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Background: The transition from revision total knee arthroplasty (RTKA) to arthrodesis involves the replacement of cemented femoral and tibial stems with a modular nail designed for arthrodesis. This conversion process is associated with challenges such as bone loss, blood loss, and prolonged surgical durations. Effectively addressing these complexities through a less invasive surgical approach could be pivotal in enhancing patient outcomes and minimizing associated complications. Case presentation: A 75-year-old white Caucasian female patient with a revision total knee arthroplasty (RTKA) performed with a modular uncemented rotating-hinge system, reporting an history of recurrent patellar dislocation, was referred to our institution after a fall resulting in periprosthetic tibial plateau fracture. The fracture was treated with open reduction and internal fixation, but afterwards the patient had been unable to walk again. Tibial stem was mobilized, and extensor mechanism was insufficient due to chronic incomplete quadriceps tendon rupture. The femoral stem was stable, so we decided to convert the rotating-hinge in a arthrodesis with an uncemented modular knee fusion nail maintaining the previous femoral stem. Conclusions: The result was a successful arthrodesis with minimal bone and blood loss, reduced operative time, and optimal functional outcome at the one-year follow-up. This case highlights the advantage of using a modular knee revision platform system that gives the opportunity to convert a RTKA in arthrodesis. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the survival rate and medium-term outcomes of patients after cemented posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) using a telemedicine platform during the COVID-19 pandemic in Italy. Methods: A total of 100 consecutive patients (mean age 73.5 ± 13.2 years) who received a cemented PS MB TKA were enrolled. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. A dedicated software that makes it possible to perform video calls, online questionnaires, and acquire X-rays remotely was used. Subjective clinical scores and objective range-of-motion (ROM) measurements were observed at an average follow-up of 54 ± 11.3 months. Results: A total of 42 of 100 enrolled patients (mean age 70.3 ± 8.4 years) completed the telemedicine follow-up. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. Age was found to be a statistically significant difference between the group that completed the telemedicine follow-up and the one that did not (p < 0.004). KOOS scores improved from 56.1 ± 11.3 to 77.4 ± 16.2, VAS scores decreased from 7.2 ± 2.1 to 2.8 ± 1.6, KSSf scores increased from 47.2 ± 13.3 to 77.1 ± 21.1, FJS scores improved from 43.4 ± 12.3 to 76.9 ± 22.9, and OKS scores increased from 31.9 ± 8.8 to 40.4 ± 9.9. All the differences were statistically significant (p < 0.05). The mean flexion improved from 88° ± 8° to 120° ± 12°. A radiographic evaluation showed a mean pre-operative mechanical axis deviation of 5.3 ± 8.0 degrees in varus, which improved to 0.4 ± 3.4 degrees of valgus post-operation. The survivorship at 5 years was 99%. Conclusions: Subject to small numbers, telemedicine presented as a useful instrument for performing remote monitoring after TKA. The most important factor in telemedicine success remains the patient's skill, which is usually age-related, as older patients have much more difficulty in approaching a technological tool. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcome measures (PROMs) are increasingly being used to assess the effectiveness of elective total knee arthroplasty (TKA). However, little is known about how PROMs scores change over time in these patients. The aim of this study was to identify the trajectories of quality of life and joint functioning, and their associated demographic and clinical features in patients undergoing elective TKA. Methods: A prospective, cohort study was conducted, in which PROMs questionnaires (Euro Quality 5 Dimensions 3L, EQ-5D-3L, and Knee injury and Osteoarthritis Outcome Score Patient Satisfaction, KOOS-PS) were administered to patients at a single center undergoing elective TKA before surgery, and at 6 and 12 months after surgery. Latent class growth mixture models were used to analyze the patterns of change in PROMs scores over time. Multinomial logistic regression was used to investigate the association between patient characteristics and PROMs trajectories. Results: A total of 564 patients were included in the study. The analysis highlighted differential patterns of improvement after TKA. Three distinct PROMs trajectories were identified for each PROMs questionnaire, with one trajectory indicating the most favorable outcome. Female gender appears to be associated with a presentation to surgery with worse perceived quality of life and joint function than males, but also more rapid improvement after surgery. Having an ASA score greater than 3 is instead associated with a worse functional recovery after TKA. Conclusion: The results suggest three main PROMs trajectories in patients undergoing elective TKA. Most patients reported improved quality of life and joint functioning at 6 months, which then stabilized. However, other subgroups showed more varied trajectories. Further research is needed to confirm these findings and to explore the potential clinical implications of these results. [ABSTRACT FROM AUTHOR]

Background: "Windswept" deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. Methods: A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). Results: All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. Conclusion: The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. Level of evidence: II —Systematic review of cohort studies. [ABSTRACT FROM AUTHOR]

Purpose: The study aims were to assess the kinematic data, Internal-External (IE) rotation, and Antero-Posterior (AP) translation of the contact points between the femoral condyles and polyethylene insert and to develop a combined dynamic RSA-FE (Radiostereometric – Finite Element) model that gives results congruent with the literature. Methods: A cohort of 15 patients who underwent cemented cruciate-retaining highly congruent mobile-bearing total knee arthroplasty were analyzed during a sit-to-stand motor task. The kinematical data from Dynamic RSA were used as input for a patient-specific FE model to calculate condylar contact points between the femoral component and polyethylene insert. Results: The femoral component showed an overall range about 4 mm of AP translation during the whole motor task, and the majority of the movement was after 40° of flexion. Concerning the IE rotation, the femoral component started from an externally rotate position (− 6.7 ± 10°) at 80° of flexion and performed an internal rotation during the entire motor task. The overall range of the IE rotation was 8.2°. Conclusions: During the sit to stand, a slight anterior translation from 40° to 0° of flexion of the femoral component with respect to polyethylene insert, which could represent a paradoxical anterior translation. Despite a paradoxical anterior femoral translation was detected, the implants were found to be stable. Dynamic RSA and FE combined technique could provide information about prosthetic component's stress and strain distribution and the influence of the different designs during the movement. [ABSTRACT FROM AUTHOR]

Background: Careful pre- and post-operative management can allow surgeons to perform outpatient TKA, making this a more affordable procedure. The aim of the present meta-analysis is to compare outpatient and inpatient TKA. Methods: A systematic search of the literature was performed in July 2020 on PubMed, Web of Science, Cochrane library, and on the grey literature databases. The papers collected were used for a meta-analysis comparing outpatient and inpatient TKA in terms of complication and readmission rates. Risk of bias and quality of evidence were defined according to Cochrane guidelines. Results: The literature search resulted in 4107 articles; of these, 8 articles were used for the meta-analysis. A total of 212,632 patients were included, 6607 of whom were TKA outpatients. The overall complication rate for outpatient TKAs was 16.1%, while inpatient TKAs had an overall lower complication rate of 10.5% (p = 0.003). The readmission rate was 4.9% in outpatient TKAs and 5.9% in inpatient TKAs. Only 3 studies reported the number of deaths, which accounted for 0%. The included studies presented a moderate risk of bias, and according to GRADE guidelines, the level of evidence for complications and readmissions was very low. Conclusions: This meta-analysis documented that outpatient TKA led to an increased number of complications although there were no differences in the number of readmissions. However, future high-level studies are needed to confirm results and indications for the outpatient approach, since the studies currently available have a moderate risk of bias and a very low quality of evidence. [ABSTRACT FROM AUTHOR]

Background: This 1-stage cell-free scaffold-based technique is indicated for the treatment of full-thickness chondral and osteochondral lesions in the knee, regardless of the lesion size. The aim of the procedure is restoration of the osteochondral unit while avoiding the issues of donor site morbidity and those related to cell management. Description: The surgical technique is simple and can be performed as a 1- stage procedure. The lesion site is visualized through a standard knee medial or lateral parapatellar arthrotomy. The defect is prepared by excision of the injured cartilage and subchondral bone to ensure adequate bone-marrow blood flow and to create a squared, regularly shaped lodging for the device. The scaffold is then shaped and sized according to the dimensions of the prepared lesion site and implanted by press-fitting or with addition of fibrin glue. Finally, the complete range of motion is tested to assess the stability of the implant before and after releasing the tourniquet. Alternatives: Nonsurgical alternatives have been reported to include nonpharmacological modalities, such as dietary supplements, and pharmacological therapies as well as physical therapies and novel biological procedures involving injections of various substances1. There are several surgical alternatives, including among others microfracture, mosaicplasty, osteochondral allograft, and total knee arthroplasty, depending primarily on the disease stage and etiology as well as the specific patient conditions2,3. Rationale: This cell-free device is engineered in 3 layers to mimic the structure and composition of the osteochondral unit in order to guide resident cells toward an ordered regeneration of both bone and cartilage layers, providing a better quality of regenerated articular surface. The treatment approach offers a useful alternative to current procedures in the field of osteochondral lesions, in particular for young and middle-aged patients affected by symptomatic defects in which subchondral bone is likely involved. The advantages of this scaffold include the ability to perform a 1-stage surgical procedure, off-the-shelf availability, a straightforward surgical technique, and lower costs compared with cell-based regenerative options. Furthermore, in contrast to some more traditional treatments, it can be used for large lesions. [ABSTRACT FROM AUTHOR]

Objectives: Falls occur frequently in patients with impaired ambulation and may dramatically affect the elderly population. Aim was to document the incidence of falls in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA), and to identify factors and treatments that may influence the risk of falls. Methods: A systematic literature search was conducted on three medical electronic databases, PubMed, PeDRO, and Cochrane Collaboration. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used. Risk of bias analysis and best evidence synthesis were performed. The main aspects related to falls were analyzed: prevalence, risk factors, correlation with clinical outcome, effect of treatments. Results: The systematic review identified 11 papers on 1237 patients. Pre-operative fall prevalence ranged from 23% to 63%, while post-operative values ranged from 12% to 38%. Moderate evidence was found on no influence of clinical scales, no BMI differences between "faller" and "non-faller", and on influence of limited preoperative range of motion. Conflicting evidence was found for sex, history of previous falls, age, kyphosis, muscle weakness, fear of falling, depression, balance, gait impairment. No evidence was found for the effectiveness of surgical or rehabilitative strategies on falls reduction. Conclusions: OA patients undergoing TKA are at high risk of falls, which is reduced but still present after surgery. Although some risk factors were identified, there are no studies demonstrating the possibility of reducing the incidence of this deleterious event, which warrants further research efforts to better manage this fragile population of elderly patients. [ABSTRACT FROM AUTHOR]

Background: Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate. Questions/purposes: We compared The Knee Society Score (KSS), incidences of complications, maximum knee flexion, residual extension lag, and reinfection rate in patients with prosthetic knee infections treated with two-stage RTKAs using either the tibial tubercle osteotomy (TTO) or the quadriceps snip (QS) for exposure at the time of reimplantation. Methods: We prospectively followed 81 patients with chronic prosthetic knee infections treated between 1997 and 2004. Patients were randomized to receive a TTO or QS for exposure at the time of reimplantation. All patients had the same rehabilitation protocol. The minimum followup was 8 years (mean, 12 years; range, 8-15 years). Results: Patients in the TTO group had a higher mean KSS than the QS group (88 versus 70, respectively). Mean maximum knee flexion was greater in the TTO group (113° versus 94°); with a lower incidence of extension lag (45% versus 13%). We observed no differences in reinfection rate between groups. Conclusions: We found the TTO combined with an early rehabilitation protocol associated with superior KSS did not impair extensor mechanism function or increase the reinfection rate. We believe a two-stage RTKA with TTO is a reasonable approach for treating prosthetic knee infections. Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]