IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-02-03 DOI: 10.1016/j.knee.2026.104354

Steve Robins , Eliott Martinson , Gillian Leitch , Nick D. Clement

Aim

To define the Patient-Acceptable Symptom State (PASS) in the Oxford Knee Score (OKS) following total knee arthroplasty (TKA) and identify independent preoperative factors associated with failure to achieve this threshold.

Methods

A retrospective cohort of 3304 patients undergoing primary TKA who completed preoperative and 6-month OKS was identified from an arthroplasty registry. The PASS was defined using receiver operating curve analysis, using patient satisfaction at 6 months as the anchor. Regression analysis was used to identify independent preoperative predictors of achieving the PASS.

Results

The PASS was defined as OKS ≥31 (area under the curve [AUC] 0.865, 95% CI 0.850–0.881) with 2333 (70.6%) patients achieving this. Patients not achieving a PASS were younger, had a higher BMI, and worse baseline PROMs (all p < 0.001). Higher preoperative OKS (odds ratio [OR] 1.09 per point) and EQ-VAS (OR 1.01 per point) were independently associated with achieving a PASS (both p < 0.001). A preoperative OKS ≤19 was associated with achieving a PASS (AUC 0.707). PASS achievers were more likely to be satisfied (OR 15.3, p < 0.001), though 54.4% of non-achievers were also satisfied.

Conclusion

The PASS was defined as ≥31 points in the OKS at 6 months following TKA. Lower preoperative OKS and EQ-VAS scores were associated with failure to achieve this threshold. While PASS attainment was associated with patient satisfaction, 54% of those not achieving a PASS were still satisfied, highlighting a limitation of this PROM threshold in isolation.

Level of evidence

Retrospective study, Level III.

目的：定义全膝关节置换术（TKA）后牛津膝关节评分（OKS）中的患者可接受症状状态（PASS），并确定与未能达到该阈值相关的独立术前因素。方法：从关节置换术登记处确定3304例完成术前和6个月OKS的原发性TKA患者的回顾性队列。PASS采用受试者工作曲线分析来定义，以患者6个月时的满意度为锚点。回归分析用于确定实现PASS的独立术前预测因素。结果：通过定义为OKS≥31（曲线下面积[AUC] 0.865, 95% CI 0.850-0.881）， 2333例（70.6%）患者达到该标准。未达到PASS的患者更年轻，BMI更高，基线PROMs更差（均为p）。结论：TKA后6个月的OKS中，PASS的定义为≥31分。术前较低的OKS和EQ-VAS评分与未能达到该阈值相关。虽然达到PASS与患者满意度相关，但54%未达到PASS的患者仍然满意，这突出了孤立的PROM阈值的局限性。证据级别：回顾性研究，III级。

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引用次数: 0

Elevated risks of pneumonia, cognitive dysfunction, and cerebrovascular disorder in super-elderly knee arthroplasty patients: insights from a nationwide Japanese database 超级高龄膝关节置换术患者肺炎、认知功能障碍和脑血管疾病的风险升高：来自日本全国数据库的见解

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-02-02 DOI: 10.1016/j.knee.2026.104351

Yu Mori , Kunio Tarasawa , Hidetatsu Tanaka , Masayuki Kamimura , Kento Harada , Naoko Mori , Kiyohide Fushimi , Toshimi Aizawa , Kenji Fujimori

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

导言：膝关节置换术是治疗晚期骨关节炎和类风湿关节炎的有效选择，即使在老年患者中也是如此。然而，超高龄患者面临住院死亡率、深静脉血栓形成、肺炎、脑血管事件和认知功能障碍等术后并发症的风险增加。本研究旨在利用日本全国DPC数据库分析行全膝关节置换术（TKA）或单室膝关节置换术（UKA）的超高龄患者（85岁及以上）和老年患者（70-84岁）术后并发症。通过倾向得分匹配调整混杂因素后进行分析。方法：我们对2016年至2023年期间接受TKA或UKA的200,925例患者进行了回顾性研究。根据年龄、性别、体重指数、手术方式和合并症进行倾向评分匹配（1:1）后，每组纳入21,117例患者。分析术后并发症，包括住院死亡率、深静脉血栓形成、肺炎、脑血管事件和认知功能障碍。多因素logistic回归确定了术后并发症的独立危险因素。结果：超高龄组肺炎（2.227,95% CI: 1.494-3.319）、脑血管事件（1.720,95% CI: 1.305-2.266）和认知功能障碍（1.767,95% CI: 1.485-2.103）的优势比更高。他们也有更长的住院时间和更高的输血需求。然而，在深静脉血栓、肺栓塞或住院死亡率方面没有观察到显著差异。结论：超高龄患者出现某些并发症的风险增加，但死亡率没有增加。在临床合适的情况下，在85岁之前进行膝关节置换术可能有助于降低这些风险。

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引用次数: 0

The effect of Agilium Freestep ankle–foot orthosis on the kinetic and kinematic parameters of gait in patients with knee osteoarthritis Agilium Freestep踝足矫形器对膝骨关节炎患者步态动力学和运动学参数的影响。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-31 DOI: 10.1016/j.knee.2026.104353

Mahsa Kavyani Boroujeni , Mohammad Taghi Karimi , Masoud Rafiaei , Hossein Akbari Aghdam

Background

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.

Methods

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.

Results

The current study showed that immediately after wearing AFO, stride length significantly decreased (1.141 ± 0.103 vs. 1.101 ± 0.095 m, P = 0.02). Moreover, the second peak of vertical ground reaction force decreased significantly (1.034 ± 0.035 vs. 1.013 ± 0.030, P = 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.

Conclusion

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.

背景：膝关节骨关节炎有几种矫形治疗方案。踝足矫形器（AFO）是这方面的一种新方法；它的目的是减少膝关节负荷，从而减少关节软骨退变过程。以往的研究将膝关节内收力矩作为膝关节负荷的替代指标，膝关节接触力没有精确测量。此外，这种矫形器对关节运动学和地面反作用力的影响在以前的研究中没有得到评估。因此，本研究的目的是评估使用AFO的膝关节内侧室骨关节炎患者的步态动力学参数，包括关节力矩和关节接触力以及运动学参数。方法：10例女性膝关节骨性关节炎患者参与本研究。患者在两种情况下进行评估：带AFO和不带AFO行走（Agilium Freestep®，Ottobock, Duderstadt，德国）。将36个反射标记物附着在患者下肢解剖标记物上，用运动分析系统监测标记物的运动，用Kistler力板采集施加在腿部的力。采用OpenSim软件测量膝关节运动、力矩，估算膝关节接触力。结果：本研究显示，佩戴AFO后，步幅明显缩短（1.141±0.103 vs. 1.101±0.095 m, P = 0.02）。垂直地面反力第二峰显著降低（1.034±0.035 vs. 1.013±0.030,P = 0.02）。在佩戴AFO后，在膝关节接触力成分或踝关节和膝关节的运动范围中没有观察到统计学上显著的变化。结论：佩戴Agilium AFO后即刻对降低膝关节接触力和膝关节矢状力矩的影响无统计学差异。值得注意的是，由于本研究的样本量小，短期性质，这些发现的普遍性是有限的。建议采用更大的队列和更长的随访期进行进一步研究，以澄清和证实这些初步发现。然而，治疗师可以考虑向骨关节炎患者推荐这种AFO，以潜在地减少膝关节负荷，特别是那些不能忍受膝关节矫形器的患者。

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引用次数: 0

Reliability and validity of the Persian knee Self-Efficacy Scale in patients with knee injuries: a cross-sectional validation study 波斯膝关节自我效能量表在膝关节损伤患者中的信度和效度：一项横断面验证研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-31 DOI: 10.1016/j.knee.2026.104326

Bahram Sheikhi , Pouya Rabiei , Amir Letafatkar , Malihe Hadadnezhad , Hadi Akbari

Purpose

The Knee Self-Efficacy Scale (K-SES) is widely used to assess patients’ confidence after knee injury, but no validated Persian version exists, limiting its use in Persian-speaking populations. This study aimed to translate, adapt, and evaluate the psychometric properties of the Persian-language versions of the K-SES (K-SES-Persian).

Methods

One hundred and six Persian patients with knee injuries were recruited from orthopedic and physiotherapy centers. Construct validity was examined using confirmatory factor analysis and Pearson correlations. Reliability was assessed by Cronbach’s alpha and intraclass correlation coefficients (ICC). Convergent validity was tested with the Oxford Knee Score (OKS) and Knee outcome survey activities for daily living (KOS-ADL). Test-retest reliability was assessed in 53 patients after 7–8 days.

Results

The K-SES-Persian showed excellent internal consistency for total score (α = 0.965). An excellent internal consistency (α = 0.953) was shown for present score and good internal consistency (α = 0.898) for the future score. The factor loading for each item was greater than 0.70. The K-SES-Persian showed significant correlations with the OKS (r = 0.37, 95% CI: 0.19–0.53, p < 0.001) and the KOS-ADL (r = 0.33, 95% CI: 0.15–0.49, p = 0.001). A significant but weak correlation was found between the OKS and KOS-ADL (r = 0.219 p = 0.024), indicating limited consistency between the comparator measures used for evaluating the convergent validity of the K-SES-Persian. No floor or ceiling effects were observed.

Conclusions

The K-SES-Persian was successfully adapted and demonstrated sound psychometric properties, including construct validity, internal consistency, and test–retest reliability, with internal consistency varying across subscales, supporting its use among Persian-speaking patients with knee injuries.

目的：膝关节自我效能量表（K-SES）被广泛用于评估膝关节损伤后患者的信心，但没有有效的波斯语版本，限制了其在波斯语人群中的使用。本研究旨在翻译、改编和评估波斯语版本的K-SES （K-SES- persian）的心理测量特性。方法：从骨科和物理治疗中心招募106例波斯膝关节损伤患者。建构效度采用验证性因子分析及Pearson相关检验。信度采用Cronbach’s alpha和类内相关系数（ICC）进行评估。采用牛津膝关节评分（OKS）和日常生活膝关节结局调查活动（KOS-ADL）检验收敛效度。在7-8天后对53例患者进行重测信度评估。结果：k - ses -波斯总分具有良好的内部一致性（α = 0.965）。当前评分具有良好的内部一致性（α = 0.953），未来评分具有良好的内部一致性（α = 0.898）。各题项的因子负荷均大于0.70。k - ses -波斯量表与OKS具有显著的相关性（r = 0.37, 95% CI: 0.19-0.53, p）。结论：k - ses -波斯量表被成功地采用，并表现出良好的心理测量特性，包括结构效度、内部一致性和测试重测信度，内部一致性在各子量表中有所不同，支持其在波斯语膝损伤患者中的应用。

{"title":"Reliability and validity of the Persian knee Self-Efficacy Scale in patients with knee injuries: a cross-sectional validation study","authors":"Bahram Sheikhi , Pouya Rabiei , Amir Letafatkar , Malihe Hadadnezhad , Hadi Akbari","doi":"10.1016/j.knee.2026.104326","DOIUrl":"10.1016/j.knee.2026.104326","url":null,"abstract":"<div><h3>Purpose</h3><div>The Knee Self-Efficacy Scale (K-SES) is widely used to assess patients’ confidence after knee injury, but no validated Persian version exists, limiting its use in Persian-speaking populations. This study aimed to translate, adapt, and evaluate the psychometric properties of the Persian-language versions of the K-SES (K-SES-Persian).</div></div><div><h3>Methods</h3><div>One hundred and six Persian patients with knee injuries were recruited from orthopedic and physiotherapy centers. Construct validity was examined using confirmatory factor analysis and Pearson correlations. Reliability was assessed by Cronbach’s alpha and intraclass correlation coefficients (ICC). Convergent validity was tested with the Oxford Knee Score (OKS) and Knee outcome survey activities for daily living (KOS-ADL). Test-retest reliability was assessed in 53 patients after 7–8 days.</div></div><div><h3>Results</h3><div>The K-SES-Persian showed excellent internal consistency for total score (α = 0.965). An excellent internal consistency (α = 0.953) was shown for present score and good internal consistency (α = 0.898) for the future score. The factor loading for each item was greater than 0.70. The K-SES-Persian showed significant correlations with the OKS (<em>r</em> = 0.37, 95% CI: 0.19–0.53, <em>p</em> < 0.001) and the KOS-ADL (<em>r</em> = 0.33, 95% CI: 0.15–0.49, <em>p</em> = 0.001). A significant but weak correlation was found between the OKS and KOS-ADL (<em>r</em> = 0.219 <em>p</em> = 0.024), indicating limited consistency between the comparator measures used for evaluating the convergent validity of the K-SES-Persian. No floor or ceiling effects were observed.</div></div><div><h3>Conclusions</h3><div>The K-SES-Persian was successfully adapted and demonstrated sound psychometric properties, including construct validity, internal consistency, and test–retest reliability, with internal consistency varying across subscales, supporting its use among Persian-speaking patients with knee injuries.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104326"},"PeriodicalIF":2.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101091","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}

引用次数: 0

Arthroscopic findings and intra-articular anomalies in congenital cruciate ligament deficiency 先天性交叉韧带缺乏的关节镜表现及关节内异常

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-29 DOI: 10.1016/j.knee.2026.104349

Sheba Z. Basheer , Tariq A. Kwaees , Paul Haslam, Fazal M. Ali, Nicolas Nicolaou

Background

This study aims to evaluate the arthroscopic findings of patients undergoing surgery for congenital cruciate ligament deficiency. Specifically, it investigates the frequency and types of intra-articular meniscal and ligament abnormalities associated with this rare condition, which often presents with knee instability in conjunction with longitudinal limb deficiency.

Methods

This prospective case series included 53 knees from 51 patients undergoing surgery for congenital cruciate ligament deficiency over a seven year period at a single tertiary centre. Patient demographics, clinical findings, imaging and surgical outcomes were documented. Preoperative MRI scans were used to assess intra-articular anatomy and arthroscopic findings were recorded, focusing on osseous and meniscal morphology as well as ligament anomalies.

Results

Among the 53 knees, 61% were associated with congenital longitudinal limb deficiencies, primarily fibular hemimelia. The ACL was deficient in all cases, while the PCL was also absent or underdeveloped in seven knees. Meniscal abnormalities were found in 42 knees (79.25%), including atypical shape, abnormal attachments and hypertrophied meniscofemoral ligaments that seemed to have a role in constraining sagittal instability.

Conclusion

Congenital cruciate ligament deficiency presents complex intra-articular anomalies, notably in ligament and meniscal structure. Hypertrophied meniscofemoral ligaments often provide compensatory stability, which can be disrupted by trivial trauma. Arthroscopic assessment is critical in planning reconstruction, especially given the atypical anatomy in these patients.

本研究旨在评估先天性交叉韧带缺乏手术患者的关节镜表现。具体来说，它调查了与这种罕见疾病相关的关节内半月板和韧带异常的频率和类型，这种疾病通常表现为膝关节不稳定并伴有纵向肢体缺陷。方法本前瞻性病例系列包括51例先天性交叉韧带缺乏症患者的53个膝关节，在单一三级中心进行了7年的手术。记录了患者的人口统计学、临床表现、影像学和手术结果。术前MRI扫描用于评估关节内解剖，并记录关节镜检查结果，重点是骨和半月板形态以及韧带异常。结果53例膝关节中，61%伴有先天性纵肢缺陷，以腓骨偏瘫为主。所有病例均有前交叉韧带缺失，而7例膝关节前交叉韧带缺失或发育不全。42例膝关节（79.25%）发现半月板异常，包括形状不典型、附着异常和半月板股骨韧带肥大，这似乎对限制矢状面不稳定起作用。结论先天性交叉韧带缺损表现为复杂的关节内异常，尤其是韧带和半月板结构异常。肥厚的半月板股骨韧带通常提供代偿稳定性，可被轻微的创伤破坏。关节镜评估是计划重建的关键，特别是考虑到这些患者的非典型解剖结构。

{"title":"Arthroscopic findings and intra-articular anomalies in congenital cruciate ligament deficiency","authors":"Sheba Z. Basheer , Tariq A. Kwaees , Paul Haslam, Fazal M. Ali, Nicolas Nicolaou","doi":"10.1016/j.knee.2026.104349","DOIUrl":"10.1016/j.knee.2026.104349","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to evaluate the arthroscopic findings of patients undergoing surgery for congenital cruciate ligament deficiency. Specifically, it investigates the frequency and types of intra-articular meniscal and ligament abnormalities associated with this rare condition, which often presents with knee instability in conjunction with longitudinal limb deficiency.</div></div><div><h3>Methods</h3><div>This prospective case series included 53 knees from 51 patients undergoing surgery for congenital cruciate ligament deficiency over a seven year period at a single tertiary centre. Patient demographics, clinical findings, imaging and surgical outcomes were documented. Preoperative MRI scans were used to assess intra-articular anatomy and arthroscopic findings were recorded, focusing on osseous and meniscal morphology as well as ligament anomalies.</div></div><div><h3>Results</h3><div>Among the 53 knees, 61% were associated with congenital longitudinal limb deficiencies, primarily fibular hemimelia. The ACL was deficient in all cases, while the PCL was also absent or underdeveloped in seven knees. Meniscal abnormalities were found in 42 knees (79.25%), including atypical shape, abnormal attachments and hypertrophied meniscofemoral ligaments that seemed to have a role in constraining sagittal instability.</div></div><div><h3>Conclusion</h3><div>Congenital cruciate ligament deficiency presents complex intra-articular anomalies, notably in ligament and meniscal structure. Hypertrophied meniscofemoral ligaments often provide compensatory stability, which can be disrupted by trivial trauma. Arthroscopic assessment is critical in planning reconstruction, especially given the atypical anatomy in these patients.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104349"},"PeriodicalIF":2.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080516","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}

引用次数: 0

Liposomal bupivacaine reduced postoperative analgesia in patients undergoing knee arthroplasty 布比卡因脂质体减少膝关节置换术患者术后镇痛

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-28 DOI: 10.1016/j.knee.2026.104346

Jad Mansour , Mohammad Daher , Matthew Nakouzi , Jonathan Liu , Michel Estephan , Amer Sebaaly , Alan H. Daniels , Mouhanad M. El-Othmani

Background

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.

Methods

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.

Results

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, P = 0.03), and less pain compared with the control groups as a whole 2 days postoperatively (standardized mean difference = −0.44, P < 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, P < 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, P = 0.02; mean difference = −4.59 MME, P < 0.001, respectively).

Conclusion

LB reduces postoperative pain and opioid consumption after knee arthroplasty with no increased risk of N/V.

布比卡因脂质体（LB）是一种缓释制剂，旨在延长局部镇痛，并已被研究作为围手术期疼痛管理的解决方案。这项随机对照试验（rct）的荟萃分析评估了LB在膝关节置换术患者中的益处。方法按照PRISMA指南，检索PubMed、Cochrane和谷歌Scholar，检索时间截止到2025年11月。提取的数据包括术后1、2和3天的恶心/呕吐风险（N/V）、住院时间（LOS）、术后疼痛和阿片类药物消耗。结果共纳入6项随机对照试验，其中LB组311例，对照组318例。两组间N/V和LOS无差异。然而，术后1天接受LB治疗的患者与接受罗哌卡因治疗的患者相比疼痛减轻（标准化平均差异= - 0.69,P = 0.03），术后2天与对照组相比疼痛减轻（标准化平均差异= - 0.44,P < 0.001）。术后1、2、3天，与标准布比卡因组相比，LB组的阿片类药物消耗量更低（平均差值= - 11.52吗啡毫克当量（MME），平均差值= - 9.02 MME，平均差值= - 4.58 MME, P < 0.001）。同样，与对照组相比，LB组在术后2和3天的阿片类药物消耗总体上较低（平均差异= - 7.01 MME, P = 0.02；平均差异= - 4.59 MME, P < 0.001）。结论lb减轻了膝关节置换术后疼痛和阿片类药物的消耗，未增加N/V的风险。

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引用次数: 0

Cemented metal-on-polyethylene spacers have similar cost profiles with lower complications rates compared to molded all-cement articulating spacers for treatment of knee periprosthetic joint infection 在治疗膝关节假体周围关节感染方面，与模塑全水泥关节垫片相比，金属-聚乙烯粘合垫片成本相似，并发症发生率更低

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-28 DOI: 10.1016/j.knee.2026.104347

Angel X Xiao , Ramesh B Ghanta , Alejandro S. Cazzulino , Kelechi Nwachuku , Erdan Kayupov , Erik N. Hansen

Background

All-cement spacers or metal-on-polyethylene (MoP) spacers are types of articulating spacers used in two-stage treatment of total knee arthroplasty (TKA) periprosthetic joint infection (PJI). While MoP spacers have improved durability and versatility, there is concern that use of primary arthroplasty components as a temporary spacer is not cost-effective. We investigated the cost of MoP versus molded all-cement articulating spacers for the treatment of TKA PJI.

Methods

A retrospective review of primary TKA PJIs treated with articulating spacers between 2013 and 2020 was performed. Primary TKA implants were used for MoP spacers and molds were used to create all-cement spacers. Supply, implant, and surgical encounter costs were reviewed. Total cost and complications were reviewed.

Results

Thirty-two molded all-cement and 17 MoP spacers were included. There was no difference between all-cement and MoP spacer Stage 1 cost ($4184 vs $4365), Stage 2 cost ($20,026 vs $20,441) or total cost ($24,210 vs $24,614). Moreover, spacer cost accounted for 17% of total cost. 3 patients in the all-cement group had mechanical complications requiring additional surgery. The MoP group had a shorter length of stay (LOS) after stage 2 (2.06 vs 4.16 days). Spacer choice did not affect stage 1 LOS, discharge disposition, operating room time, or reinfection rate.

Conclusion

MoP spacers have similar cost profiles, but lower incidence of complications compared to molded all-cement articulating spacers for two-stage exchange in treatment of TKA PJI. More than 80% of the surgical implant and supply cost is incurred during Stage 2 regardless of the spacer construct utilized.

背景全水泥垫片或金属对聚乙烯（MoP）垫片是用于全膝关节置换术（TKA）假体周围关节感染（PJI）两阶段治疗的关节垫片类型。虽然MoP垫片提高了耐用性和多功能性，但人们担心使用初级关节置换术部件作为临时垫片的成本效益不高。我们研究了MoP与模塑全水泥关节垫片治疗TKA PJI的成本。方法回顾性分析2013年至2020年使用关节间隔器治疗原发性TKA PJIs的病例。初次TKA植入物用于MoP垫片，并用模具制作全水泥垫片。我们回顾了供应、植入和手术费用。回顾了总费用和并发症。结果32例全水泥模塑，17例MoP垫片。全水泥和MoP隔离器第一阶段的成本（4184美元对4365美元）、第二阶段的成本（20,026美元对20,441美元）或总成本（24,210美元对24,614美元）没有差异。此外，封隔器成本占总成本的17%。全水泥组3例患者出现机械并发症，需进行额外手术。MoP组在2期后的停留时间（LOS）较短（2.06天vs 4.16天）。隔离剂的选择不影响1期LOS、出院处置、手术室时间或再感染率。结论与模塑全水泥关节垫片相比，mop垫片两段置换治疗TKA PJI的成本相似，但并发症发生率较低。超过80%的手术植入和供应成本发生在第二阶段，无论使用的是哪种间隔结构。

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引用次数: 0

Anterolateral skin incision for total knee arthroplasty is associated with lower prevalence of postoperative hypoesthesia at 1-year: a meta-analysis of randomised trials 全膝关节置换术前外侧皮肤切口与术后1年低感觉发生率相关：一项随机试验荟萃分析

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-23 DOI: 10.1016/j.knee.2026.104345

Omar E.S. Mostafa , Eden E.S. Mostafa , Tahir Khaleeq , Osama Aweid , Loiy Alkhatib , Amit Meena , Bolarinwa Akinola , Usman Ahmed , Shahbaz S. Malik

Background

A meta-analysis of randomised trials was conducted to compare clinical and functional outcomes between the standard anteromedial or midline skin incision and unconventional anterolateral incision for total knee arthroplasty (TKA).

Methods

This study was registered prospectively on the INPLASY database. Literature search was performed on 14th December 2024 in accordance with PRISMA. Only randomised controlled trials (RCTs) comparing anterolateral incision (ALI) versus standard (midline or anteromedial) incision (SI) were included and quality-assessed. Outcomes at 1 year postoperatively were prevalence of numbness, surface area of skin numbness, degrees of knee flexion, Visual Analogue Scale (VAS), Forgotten Joint Score (FJS) and Knee Injury and Osteoarthritis Outcome Score (KOOS).

Results

Eight RCTs totalling 609 patients (ALI 276 vs. SI 333) were included. Mean age, BMI and proportion of male patients were comparable between the two groups. There was no baseline difference between the two groups for the incision length or operative duration. Statistical difference was observed for two outcomes favouring the ALI group: prevalence of hypoesthesia (OR 0.36, CI 0.17–0.77, P = 0.008) and surface area of numbness (SMD −1.04, CI −1.80 to −0.28, P = 0.007). No significant difference was observed in KOOS (SMD 0.16, CI – 0.07 to revman 0.38, P = 0.17), FJS (SMD −0.14, CI −0.39 to 0.12, P = 0.30) and VAS (SMD −0.10, CI −0.39 to 0.20, P = 0.51).

Conclusion

An anterolateral incision to TKA results in a lower rate and smaller surface area of numbness at 1-year, with no difference in patient-reported outcome measures.

背景：一项随机试验荟萃分析比较全膝关节置换术（TKA）中标准前内侧或中线皮肤切口与非常规前外侧切口的临床和功能结果。方法本研究在INPLASY数据库中进行前瞻性注册。文献检索于2024年12月14日按照PRISMA进行。仅纳入比较前外侧切口（ALI）与标准（中线或前内侧）切口（SI）的随机对照试验（rct）并进行质量评估。术后1年的结果是麻木的发生率、皮肤麻木的表面积、膝关节屈曲程度、视觉模拟量表（VAS）、遗忘关节评分（FJS）和膝关节损伤和骨关节炎结局评分（oos）。结果共纳入8项rct，共609例患者（ALI 276 vs. SI 333）。两组患者的平均年龄、BMI和男性患者比例具有可比性。两组之间的切口长度和手术时间没有基线差异。ALI组的两项结果有统计学差异：感觉不足发生率（OR 0.36, CI 0.17-0.77, P = 0.008）和麻木表面积（SMD - 1.04, CI - 1.80 - 0.28, P = 0.007）。KOOS （SMD - 0.16, CI - 0.07 ~ revman 0.38, P = 0.17）、FJS （SMD - 0.14, CI - 0.39 ~ 0.12, P = 0.30）和VAS （SMD - 0.10, CI - 0.39 ~ 0.20, P = 0.51）均无显著差异。结论TKA前外侧切口1年的麻木率较低，麻木面积较小，患者报告的结果测量无差异。

{"title":"Anterolateral skin incision for total knee arthroplasty is associated with lower prevalence of postoperative hypoesthesia at 1-year: a meta-analysis of randomised trials","authors":"Omar E.S. Mostafa , Eden E.S. Mostafa , Tahir Khaleeq , Osama Aweid , Loiy Alkhatib , Amit Meena , Bolarinwa Akinola , Usman Ahmed , Shahbaz S. Malik","doi":"10.1016/j.knee.2026.104345","DOIUrl":"10.1016/j.knee.2026.104345","url":null,"abstract":"<div><h3>Background</h3><div>A meta-analysis of randomised trials was conducted to compare clinical and functional outcomes between the standard anteromedial or midline skin incision and unconventional anterolateral incision for total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>This study was registered prospectively on the INPLASY database. Literature search was performed on 14th December 2024 in accordance with PRISMA. Only randomised controlled trials (RCTs) comparing anterolateral incision (ALI) versus standard (midline or anteromedial) incision (SI) were included and quality-assessed. Outcomes at 1 year postoperatively were prevalence of numbness, surface area of skin numbness, degrees of knee flexion, Visual Analogue Scale (VAS), Forgotten Joint Score (FJS) and Knee Injury and Osteoarthritis Outcome Score (KOOS).</div></div><div><h3>Results</h3><div>Eight RCTs totalling 609 patients (ALI 276 vs. SI 333) were included. Mean age, BMI and proportion of male patients were comparable between the two groups. There was no baseline difference between the two groups for the incision length or operative duration. Statistical difference was observed for two outcomes favouring the ALI group: prevalence of hypoesthesia (OR 0.36, CI 0.17–0.77, <em>P</em> = 0.008) and surface area of numbness (SMD −1.04, CI −1.80 to −0.28, <em>P</em> = 0.007). No significant difference was observed in KOOS (SMD 0.16, CI – 0.07 to revman 0.38, <em>P</em> = 0.17), FJS (SMD −0.14, CI −0.39 to 0.12, <em>P</em> = 0.30) and VAS (SMD −0.10, CI −0.39 to 0.20, <em>P</em> = 0.51).</div></div><div><h3>Conclusion</h3><div>An anterolateral incision to TKA results in a lower rate and smaller surface area of numbness at 1-year, with no difference in patient-reported outcome measures.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104345"},"PeriodicalIF":2.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039605","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}

引用次数: 0

Artificial intelligence in knee osteoarthritis imaging and total knee arthroplasty: advances, challenges, and segmentation methods – A review 人工智能在膝关节骨关节炎成像和全膝关节置换术中的应用：进展、挑战和分割方法综述

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-21 DOI: 10.1016/j.knee.2026.104327

Ahsan Humayun , Mustafain Rehman , Muhammad Zainulabideen

Background

Knee osteoarthritis (KOA) is one of the most prevalent degenerative joint diseases and a significant cause of disability. Total Knee Arthroplasty (TKA) is the standard treatment for advanced cases, but its success depends on accurate imaging, precise preoperative planning, and intraoperative execution. Imaging modalities such as radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound are widely used in TKA workflows. Still, they are often limited by anatomical variability, image artifacts, and poor soft tissue contrast.

Methods

This review surveys automated segmentation and analysis approaches for knee imaging, covering classical methods including region-, boundary-, atlas-, and model-based techniques, as well as recent artificial intelligence (AI)-driven approaches, particularly deep learning models. Their capabilities, limitations, and clinical relevance in TKA planning and evaluation are discussed.

Results

Classical segmentation methods provide foundational tools but often exhibit limited generalization and robustness in heterogeneous clinical datasets. AI-based methods, particularly deep learning, enable automated feature extraction, improved segmentation accuracy, and enhanced classification and outcome prediction. These methods address many limitations of traditional approaches, although their dependence on large annotated datasets and variability in imaging protocols remains a significant challenge.

Conclusion

This review presents a comprehensive overview of knee anatomy, imaging modalities, and segmentation techniques relevant to TKA. Comparing classical and AI-based approaches highlights their strengths, limitations, and persistent challenges, while also identifying opportunities for integrating AI into clinical workflows to achieve more precise, reliable, and patient-specific knee arthroplasties.

膝关节骨性关节炎（KOA）是最常见的退行性关节疾病之一，也是导致残疾的重要原因。全膝关节置换术（TKA）是晚期病例的标准治疗方法，但其成功取决于准确的成像、精确的术前计划和术中执行。成像方式，如x光片、计算机断层扫描（CT）、磁共振成像（MRI）和超声在TKA工作流程中广泛使用。尽管如此，它们经常受到解剖学变异性、图像伪影和软组织对比度差的限制。本文综述了膝关节成像的自动分割和分析方法，涵盖了经典的方法，包括基于区域、边界、图谱和模型的技术，以及最近的人工智能（AI）驱动的方法，特别是深度学习模型。讨论了它们在TKA计划和评估中的能力、局限性和临床相关性。结果经典的分割方法提供了基础工具，但在异构临床数据集中往往表现出有限的泛化和鲁棒性。基于人工智能的方法，特别是深度学习，可以实现自动特征提取，提高分割精度，增强分类和结果预测。这些方法解决了传统方法的许多局限性，尽管它们对大型注释数据集的依赖和成像协议的可变性仍然是一个重大挑战。本文综述了与TKA相关的膝关节解剖、成像方式和分割技术。比较经典方法和基于人工智能的方法突出了它们的优势、局限性和持续的挑战，同时也确定了将人工智能集成到临床工作流程中的机会，以实现更精确、可靠和患者特异性的膝关节置换。

{"title":"Artificial intelligence in knee osteoarthritis imaging and total knee arthroplasty: advances, challenges, and segmentation methods – A review","authors":"Ahsan Humayun , Mustafain Rehman , Muhammad Zainulabideen","doi":"10.1016/j.knee.2026.104327","DOIUrl":"10.1016/j.knee.2026.104327","url":null,"abstract":"<div><h3>Background</h3><div>Knee osteoarthritis (KOA) is one of the most prevalent degenerative joint diseases and a significant cause of disability. Total Knee Arthroplasty (TKA) is the standard treatment for advanced cases, but its success depends on accurate imaging, precise preoperative planning, and intraoperative execution. Imaging modalities such as radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound are widely used in TKA workflows. Still, they are often limited by anatomical variability, image artifacts, and poor soft tissue contrast.</div></div><div><h3>Methods</h3><div>This review surveys automated segmentation and analysis approaches for knee imaging, covering classical methods including region-, boundary-, atlas-, and model-based techniques, as well as recent artificial intelligence (AI)-driven approaches, particularly deep learning models. Their capabilities, limitations, and clinical relevance in TKA planning and evaluation are discussed.</div></div><div><h3>Results</h3><div>Classical segmentation methods provide foundational tools but often exhibit limited generalization and robustness in heterogeneous clinical datasets. AI-based methods, particularly deep learning, enable automated feature extraction, improved segmentation accuracy, and enhanced classification and outcome prediction. These methods address many limitations of traditional approaches, although their dependence on large annotated datasets and variability in imaging protocols remains a significant challenge.</div></div><div><h3>Conclusion</h3><div>This review presents a comprehensive overview of knee anatomy, imaging modalities, and segmentation techniques relevant to TKA. Comparing classical and AI-based approaches highlights their strengths, limitations, and persistent challenges, while also identifying opportunities for integrating AI into clinical workflows to achieve more precise, reliable, and patient-specific knee arthroplasties.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104327"},"PeriodicalIF":2.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146001788","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}

引用次数: 0

Patient-reported opioid dependency and reasons for use 12 months following knee arthroplasty: a prospective observational study 膝关节置换术后12个月患者报告的阿片类药物依赖及其使用原因：一项前瞻性观察研究

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-21 DOI: 10.1016/j.knee.2026.104325

Mette J. Hansen , Mette Garval , Jeppe Lange , Charlotte Runge , Søren T. Skou , Nicolai K. Kristensen

Background

Opioids are prescribed to alleviate pain after knee arthroplasty. However, prolonged postoperative opioid use may complicate recovery and potentially increase the risk of persistent use. This study explores opioid use following fast-track knee arthroplasty.

Method

This prospective, single-center, observational study included patients scheduled for fast-track knee arthroplasty. A total of 1195 patients were included, of whom 996 underwent total knee arthroplasty (TKA) and 199 medial unicompartmental knee arthroplasty (mUKA). Participants completed a study-specific questionnaire on opioid use before surgery and at 3- and 12-month follow-up (FU).

Patient-reported data at 12-month FU were available for 797 TKA (80%) and 160 mUKA (80%).

Participants were categorized based on preoperative opioid use. The primary outcome was patient-reported opioid use at 12-month FU. Reasons for opioid use were also registered.

Results

At 12-month FU, 3% (95% confidence interval (CI) 2–4; 24 patients) of TKA patients reported daily opioid use attributed to prosthetic knee joint pain; the proportion was higher among patients with preoperative daily opioid use (17%, CI 10–26, 17 patients) compared to those without preoperative use (1%, CI 0.2–1.5, 4 patients). 1 mUKA patient (0.6%, CI 0–3) reported daily opioid use attributed to prosthetic knee joint pain at 12-month FU.

Conclusion

Persistent daily opioid use due to pain in the prosthetic knee joint was rare 12 months after fast-track TKA and mUKA. Patients with preoperative daily opioid use had a markedly higher risk of continued use compared to those without prior opioid use.

背景：阿片类药物被用于缓解膝关节置换术后的疼痛。然而，术后长时间使用阿片类药物可能会使恢复复杂化，并可能增加持续使用的风险。本研究探讨快速通道膝关节置换术后阿片类药物的使用。方法这项前瞻性、单中心、观察性研究纳入了计划行快速膝关节置换术的患者。共纳入1195例患者，其中996例行全膝关节置换术（TKA）， 199例行内侧单室膝关节置换术（mUKA）。参与者在手术前和3个月和12个月的随访（FU）中完成了一份关于阿片类药物使用的研究特定问卷。在12个月FU时，有797例TKA（80%）和160例mUKA（80%）患者报告的数据。参与者根据术前阿片类药物使用情况进行分类。主要终点是12个月FU时患者报告的阿片类药物使用情况。阿片类药物使用的原因也进行了登记。结果12个月FU， 3%(95%置信区间（CI） 2-4；24例TKA患者报告因假体膝关节疼痛而每日使用阿片类药物；术前每日使用阿片类药物的患者比例（17%,CI 10 - 26,17例）高于术前未使用阿片类药物的患者（1%,CI 0.2-1.5, 4例）。1名mUKA患者（0.6%,CI 0-3）报告在FU 12个月时因假体膝关节疼痛而每天使用阿片类药物。结论快速通道TKA和mUKA术后12个月因人工膝关节疼痛持续每日使用阿片类药物的情况较为罕见。术前每日使用阿片类药物的患者与未使用阿片类药物的患者相比，继续使用阿片类药物的风险明显更高。

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引用次数: 0

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