IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-01 Epub Date: 2025-12-20 DOI: 10.1016/j.knee.2025.104303

Juan Miguel Gómez-Palomo , Juan José García-Vera , Amparo Zamora-Mogollo , Carmen Tara-Abad , Ana Martínez-Crespo , Elvira Montañez-Heredia

Purpose

To quantify 10-year survivorship after medial opening-wedge high tibial osteotomy (MOWHTO) and identify modifiable predictors of conversion to total knee arthroplasty (TKA), focusing on joint-line obliquity (JLO), obesity and smoking.

Methods

Single-centre retrospective cohort of 138 MOWHTOs (2007–2022) with Ahlbäck I–II medial osteoarthritis, correctable varus and ≥24-month follow-up. Long-leg radiographs measured alignment, JLO (tibial plateau angle relative to floor) and medial proximal tibial angle (MPTA; pre-/post-operative). Primary outcome: TKA conversion. Kaplan–Meier estimated survivorship; multivariable Cox with proportional-hazards checks and Fine–Gray competing-risk analyses were used. A sensitivity model added post-operative JLO and deviation from planned hip–knee–ankle (HKA) alignment; a complementary model evaluated post-operative MPTA >95°.

Results

Mean age 46.9 years; mean follow-up 83.4 months. Twelve of 138 knees (8.7 %) underwent TKA; survivorship was 98.5 % at 2 years, 90.4 % at 5 years and 79.7 % at 10 years. Independent predictors of conversion were age (HR 1.09/year), BMI ≥30 (HR 1.12), smoking (HR 2.85) and pre-operative JLO >5° (HR 1.32) (all p < 0.05). Post-operative MPTA >95° was not significant. Findings were consistent in competing-risk analyses. Complications occurred in 13.0 % (hinge fracture 5.1 %, delayed/non-union 3.6 %, infection 4.3 %). WOMAC improved from 45.8 to 22.1 (p < 0.001); all KOOS domains improved (p < 0.001); satisfaction 86.2 %.

Conclusions

MOWHTO achieved ∼80 % 10-year TKA-free survivorship with durable functional gains. Older age, obesity, smoking and increased pre-operative JLO predicted earlier conversion; post-operative MPTA >95° was not significant. Considering MPTA thresholds alongside pre-operative JLO may help avoid excessive obliquity and optimise longevity.

Level of evidence: Level IV (retrospective cohort/case series).

目的：量化内侧开楔形高位胫骨截骨术（MOWHTO）后的10年生存率，并确定转换为全膝关节置换术（TKA）的可改变预测因素，重点是关节线倾角（JLO）、肥胖和吸烟。方法：单中心回顾性队列研究138例（2007-2022）患有Ahlbäck I-II型内侧骨关节炎、可矫正内翻的MOWHTOs患者，随访≥24个月。长腿x线片测量对齐，JLO（胫骨平台相对于底的角度）和内侧胫骨近端角度（MPTA；术前/术后）。主要结局：TKA转换。Kaplan-Meier估计存活率；采用多变量Cox、比例风险检验和Fine-Gray竞争风险分析。灵敏度模型增加了术后JLO和偏离计划髋关节-膝关节-踝关节（HKA）对准；补充模型评估术后MPTA bb0 95°。结果：平均年龄46.9岁；平均随访83.4个月。138例膝关节中12例（8.7%）行全膝关节置换术；2年生存率为98.5%，5年为90.4%，10年为79.7%。转换的独立预测因子为年龄（HR 1.09/年）、BMI≥30 （HR 1.12）、吸烟（HR 2.85）和术前JLO bb0.5°（HR 1.32）（p 95°均无统计学意义）。竞争风险分析的结果是一致的。并发症发生率为13.0%（铰链骨折5.1%，延迟/不愈合3.6%，感染4.3%）。WOMAC从45.8提高到22.1 (p)。结论：MOWHTO实现了约80%的10年无tka生存率和持久的功能获益。年龄较大、肥胖、吸烟和术前JLO增加预测早期转化；术后MPTA >95°无明显差异。考虑MPTA阈值与术前JLO可能有助于避免过度倾斜和优化寿命。证据等级：四级（回顾性队列/病例系列）。

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引用次数: 0

Patients' consultation for artificial intelligence: Untouched threats. 人工智能患者会诊：未触及的威胁。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-02-24 DOI: 10.1016/j.knee.2026.104410

Shigeki Matsubara

引用次数: 0

Comparison of methods for evaluating soft tissue balance in robotic-assisted total knee arthroplasty: A cadaveric study 机器人辅助全膝关节置换术中软组织平衡评估方法的比较：一项尸体研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-12-03 DOI: 10.1016/j.knee.2025.11.012

Yasuaki Tamaki , Daisuke Hamada , Keizo Wada , Shota Shigekiyo , Yuto Sugimine , Yutaka Kinoshita , Koichi Tomita , Koichi Sairyo

Background

Robotic-assisted total knee arthroplasty (TKA) can simulate postoperative soft tissue balance based on three-dimensional positional information for the prosthesis and preoperative soft tissue balance data. However, the accuracy of soft tissue balance data obtained during robotic-assisted TKA is unclear. This study aimed to compare the reproducibility of three different assessment methods for soft tissue balance in robotic-assisted TKA and to examine the influence of examiner experience.

Methods

Seven fresh-frozen cadavers were used. Three examiners assessed the medial and lateral gaps by applying a continuous varus/valgus load to the knee throughout the full range of motion using an image-free system (Navio). Soft tissue balance was evaluated by applying mild manual stress (mild group), maximum manual stress (max group), and a Z-retractor (Z group). Each examiner performed the procedure twice, and intra-rater and inter-rater reliability was evaluated using the intraclass correlation coefficient (ICC).

Results

In medial gap assessment, the ICCs for intra-rater reliability ranged from 0.88 to 0.95 in the mild group, 0.89 to 0.94 in the max group, and 0.89 to 0.95 in the Z group, with respective ICCs of 0.88, 0.88, and 0.92 for inter-rater reliability. In lateral gap assessment, the ICCs for intra-rater reliability ranged from 0.37 to 0.66 in the mild group, 0.33 to 0.86 in the max group, and 0.62 to 0.96 in the Z group, with respective ICCs of 0.41, 0.24, and 0.57 for inter-rater reliability.

Conclusion

Intra-rater and inter-rater reliability was high for the medial gap assessment but lower for the lateral gap assessment.

背景：机器人辅助全膝关节置换术（robot -assisted total knee arthroplasty， TKA）可以基于假体的三维位置信息和术前软组织平衡数据模拟术后软组织平衡。然而，在机器人辅助TKA中获得的软组织平衡数据的准确性尚不清楚。本研究旨在比较机器人辅助TKA中软组织平衡的三种不同评估方法的可重复性，并检查检查者经验的影响。方法：采用新鲜冷冻尸体7具。三名检查人员通过使用无图像系统（Navio）在整个活动范围内对膝关节施加连续的内翻/外翻负荷来评估内侧和外侧间隙。通过施加轻度手动应力（mild组）、最大手动应力（max组）和Z形牵开器（Z组）来评估软组织平衡。每个审查员执行两次程序，并使用类内相关系数（ICC）评估评估者内部和内部的信度。结果：在中等差距评估中，轻度组评分内信度的ICCs为0.88 ~ 0.95，最大组为0.89 ~ 0.94，Z组为0.89 ~ 0.95，评分间信度的ICCs分别为0.88、0.88和0.92。在横向间隙评估中，轻度组评分内信度的ICCs为0.37 ~ 0.66，最大组为0.33 ~ 0.86，Z组为0.62 ~ 0.96，评分间信度的ICCs分别为0.41、0.24和0.57。结论：内侧间隙评估的信度高，外侧间隙评估的信度低。

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引用次数: 0

Uniform and reliable assessment of bone union on radiographs in osteotomies around the knee: a novel classification system 膝关节周围截骨术中统一可靠的x线片骨愈合评估：一种新的分类系统。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-04 DOI: 10.1016/j.knee.2025.10.016

E.A. Bax , N. van Egmond , R.J.H. Custers , K.L. Vincken , M.C. Kruyt , W. Foppen

Background

To evaluate the inter- and intra-rater reliability of the Unified Bone Union (UBU) classification for assessing time-dependent bone healing on radiographs in osteotomies around the knee, including negative union signs. Secondary aims included assessing union progression over time, applicability across osteotomy types, and correlation between radiographic and CT-based UBU scores.

Methods

The UBU classification assesses bone healing on anteroposterior radiographs in three anatomical zones, graded from phase 0 (no callus) to phase 3 (bridging callus), including radiological negative union signs. Radiographs (n = 110) from 38 medial opening-wedge high tibial osteotomy patients were retrospectively reviewed twice by three independent raters. Inter- and intra-rater reliability were assessed using quadratic-weighted kappa (κ). Percent agreement was calculated for classification modifiers. Time-dependent changes in union were analyzed. Reliability was also tested across osteotomy types. Correlation between 6-month radiographic and CT-based UBU scores was determined using Spearman’s rho.

Results

Interrater reliability was substantial (κ 0.74–0.79), while intra-rater reliability showed almost perfect agreement (κ 0.78–0.98). Modifier agreement was good (inter-rater: 91–98 %; intra-rater: 89–95 %). The UBU score increased over time. The UBU showed substantial interrater reliability (κ = 0.75) across various osteotomy types. A strong correlation was found between radiographic and CT-based UBU scores (r = 0.82, p < 0.01).

Conclusion

The UBU classification provides a reliable and standardized method for evaluating bone union after osteotomies around the knee. It incorporates negative union signs and demonstrates strong inter- and intra-rater agreement, as well as strong correlation with CT imaging. Further research should validate its diagnostic accuracy and clinical utility.

背景：评估统一骨愈合（UBU）分类在评估膝关节周围截骨术中随时间变化的骨愈合时的可靠性，包括阴性愈合迹象。次要目的包括评估骨愈合随时间的进展，不同截骨类型的适用性，以及x线摄影和基于ct的UBU评分之间的相关性。方法：UBU分级评估骨愈合在三个解剖区域的正位x线片上，从0期（无骨痂）到3期（桥接骨痂），包括放射学阴性愈合征象。本文回顾性分析了38例内侧楔形高位胫骨截骨术患者的x线片（n = 110），由三位独立评分者进行了两次评估。使用二次加权kappa （κ）评估评分间和评分内的信度。计算了分类修饰符的一致性百分比。分析了结合度随时间的变化。也测试了不同截骨类型的可靠性。使用Spearman’s rho确定6个月x线摄影和基于ct的UBU评分之间的相关性。结果：评分间信度显著（κ 0.74-0.79），评分内信度几乎完全一致（κ 0.78-0.98）。修饰语一致性较好（内部修饰语一致性：91- 98%；内部修饰语一致性：89- 95%）。UBU评分随着时间的推移而增加。UBU在各种截骨类型中显示出显著的互信度（κ = 0.75）。x线片评分与ct评分之间存在很强的相关性（r = 0.82, p）。结论：UBU分级为评估膝关节周围截骨术后骨愈合提供了一种可靠、标准化的方法。它包含负结合征象，表现出很强的骨间和骨内一致性，并与CT成像有很强的相关性。进一步的研究应验证其诊断准确性和临床应用价值。

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引用次数: 0

Impact of hybrid closed-wedge high tibial osteotomy on mechanical loading during gait in patients with medial knee osteoarthritis 混合式闭合楔形胫骨高位截骨术对膝关节内侧骨关节炎患者步态中机械负荷的影响。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-27 DOI: 10.1016/j.knee.2025.11.011

Shota Imamura , Rui Tsukagoshi , Kei Setogawa , Takafumi Mizuno , Kazuhisa Kajihara , Hiroshi Nakayama , Naoki Sasanuma , Akira Sakaguchi , Kotaro Kawaguchi , Yuki Uchiyama , Kazuhisa Domen

Background

Increased mechanical loading during gait is a risk factor for knee osteoarthritis (OA). An elevated knee adduction moment serves as an indicator of mechanical loading on the femorotibial (FT) joint. By contrast, increased knee flexion excursion and knee flexion moment are indicators of mechanical loading on the patellofemoral (PF) joint. Hybrid closed-wedge high tibial osteotomy (hybrid CWHTO) improves the static alignment of the FT and PF joints; however, the extent of changes in mechanical loading during gait remains unclear. Hence, this study aimed to evaluate the changes in the kinematics and kinetics of pre- and post-hybrid CWHTO and compare the outcomes with those observed in healthy controls.

Methods

This study included 14 patients with medial knee OA who underwent hybrid CWHTO and 21 healthy elderly controls. Gait was evaluated using two-dimensional motion analysis preoperatively and at 1 year postoperatively.

Results

The postoperative knee adduction moment was significantly reduced. However, no significant differences were found in knee flexion excursion and knee flexion moment between the preoperative and postoperative assessments. Both parameters remained lower than those observed in healthy elderly controls.

Conclusion

Although the hybrid CWHTO effectively reduces knee adduction moments, thereby decreasing mechanical stress on the FT joint, it does not change knee flexion excursion or knee flexion moments. However, radiographic evaluation demonstrated changes in patellar height, suggesting that positional factors may influence PF joint mechanics independent of sagittal-plane measures. These findings highlight the need to incorporate targeted rehabilitation interventions focused on improving the sagittal plane mechanics.

背景：步态时机械负荷增加是膝骨关节炎（OA）的危险因素。膝关节内收力矩升高可作为股胫关节机械负荷的指标。相比之下，增加的膝关节屈曲偏移和膝关节屈曲力矩是髌股关节（PF）机械负荷的指标。混合式闭合楔形高位胫骨截骨术（混合式CWHTO）改善了FT和PF关节的静态对齐；然而，在步态过程中机械负荷的变化程度仍不清楚。因此，本研究旨在评估混合前后CWHTO的运动学和动力学变化，并将结果与健康对照进行比较。方法：本研究纳入14例行混合型CWHTO的膝关节内侧OA患者和21例健康老年人对照。术前和术后1年采用二维运动分析评估步态。结果：术后膝关节内收力矩明显减小。然而，在术前和术后评估中，膝关节屈曲偏移和膝关节屈曲力矩没有发现显著差异。这两个参数仍然低于健康老年人对照组。结论：混合CWHTO虽然能有效降低膝关节内收力矩，从而降低FT关节的机械应力，但不能改变膝关节屈曲偏移或屈曲力矩。然而，x线评估显示髌骨高度的变化，这表明位置因素可能独立于矢状面测量影响PF关节力学。这些发现强调了有针对性的康复干预措施的必要性，重点是改善矢状面力学。

{"title":"Impact of hybrid closed-wedge high tibial osteotomy on mechanical loading during gait in patients with medial knee osteoarthritis","authors":"Shota Imamura , Rui Tsukagoshi , Kei Setogawa , Takafumi Mizuno , Kazuhisa Kajihara , Hiroshi Nakayama , Naoki Sasanuma , Akira Sakaguchi , Kotaro Kawaguchi , Yuki Uchiyama , Kazuhisa Domen","doi":"10.1016/j.knee.2025.11.011","DOIUrl":"10.1016/j.knee.2025.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Increased mechanical loading during gait is a risk factor for knee osteoarthritis (OA). An elevated knee adduction moment serves as an indicator of mechanical loading on the femorotibial (FT) joint. By contrast, increased knee flexion excursion and knee flexion moment are indicators of mechanical loading on the patellofemoral (PF) joint. Hybrid closed-wedge high tibial osteotomy (hybrid CWHTO) improves the static alignment of the FT and PF joints; however, the extent of changes in mechanical loading during gait remains unclear. Hence, this study aimed to evaluate the changes in the kinematics and kinetics of pre- and post-hybrid CWHTO and compare the outcomes with those observed in healthy controls.</div></div><div><h3>Methods</h3><div>This study included 14 patients with medial knee OA who underwent hybrid CWHTO and 21 healthy elderly controls. Gait was evaluated using two-dimensional motion analysis preoperatively and at 1 year postoperatively.</div></div><div><h3>Results</h3><div>The postoperative knee adduction moment was significantly reduced. However, no significant differences were found in knee flexion excursion and knee flexion moment between the preoperative and postoperative assessments. Both parameters remained lower than those observed in healthy elderly controls.</div></div><div><h3>Conclusion</h3><div>Although the hybrid CWHTO effectively reduces knee adduction moments, thereby decreasing mechanical stress on the FT joint, it does not change knee flexion excursion or knee flexion moments. However, radiographic evaluation demonstrated changes in patellar height, suggesting that positional factors may influence PF joint mechanics independent of sagittal-plane measures. These findings highlight the need to incorporate targeted rehabilitation interventions focused on improving the sagittal plane mechanics.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104285"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642796","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

Can a machine learning approach contribute to monitoring post-market surveillance of total knee arthroplasty prostheses? 机器学习方法能否有助于全膝关节置换术假体上市后的监测？

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-15 DOI: 10.1016/j.knee.2025.10.020

Khashayar Ghadirinejad , Stephen Graves , Richard de Steiger , Nicole Pratt , Lucian B. Solomon , Mark Taylor , Reza Hashemi

Background

The impact of knee replacement surgery on patients can be monitored by joint registries through the surveillance of prostheses and identification of under-performing devices – outliers. The study of new statistical methods can help determine whether a device is at a higher risk of failure by considering possible confounding factors. Self-learning algorithms with the potential to involve multiple variables simultaneously are one approach to limiting the impact of confounding factors. This study aimed to assess two machine learning (ML) techniques to detect total knee outliers while controlling for patient- and device-related confounding.

Methods

The potential to identify outliers among 160 unique prostheses was evaluated for Random Survival Forest (RSF) and regularised/unregularised Cox models. The input variables included femoral/tibial components and patient characteristics provided by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) on 265,655 primary total knee procedures. The outcome was time to first revision surgery treated as a censored case for death, and the AOANJRR gold standard was defined as the criteria to assess the effectiveness of proposed ML methods.

Results

In the study cohort, the AOANJRR standardised approach detected five conventional prosthesis combinations. Both the Cox and RSF techniques identified two of the same total knee prostheses. The regularised/unregularised Cox results were more comparable to the AOANJRR standard by detecting one additional prosthesis at a higher risk of revision.

Conclusion

Machine learning may offer a supplementary approach for the identification of prosthesis outliers. However, further analysis is required to fully comprehend the effect of confounding factors and the potential contribution of ML to the early identification of outliers.

背景：膝关节置换手术对患者的影响可以通过联合登记来监测假体和识别表现不佳的异常装置。新的统计方法的研究可以通过考虑可能的混杂因素来帮助确定一个设备是否有更高的失效风险。有可能同时涉及多个变量的自学习算法是限制混杂因素影响的一种方法。本研究旨在评估两种机器学习（ML）技术，以检测全膝关节异常值，同时控制患者和设备相关的混淆。方法：利用随机生存森林（RSF）和正则/非正则Cox模型评估160个独特假肢中识别异常值的潜力。输入变量包括由澳大利亚骨科协会国家关节置换登记处（AOANJRR）提供的265,655例初级全膝关节手术的股骨/胫骨部件和患者特征。结果是第一次翻修手术的时间，作为死亡审查病例，AOANJRR金标准被定义为评估建议的ML方法有效性的标准。结果：在研究队列中，AOANJRR标准化方法检测到5种常规假体组合。Cox和RSF技术都确定了两个相同的全膝关节假体。通过检测一个具有较高翻修风险的额外假体，规范化/非规范化Cox结果与AOANJRR标准更具可比性。结论：机器学习为义肢异常点识别提供了一种补充方法。然而，需要进一步的分析来充分理解混杂因素的影响以及ML对早期识别异常值的潜在贡献。

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引用次数: 0

Variations in graft maturity between quadriceps tendon and semitendinosus tendon at 6 months after anterior cruciate ligament reconstruction: A quantitative assessment using UTE-T2* mapping 前交叉韧带重建后6个月股四头肌肌腱和半腱肌腱间移植物成熟度的变化：使用UTE-T2*制图的定量评估

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-12-19 DOI: 10.1016/j.knee.2025.104298

Yoshihiro Ishida , Yasushi Takata , Rikuto Yoshimizu , Yusuke Yanatori , Naoki Takemoto , Miho Okuda , Yu Ueda , Satoru Demura , Junsuke Nakase

Background

The semitendinosus (ST) tendon is commonly used as a graft in anterior cruciate ligament (ACL) reconstruction. However, there is growing interest in the quadriceps tendon (QT). The reconstructed ACL undergoes a remodeling process, and its tissue quality is an important factor in determining when to return to sports activities. It remains unclear whether there are differences in tissue quality between QT and ST grafts at the same postoperative stage. UTE-T2* mapping has gained attention as a method for quantitatively evaluating the organization of the reconstructed ACL. This study aimed to reveal differences in tissue quality and collagen organization between QT and ST grafts at 6 months after ACL reconstruction using UTE-T2* mapping.

Methods

In this retrospective comparative study, twenty patients who had undergone ACL reconstruction using the QT and ST were included. UTE-T2* mapping was performed 6 months after surgery. T2* value was measured at intraarticular, femoral tunnel and tibial tunnel site. Each value were compared between the two groups (The Mann–Whitney U test).

Results

In the QT group, the T2* values were 11.8 ± 1.3 ms (intra-articular), 7.8 ± 1.6 ms (tibial), and 8.9 ± 1.5 ms (femoral). In the ST group, the corresponding UTE-T2* values were 11.1 ± 2.2 ms, 7.5 ± 1.9 ms, and 10.8 ± 1.6 ms, respectively. Notably, a significant difference was observed between the two groups in the femoral site (P = 0.026).

Conclusions

QT grafts were more mature than ST grafts within the femoral tunnel six months after ACL reconstruction.

背景：半腱肌（ST）肌腱是前交叉韧带（ACL）重建中常用的移植物。然而，人们对股四头肌肌腱（QT）的兴趣越来越大。重建的前交叉韧带经历了一个重塑过程，其组织质量是决定何时恢复体育活动的重要因素。目前尚不清楚QT移植和ST移植在同一术后阶段的组织质量是否存在差异。作为一种定量评价重建ACL组织的方法，UTE-T2*映射已受到关注。本研究旨在通过UTE-T2*作图揭示ACL重建后6个月QT和ST移植的组织质量和胶原组织的差异。方法回顾性比较分析20例采用QT和ST行ACL重建的患者。术后6个月进行UTE-T2*测绘。在关节内、股骨隧道和胫骨隧道处测量T2*值。比较两组间各值（Mann-Whitney U检验）。结果QT组T2*值分别为关节内（11.8±1.3 ms）、胫骨（7.8±1.6 ms）、股骨（8.9±1.5 ms）。ST组对应的UTE-T2*值分别为11.1±2.2 ms、7.5±1.9 ms和10.8±1.6 ms。值得注意的是，两组在股骨部位的差异有统计学意义（P = 0.026）。结论前交叉韧带重建6个月后，在股骨隧道内，sqt移植比ST移植更成熟。

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引用次数: 0

Implant camouflage – how apparently excellent registry data can mask poor implant results: an international multi-centre case-control study 植入伪装——明显优秀的注册数据如何掩盖糟糕的植入结果：一项国际多中心病例对照研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-20 DOI: 10.1016/j.knee.2025.11.004

Gerard A. Sheridan , Michael E. Neufeld , Lisa C. Howard , David Keohane , Eric Masterson , Dan Cadoux-Hudson , Simon Tilley , Doug Dunlop , John Keith Tucker , Bassam A. Masri , Donald A. Garbuz

Background

The purpose of this research is to highlight a new issue facing national joint registries called ’Implant Camouflage’, whereby a poorly performing implant combination within an overall brand portfolio is hidden by other high performing implant combinations.

Methods

This was an international multi-centre case-control study assessing implant combinations within the NexGen® TKA portfolio. There were 9392 primary TKA components included with 1744 ‘high-risk’ cases and 7648 ‘standard-risk’ controls. The median time to follow-up was 7.4 (IQR 4.8–9.4) years in the cases and 10.4 (IQR 7.5–13.8) years in the control group. The primary outcome variable was revision for aseptic loosening. All-cause revision was a secondary outcome variable. Cox regression and Kaplan-Meier (KM) survival analysis was used to determine survivorship free of revision for aseptic loosening.

Results

The high-risk cases had significantly higher rates of revision for aseptic loosening (5.2 % v 0.4 %, p < 0.001) and all-cause revision (7.9 % v 2.9 %, p < 0.001). KM curves demonstrated higher rates of aseptic loosening in the high-risk cases with no intersection of 95 % confidence intervals with the controls. On univariate analysis, older age (p < 0.001) and higher BMI (p < 0.001) patients had significantly higher rates of revision for aseptic loosening. After multivariate analysis, the high-risk component cases were the most significant predictor of early failure for aseptic tibial loosening (p < 0.001).

Conclusions

The NexGen® Option-LPS Flex and Option-LPS GSF combinations have over a 10-fold higher revision rate for aseptic loosening when compared to other implant combinations in the NexGen® portfolio.

背景：本研究的目的是强调国家联合注册所面临的一个新问题，称为“种植体伪装”，即在整个品牌组合中表现不佳的种植体组合被其他高性能种植体组合所隐藏。方法：这是一项国际多中心病例对照研究，评估NexGen®TKA产品组合中的种植体组合。9392个主要TKA组成部分包括1744个“高风险”病例和7648个“标准风险”控制。中位随访时间：病例为7.4 （IQR 4.8-9.4）年，对照组为10.4 （IQR 7.5-13.8）年。主要结局变量为无菌性松动的翻修。全因修正是次要结局变量。采用Cox回归和Kaplan-Meier （KM）生存分析来确定无菌性松动不进行翻修的生存率。结果：高危病例的无菌松动翻修率明显更高（5.2% vs 0.4%, p）。结论：与NexGen®产品组合中的其他种植体组合相比，NexGen®Option-LPS Flex和Option-LPS GSF组合的无菌松动翻修率高出10倍以上。

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引用次数: 0

Evaluating the impact of revision knee arthroplasty networks in England: an analysis of temporal trends in referral patterns, surgical volumes and early outcomes using hospital episode statistics data for England between 2012 and 2024 评估英国翻修膝关节置换术网络的影响：使用2012年至2024年英格兰医院事件统计数据分析转诊模式、手术量和早期结果的时间趋势。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-21 DOI: 10.1016/j.knee.2025.11.006

Alexander H. Matthews , William K. Gray , Jonathan P. Evans , Tim Briggs , Andrew Porteous , Jonathan Phillips , Abtin Alvand , Benjamin Bloch , Paul Baker , Andrew Price , Andrew D. Toms

Background

In 2019, revision knee replacement (RevKR) services in England were reorganised into regional networks following the publication of clinical standards. These networks aim to improve outcomes through multidisciplinary decision-making and minimum surgical activity thresholds. This study examines changes in referral patterns, surgical volumes, and clinical outcomes before and after network implementation.

Methods

RevKR procedures from 1 April 2012 to 31 December 2024 were identified using the Hospital Episode Statistics. Descriptive analysis of patient level national data assessed trends in referral patterns (based on mismatches between patient residence and surgical location), volumes, and outcomes. Low-volume surgeons (<10 cases/year) and units (<30 cases/year) were identified. The primary outcome was one-year re-revision. Secondary outcomes included 90-day mortality, readmissions, and length of stay.

Results

Across 67,363 procedures, out-of-area referrals remained stable, with slight increases in London. Since 2021, low-volume practise has declined nationally, particularly in the Northwest, London, and Northeast & Yorkshire. One-year re-revision rates improved from 11.4 % in 2012 to 7.7 % in 2023. However, 90-day mortality rose, possibly due to increasing patient complexity. Some regions showed reduced hospital stays between 2022 and 2024 compared to the pre-COVID era.

Conclusion

The data suggest early signals of regions aligning with the implementation of revision networks, especially in the Northwest, Northeast & Yorkshire, and London regions. There are encouraging improvements in re-revision rates and hospital stays which may indicate potential benefits of the new model. As revision networks mature, strategies to increase surgical volume may be key to sustaining further improvements in patient outcomes.

背景：2019年，在临床标准发布后，英国的翻修膝关节置换术（RevKR）服务被重组为区域网络。这些网络旨在通过多学科决策和最低手术活动阈值来改善预后。本研究考察了网络实施前后转诊模式、手术量和临床结果的变化。方法：使用医院事件统计对2012年4月1日至2024年12月31日的RevKR手术进行识别。对患者水平的国家数据进行描述性分析，评估转诊模式（基于患者居住地和手术地点之间的不匹配）、数量和结果的趋势。结果：在67,363例手术中，地区外转诊保持稳定，伦敦略有增加。自2021年以来，在全国范围内，尤其是在西北部、伦敦、东北部和约克郡，小批量的做法有所下降。一年的重新修订率从2012年的11.4%提高到2023年的7.7%。然而，90天死亡率上升，可能是由于患者复杂性的增加。与疫情前相比，一些地区在2022年至2024年期间的住院时间有所减少。结论：这些数据显示了地区与修订网络实施一致的早期信号，特别是在西北、东北和约克郡以及伦敦地区。在重新修订率和住院时间方面有令人鼓舞的改进，这可能表明新模式的潜在好处。随着翻修网络的成熟，增加手术量的策略可能是维持进一步改善患者预后的关键。

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引用次数: 0

Factors associated with higher inpatient opioid consumption after primary total knee arthroplasty: a retrospective tertiary centre analysis 原发性全膝关节置换术后住院阿片类药物消耗增加的相关因素：回顾性三级中心分析。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-26 DOI: 10.1016/j.knee.2025.11.005

Moe Takenoshita , Andreas Fontalis , Anthony B. Lisacek-Kiosoglous , Tiffany Oliver , Andrew Robinson , Warran Wignadasan , Fares S. Haddad

Purpose

To characterize inpatient postoperative opiate consumption(OC) and identify risk factors associated with high OC among total knee arthroplasty(TKA) patients.

Methods

In this retrospective single centre cohort study, 1,550 TKAs from May 2019 to July 2023 were analysed using electronic healthcare records. Clinical data was collected, including anaesthesia type, post anaesthesia care unit(PACU) admissions, implant fixation, operative duration, peri-operative haemoglobin levels, surgical technique, as well as OC(oral morphine milliequivalents, MME) during inpatient stay. The correlation between OC 24 h post operatively and total inpatient OC, as well as average daily inpatient OC, were assessed with Spearman’s Rank-Order correlation coefficient. Multivariate logistic regression identified predictors of high opioid use, defined as the top quartile of total inpatient opioid consumption.

Results

The cohort included 1,077 females (69.5 %) and 473 males (30.5 %), with robotic TKA performed in 786 cases (50.7 %). Median OC MME for 0–24 h post op, 24–48 h post op and 48–72 h post op was 42 mg (IQR 21.0–70.1), 29 mg (12.0–45.0), 12 mg (0.0–30.0) respectively. Median total inpatient OC for the cohort was 96.0 mg MME (IQR = 49.0–165). Opiate use decreased by 71.4 % from day 1 to day 3 post operatively. Strong positive correlations were found between early OC (24–48 h post op) and total inpatient OC (rs(1548) = 0.717, p < 0.001). On average, 86.5 % of total inpatient opiates were consumed in the first 72 h post operatively. Higher opioid use was significantly associated with earlier admission year, younger age, increased body mass index(BMI), PACU admission, ASA 3 or 4 and general anaesthesia.

Conclusions

Daily opiate use fell rapidly by the third postoperative day, whilst high OC within the first 24–48 h was associated with higher opiate use overall. Younger age, higher BMI and general anaesthesia were associated with higher opiate use. These insights can help tailor pain management strategies for patients at higher risk of opioid reliance during their inpatient stay.

目的：分析全膝关节置换术（TKA）患者术后住院阿片类药物消耗（OC）的特征，并确定与高OC相关的危险因素。方法：在这项回顾性单中心队列研究中，使用电子医疗记录对2019年5月至2023年7月的1550名tka患者进行了分析。收集临床资料，包括麻醉类型、麻醉后护理单位（PACU）入院情况、植入物固定、手术时间、围术期血红蛋白水平、手术技术以及住院期间口服吗啡毫当量（口服吗啡毫当量，MME）。采用Spearman秩序相关系数评价术后24 h住院总住院OC与平均每日住院OC的相关性。多变量逻辑回归确定了阿片类药物高使用的预测因素，定义为住院阿片类药物总消费量的前四分之一。结果：该队列包括1,077例女性（69.5%）和473例男性（30.5%），其中786例（50.7%）进行了机器人TKA。术后0 ~ 24 h、24 ~ 48 h和48 ~ 72 h的中位OC MME分别为42 mg （IQR 21.0 ~ 70.1）、29 mg（12.0 ~ 45.0）、12 mg（0.0 ~ 30.0）。该队列的住院总OC中位数为96.0 mg MME （IQR = 49.0-165）。术后第1天至第3天阿片类药物使用下降71.4%。结论：术后第3天，每日阿片类药物使用量迅速下降，而术后第24-48小时内的高OC与总体阿片类药物使用量较高相关。较年轻、较高的BMI和全身麻醉与较高的阿片类药物使用有关。这些见解可以帮助为住院期间阿片类药物依赖风险较高的患者量身定制疼痛管理策略。

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引用次数: 0

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