared with the control group as a whole at 2 and 3 days postoperatively (mean difference = −7.01 MME, <em>P</em> = 0.02; mean difference = −4.59 MME, <em>P</em> &lt; 0.001, respectively).</div></div><div><h3>Conclusion</h3><div>LB reduces postoperative pain and opioid consumption after knee arthroplasty with no increased risk of N/V.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104346"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of tibial stem extensions in patients with obesity undergoing total knee arthroplasty","authors":"Themistoklis V. Tragaris,&nbsp;Javed M. Ali,&nbsp;Mark J. Berney,&nbsp;May S. Cleary,&nbsp;Fiachra E. Rowan","doi":"10.1016/j.knee.2026.104386","DOIUrl":"10.1016/j.knee.2026.104386","url":null,"abstract":"<div><h3>Background</h3><div>Patients with higher body mass index (BMI) are becoming the main cohort undergoing total knee arthroplasty (TKA). This demographic may be at greater risk of aseptic tibial loosening than patients in the normal BMI range, necessitating interventions to improve outcomes. Stem extensions in tibial components have emerged as a potential solution, however no consensus or protocol currently exist to guide clinicians.</div></div><div><h3>Methods</h3><div>A systematic review was conducted to assess the protective role of stem extensions against aseptic tibial loosening in primary TKAs for patients with obesity. Medline, Embase, and Central databases were searched as per the PRISMA process. Data analysis included quality assessment of our selection with the NHLBI tool for controlled intervention studies and the MINORS tool for non-randomized studies. Additionally, the analysis scrutinized the performance of stem extensions based on the various suggested lengths and combinations with different BMI cut-offs.</div></div><div><h3>Results</h3><div>Twelve studies met eligibility criteria, comprising a total of 42,547 TKAs. Stem extensions showed favourable or equivalent outcomes compared with non-stemmed tibial components, with no inferior performance observed. The most utilized stem lengths were 30 and 100 mm with BMI cut-offs of 30, 35 and 40 kg/m². Some evidence of superior results of the 30-mm stems was also obtained. The study quality check derived fair to good results.</div></div><div><h3>Conclusion</h3><div>The findings supported the use of stem extensions in primary TKAs of patients with obesity as a safe and effective means to mitigate aseptic tibial loosening. The recommendations made here include employing a 30-mm extension stem and ensuring adequate metaphyseal fixation based on the zonal fixation concept. The use of standard terms is also suggested, due to high variability in terminology. Limitations involved heterogeneity of stem lengths and BMI thresholds along with marginal follow up. Nevertheless, the selection contained good quality data, proposing a specific protocol or guidelines for optimizing outcomes in TKAs of patients with obesity.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104386"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}