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Background: Knee arthroplasty procedures improve pain, function, stability, and appearance of the limb. Total knee arthroplasty (TKA) in severe, long-standing osteoarthritis (OA) with large medial tibial defects could be a challenge. This paper looks at TKA outcomes when large tibial defects are managed without metal wedges or stems.Methods: TKA cases done for OA with tibial defects of 15-25 mm, without any metal wedge or stem from 2004 to 2017 by a single surgeon in Shiraz, Iran, were clinically and radiographically evaluated. The preoperative questionnaires of SF36, WOMAC, KSS, and radiographs were compared with the follow-up assessments of the same parameters. Data were analyzed by R programming language using student t test, ANOVA, and Kruskal-Wallis. P

About 1.5% of patients undergoing total hip (THA) or total knee arthroplasty (TKA) still develop postoperative venous thromboembolism (VTE), indicating that the current thromboprophylaxis strategy is not optimal. To evaluate the feasibility of therapeutic dosages of direct oral anticoagulants (DOACs) as thromboprophylaxis for high VTE risk patients, we determined the risks of major bleeding and VTE in patients who underwent THA/TKA and were treated with DOACs in therapeutic dosages for atrial fibrillation (AF). We conducted a registry-based cohort study from 2010 to 2018 in Denmark and included AF patients on therapeutic DOACs dose who underwent THA/TKA. AF patients were utilized as proxy since they have a life-long indication for therapeutic anticoagulant medication. The 49-days cumulative incidence (with death as competing risk) of major bleeding was assessed. The same was done for VTE at 49- and 90-days. 1,354 THA and TKA procedures were included. The 49-days cumulative incidence of major bleeding was 1.40% (95%Confidence Interval[CI] 0.88–2.14%). Most bleeding events occurred at the surgical site. The cumulative incidence of VTE at 49-days was 0.59% (95%CI 0.28–1.13%) and 0.74% (95%CI 0.38–1.32%) at 90-days. The incidence of major bleeding in THA/TKA patients on DOACs in therapeutic dosages was in line with previously reported incidences among THA/TKA patients on thromboprophylaxis dosages, while the incidence of VTE was relatively low. These data provide a solid basis for the design of randomized controlled trials to establish the safety and efficacy of therapeutic dosages of DOACs to prevent VTE in high-risk patients. Essentials: • Some arthroplasty patients still develop venous thromboembolism (VTE), despite thromboprophylaxis. • We assessed the feasibility of DOACs used in therapeutic dosage as thromboprophylaxis in high-risk THA/TKA patients. • Observed risks of major bleeding and VTE were 1.40% (49-days) and 0.74% (90-days), respectively. • A randomized clinical trial investigating the possible benefit of therapeutic dosages of DOACs as prophylactic strategy in high-risk arthroplasty patients seems a feasible next step. [ABSTRACT FROM AUTHOR]

Abstract Background There is a lack of relevant studies to grade the evidence on the risk factors of chronic pain after total knee arthroplasty (TKA), and only quantitative methods are used for systematic evaluation. The review aimed to systematically identify risk factors of chronic postoperative pain following TKA and to evaluate the strength of the evidence underlying these correlations. Methods PubMed, Web of Science, Cochrane Library, Embase, and CINAHL databases were searched from initiation to September 2023. Cohort studies, case-control studies, and cross-sectional studies involving patients undergoing total knee replacement were included. A semi-quantitative approach was used to grade the strength of the evidence-based on the number of investigations, the quality of the studies, and the consistency of the associations reported by the studies. Results Thirty-two articles involving 18,792 patients were included in the final systematic review. Ten variables were found to be strongly associated with postoperative pain, including Age, body mass index (BMI), comorbidities condition, preoperative pain, chronic widespread pain, preoperative adverse health beliefs, preoperative sleep disorders, central sensitization, preoperative anxiety, and preoperative function. Sixteen factors were identified as inconclusive evidence. Conclusions This systematic review clarifies which risk factors could be involved in future research on TKA pain management for surgeons and patients. It highlights those factors that have been controversial or weakly correlated, emphasizing the need for further high-quality studies to validate them. Most crucially, it can furnish clinicians with vital information regarding high-risk patients and their clinical attributes, thereby aiding in the development of preventive strategies to mitigate postoperative pain following TKA. Trial registration This systematic review has been registered on the PROSPERO platform (CRD42023444097).

Introduction: Length of stay (LOS) has been extensively assessed as a marker for healthcare utilization, functional outcomes, and cost of care for patients undergoing arthroplasty. The notable patient-to-patient variation in LOS following revision hip and knee total joint arthroplasty (TJA) suggests a potential opportunity to reduce preventable discharge delays. Previous studies investigated the impact of social determinants of health (SDoH) on orthopaedic conditions and outcomes using deprivation indices with inconsistent findings. The aim of the study is to compare the association of three publicly available national indices of social deprivation with prolonged LOS in revision TJA patients. Materials and methods: 1,047 consecutive patients who underwent a revision TJA were included in this retrospective study. Patient demographics, comorbidities, and behavioral characteristics were extracted. Area deprivation index (ADI), social deprivation index (SDI), and social vulnerability index (SVI) were recorded for each patient, following which univariate and multivariate logistic regression analyses were performed to determine the relationship between deprivation measures and prolonged LOS (greater than five days postoperatively). Results: 193 patients had a prolonged LOS following surgery. Categorical ADI was significantly associated with prolonged LOS following surgery (OR = 2.14; 95% CI = 1.30–3.54; p = 0.003). No association with LOS was found using SDI and SVI. When accounting for other covariates, only ASA scores (ORrange=3.43–3.45; p < 0.001) and age (ORrange=1.00–1.03; prange=0.025–0.049) were independently associated with prolonged LOS. Conclusion: The varying relationship observed between the length of stay and socioeconomic markers in this study indicates that the selection of a deprivation index could significantly impact the outcomes when investigating the association between socioeconomic deprivation and clinical outcomes. These results suggest that ADI is a potential metric of social determinants of health that is applicable both clinically and in future policies related to hospital stays including bundled payment plan following revision TJA. [ABSTRACT FROM AUTHOR]

Background: There is a lack of relevant studies to grade the evidence on the risk factors of chronic pain after total knee arthroplasty (TKA), and only quantitative methods are used for systematic evaluation. The review aimed to systematically identify risk factors of chronic postoperative pain following TKA and to evaluate the strength of the evidence underlying these correlations. Methods: PubMed, Web of Science, Cochrane Library, Embase, and CINAHL databases were searched from initiation to September 2023. Cohort studies, case-control studies, and cross-sectional studies involving patients undergoing total knee replacement were included. A semi-quantitative approach was used to grade the strength of the evidence-based on the number of investigations, the quality of the studies, and the consistency of the associations reported by the studies. Results: Thirty-two articles involving 18,792 patients were included in the final systematic review. Ten variables were found to be strongly associated with postoperative pain, including Age, body mass index (BMI), comorbidities condition, preoperative pain, chronic widespread pain, preoperative adverse health beliefs, preoperative sleep disorders, central sensitization, preoperative anxiety, and preoperative function. Sixteen factors were identified as inconclusive evidence. Conclusions: This systematic review clarifies which risk factors could be involved in future research on TKA pain management for surgeons and patients. It highlights those factors that have been controversial or weakly correlated, emphasizing the need for further high-quality studies to validate them. Most crucially, it can furnish clinicians with vital information regarding high-risk patients and their clinical attributes, thereby aiding in the development of preventive strategies to mitigate postoperative pain following TKA. Trial registration: This systematic review has been registered on the PROSPERO platform (CRD42023444097). [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of adductor canal block combined with general anesthesia on postoperative pain and cognitive function in elderly patients undergoing total knee arthroplasty (TKA). Methods A total of 72 elderly patients undergoing elective TKA were selected and divided into the control group and the observation group with 36 patients in each group using a random number table method. The control group was given simple general intravenous anesthesia, and the observation group received adductor canal block under ultrasound guidance combined with general anesthesia. Both groups of patients were connected to patient-controlled intravenous analgesia (PCIA) pumps after surgery. Data of heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at the time of entering the operating room (T0), insertion of the laryngeal mask (T1), 30 minutes after the start of surgery (T2) and the end of surgery (T3). Visual analog scale (VAS) pain scores were recorded in the first 48 hours postoperatively. Levels of C-reactive protein (CRP), interleukin-6 (IL-6) and Mini-Mental State Examination (MMSE) scores were recorded 3 days after surgery. Additionally, the dosage of propofol and sufentanil, PCIA press times, awakening time, extubation time, first time out of bed and length of hospital stay were compared between the two groups. Results Compared with the control group, the observation group showed a decrease in HR at T1 and T3, and an increase in SBP and DBP (P＜0.05). In comparison with the control group, the observation group showed lower VAS scores, along with reduced CRP and IL-6 levels, and higher MMSE scores (P＜0.05) at the same postoperative time points. Patients in the observation group showed reduced doses of propofol and sufentanil, fewer PCIA presses, shorter postoperative recovery, extubation, first time out of bed and hospital stay than those of patients in the control group (P＜0.05). Conclusion The application of ultrasound-guided adductor canal block combination with general anesthesia helps alleviate postoperative pain, relieve stress responses and improve cognitive function level in elderly patients with total knee replacement surgery. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the distribution of coronal plane alignment of the knee (CPAK) classification and functional knee phenotypes in a Chinese osteoarthritis (OA) population and to compare different lower limb alignment targets according to the distribution characteristics to find suitable total knee arthroplasty (TKA) bone cut strategies for the Chinese OA patients. Methods: The computed tomography (CT) images were retrospectively collected and the three‐dimensional (3D) models were reconstructed from 434 Chinese OA patients, including 93 males and 341 females, with a mean age of 66.4 ± 9.3 years. Femoral mechanical angle (FMA), tibial mechanical angle (TMA) and mechanical hip–knee–ankle angle (mHKA) were measured on the 3D models. Arithmetic hip–knee–ankle angle (aHKA) was calculated using FMA plus TMA, and joint line obliquity was calculated as 180 + TMA–FMA. The CPAK according to MacDessi and the functional knee phenotypes according to Hirschmann were performed. In addition, the suitable TKA bone cut strategies were explored according to the phenotypes and based on the characteristics of different alignment targets, such as mechanical alignment, anatomic alignment (AA), kinematic alignment, restricted KA (rKA) and adjusted MA (aMA). Statistical differences were determined using the independent‐samples t‐test or the two independent‐samples Wilcoxon test, with p < 0.05 considered statistically significant. Results: The Chinese OA population showed a varus alignment tendency (mHKA = 172.1° ± 7.2°), to which the TMA was a major contributor (TMA = 84.7° ± 4.4° vs. FMA = 91.3° ± 3.2°). The mHKA was on average 3.9° more varus than the aHKA. A total of 140 functional knee phenotypes were found and 45.6% were concentrated in VARFMA3°–NEUFMA0° to VARTMA3°–NEUTMA0°. More than 70% of patients had different FMA and TMA phenotypes. There were 92.9% of CPAK distributed in types I to IV, with type I accounting for 53.9%. The FMA phenotypes were less changed if the aMA and rKA were chosen, and the TMA phenotypes were less changed if the AA and rKA were chosen. Conclusion: Compared with the CPAK, the functional knee phenotypes were more suitable for the Chinese OA population with a wide distribution and a varus tendency, and it seemed more appropriate to choose aMA and rKA as TKA alignment targets for resection. Level of Evidence: Level Ⅲ. [ABSTRACT FROM AUTHOR]

Functional assessments are crucial for the evaluation of rehabilitation after total knee (TKA) and hip (THA) arthroplasty. Muscle strength, a key determinant of physical function (PF), is often measured with isokinetic dynamometry (ID), which is considered the gold standard. However, studies lack evaluations of responsiveness—the ability to detect changes over time. This study aims to determine the responsiveness of ID in measuring PF in TKA and THA rehabilitation—is muscle strength a valid indicator for assessing improvement in rehabilitation processes? The pre- and post-surgery PF of 20 osteoarthritis patients (age 55–82) was assessed, using ID, performance-based and self-reported measures. Responsiveness was evaluated by comparing the observed relationship of changes in ID and PF scores with the a priori defined expected relationship of change scores. While the performance-based and self-reported measures showed significant improvements post-surgery (Cohen's d [0.42, 1.05] p < 0.05), ID showed no significant differences. Moderate correlations were found between changes in some ID parameters and selected functional tests (r ≈|0.5|, p < 0.05). Responsiveness was solely found for the peak torque of knee extension at 180°/s on the operated side. Responsiveness is an often-overlooked psychometric property of outcome measurements. The findings suggest that ID may not be fully responsive to the construct of PF after TKA and THA, raising questions about its role and usefulness in this context and the need for more appropriate assessment methods. [ABSTRACT FROM AUTHOR]

Objective To investigate the influence of preoperative lipids and glucose on the postoperative recovery of patients undergoing total knee arthroplasty (TKA) for knee osteoarthritis (KOA). Methods Clinical data were collected from 492 patients with KOA who were hospitalized and underwent surgical treatment in Department of Joint Surgery, The Affiliated Hospital of Qingdao University, from January 2021 to January 2022, including general clinical data and related blood biochemical para-meters in the fasting state before surgery. American Knee Society (AKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded for the patients at six months after surgery, and WOMAC score 35 was considered poor postoperative recovery; AKS score >70 was consi-dered good postoperative recovery, and AKS score

Abstract Objective: To identify blood transfusion requirements and postoperative complications in patients undergoing total knee arthroplasty (TKA) with no tourniquet and intraoperative intravenous administration of tranexamic acid. Methods: This retrospective observational study analyzed 49 preopeative and postoperative medical records of patients undergoing TKA. A paired t-test compared changes in hemoglobin (HB) and packed cell volume (PCV), and an independent t-test with Welch correction compared HB and PCV changes between genders. A Spearman correlation test determined associations between age and days of postoperative hospitalization with HB and PCV changes. The significance level adopted was p < 0.05. Results: The patients' mean age was 71.9 ± 6.7 years; most subjects were women (73.5%). The right side (59.2%) was the most affected. Only one participant required a blood transfusion, while three subjects had complications during the postoperative follow-up. No patient had a thromboembolic event. The median length of postoperative hospital stay was 2 days (interquartile range [IQR] = 1.0). There were reductions in HB and PCV levels between the pre-operative and postoperative period, and female patients had a higher HB reduction. Conclusion: TKA with tranexamic acid and no tourniquet did not cause significant postoperative complications or require blood transfusions.

Abstract Objective This study evaluated and compared the tibial component migration in cemented and uncemented total knee arthroplasty (TKA) with no hydroxyapatite coating 2, 5, and 10 years after surgery. Methods This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) based on PubMed and MeSH database queries from June to July 2022. Results The meta-analysis included eight randomized clinical studies evaluating 668 knees undergoing TKA. The maximum total point motion (MTPM) in cemented TKAs was higher in 5 years, with a mean value of 0.67 mm (95% confidence interval [CI], 0.52 to 0.87). Uncemented TKAs also presented higher mean MTPM in 5 years (1 mm; 95% CI, 0.82 to 1.22). Uncemented coated ATKs had a higher mean MTPM in 10 years (1.30 mm; 95% CI, 0.70 to 2.39). MTPM was statistically similar in the short- and long-term for cemented and uncemented techniques, with a standardized mean difference of -0.65 (95% CI, -1.65 to 0.35). Conclusion Tibial component migration in TKA was statistically similar at 2, 5, and 10 years in cemented and uncemented techniques, either with or without coating. However, due to the scarce literature, further studies are required with a longer follow-up time.

Abstract Objective The objective of this work is to compare blood loss during primary knee arthroplasty with the use of intravenous and intraarticular (IV + IA) tranexamic acid versus intraarticular (IA) tranexamic acid alone. Methods This is a randomized, double-blind clinical trial. Patients with indication for primary total knee arthroplasty were recruited in a specialized clinic, where they were operated by the same surgeon, always using the same surgical technique. Thirty patients were allocated in the IV + IA tranexamic acid group and 30 patients in the IA tranexamic acid group, according to randomization. Blood loss was compared through hemoglobin, hematocrit, drain volume, and blood loss estimation (Gross and Nadler calculus). Results After collection, data from 40 patients were analyzed, 22 in the IA group and 18 in the IV +IA group. There were 20 losses due to collection error. Between groups IA and IV + IA, there were no significant differences in 24 hours between hemoglobin levels (10.56 vs. 10.65 g/dL; F1.39 = 0.63, p =0.429), erythrocyte (3.63 vs. 3.73 million/mm³; F1.39 = 0.90, p = 0.346); hematocrit (32.14 vs. 32.60%; F1.39 = 1.39, p = 0.240); drainage volume (197.0 vs. 173.6 mL; F1.39 = 3.38 p = 0.069); and estimated blood loss (1,002.5 vs. 980.1; F1.39 =0.09, p = 0.770). The same occurred in comparisons conducted after 48 hours postoperatively. Time was a significant factor for the change of all outcome variables. However, the treatment did not modify the effect of time on these outcomes. No individual presented any thromboembolic event during the work period. Conclusions The use of IV + IA tranexamic acid showed no advantage in reducing blood loss when compared to the use of IA tranexamic acid alone in primary knee arthroplasties. This technique proved to be safe, since no thromboembolic event occurred during the development of the work.

Abstract Objective With the increasing prevalence of osteoarthritis of the hip and knee, total joint replacement, the end-stage treatment, provides pain relief and restoration of function, but is often associated with massive blood loss. Tranexamic acid (TXA) has been reported to reduce perioperative blood loss in hip or knee arthroplasty. However, the optimal dose of TXA administration remains controversial. Therefore, we performed a meta-analysis combining data from 5 trials comparing the efficacy and safety of one fixed dose of 1 g intravenously administered TXA with two doses of 1 g each administered intravenously for hip or knee arthroplasty. Methods PubMed, Medline, Embase, Web of Science, and The Cochrane Library were searched from January 2000 to February 2023. Our meta-analysis included randomized controlled trials and cohort studies comparing the efficacy and safety of different doses of intravenous TXA (IV-TXA) for THA or TKA. The observation endpoints included total blood loss, postoperative hemoglobin drop, blood transfusion rate, length of hospital stay, incidence of deep venous thrombosis (DVT), and incidence of pulmonary embolism (PE). Meta-analysis was performed according to Cochrane's guidelines and PRISMA statement. The Danish RevMan5.3 software was used for data merging. Results Five cohort studies involving 5542 patients met the inclusion criteria. Our meta-analysis showed that the two groups were significantly higher in total blood loss (mean difference (MD) = − 65.60, 95% confidence interval (CI) [− 131.46, 0.26], P = 0.05); blood transfusion rate (risk difference (RD) = 0.00, 95% CI [− 0.01, 0.02], P = 0.55); postoperative hemoglobin (MD = 0.02, 95% CI [− 0.09, 0.13], P = 0.31); postoperative hospital stay days (MD = − 0.13), 95% CI [− 0.35, 0.09], P = 0.25); DVT (RD = 0.00, 95% CI [− 0.00, 0.01], P = 0.67); PE (RD = 0.00, 95% CI [− 0.01, 0.00], P = 0.79). There was some inherent heterogeneity due to variance in sample size across each major study. Conclusion 1 dose of 1 g and 2 doses of 1 g IV-TXA each time have similar effects on reducing blood loss, blood transfusion rate, postoperative hemoglobin level, and postoperative hospital stay after TKA or THA, without increasing the risk of postoperative complications risk. For patients at high risk of thromboembolic events, one dose of 1 g TXA throughout surgery may be preferred. However, higher-quality RCT is needed to explore the optimal protocol dose to recommend the widespread use of TXA in total joint arthroplasty. Trial registration We conducted literature selection, eligibility criteria evaluation, data extraction and analysis on the research program registered in Prospero (CRD42023405387) on March 16, 2023.

Objective: With the increasing prevalence of osteoarthritis of the hip and knee, total joint replacement, the end-stage treatment, provides pain relief and restoration of function, but is often associated with massive blood loss. Tranexamic acid (TXA) has been reported to reduce perioperative blood loss in hip or knee arthroplasty. However, the optimal dose of TXA administration remains controversial. Therefore, we performed a meta-analysis combining data from 5 trials comparing the efficacy and safety of one fixed dose of 1 g intravenously administered TXA with two doses of 1 g each administered intravenously for hip or knee arthroplasty. Methods: PubMed, Medline, Embase, Web of Science, and The Cochrane Library were searched from January 2000 to February 2023. Our meta-analysis included randomized controlled trials and cohort studies comparing the efficacy and safety of different doses of intravenous TXA (IV-TXA) for THA or TKA. The observation endpoints included total blood loss, postoperative hemoglobin drop, blood transfusion rate, length of hospital stay, incidence of deep venous thrombosis (DVT), and incidence of pulmonary embolism (PE). Meta-analysis was performed according to Cochrane's guidelines and PRISMA statement. The Danish RevMan5.3 software was used for data merging. Results: Five cohort studies involving 5542 patients met the inclusion criteria. Our meta-analysis showed that the two groups were significantly higher in total blood loss (mean difference (MD) = − 65.60, 95% confidence interval (CI) [− 131.46, 0.26], P = 0.05); blood transfusion rate (risk difference (RD) = 0.00, 95% CI [− 0.01, 0.02], P = 0.55); postoperative hemoglobin (MD = 0.02, 95% CI [− 0.09, 0.13], P = 0.31); postoperative hospital stay days (MD = − 0.13), 95% CI [− 0.35, 0.09], P = 0.25); DVT (RD = 0.00, 95% CI [− 0.00, 0.01], P = 0.67); PE (RD = 0.00, 95% CI [− 0.01, 0.00], P = 0.79). There was some inherent heterogeneity due to variance in sample size across each major study. Conclusion: 1 dose of 1 g and 2 doses of 1 g IV-TXA each time have similar effects on reducing blood loss, blood transfusion rate, postoperative hemoglobin level, and postoperative hospital stay after TKA or THA, without increasing the risk of postoperative complications risk. For patients at high risk of thromboembolic events, one dose of 1 g TXA throughout surgery may be preferred. However, higher-quality RCT is needed to explore the optimal protocol dose to recommend the widespread use of TXA in total joint arthroplasty. Trial registration We conducted literature selection, eligibility criteria evaluation, data extraction and analysis on the research program registered in Prospero (CRD42023405387) on March 16, 2023. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Distal femoral and proximal tibial fractures often lead to nonunion and post-traumatic osteoarthritis, and total knee arthroplasty (TKA) has emerged as an effective alternative for older patients. This report includes 3 cases of successful TKA treatment. The cases involve a 42-year-old man and a 62-year-old man with Hoffa coronal fractures of the distal femur, and a 50-year-old man with a proximal tibial fracture. These patients underwent multiple osteosynthesis procedures before receiving TKA. Case Reports: Case 1: A 42-year-old man with a displaced Hoffa's fracture had persistent knee pain. Nonunion post-initial fixation led to reoperation with iliac bone grafting and plate fixation. TKA using a Posterior Stabilized (PS)-type implant resulted in improved motion and function after 3 years. Case 2: A 62-year-old man suffered lateral condyle and ligament injuries from a displaced Hoffa's fracture. Despite plate fixation, dislocation occurred, requiring conversion. TKA with long-stem hinge-type implant, using augmentation block, led to enhanced stability and outcomes at 2 years. Case 3: A 50-year-old man's tibial nonunion, treated with plate fixation, resulted in infection and bone fusion. TKA using a constrained PS-type implant insert addressed the lateral tibial adhesions via iliotibial band (ITB) release and treated severe tibial plateau damage. Positive results were seen at 1 year. Conclusions: The challenges of pseudarthrosis, like bone defects and compromised tissue, highlight the need for precise implant selection based on evaluations of bone quality, defects, knee stability, and hyperextension, rather than resorting to overly-constrained implants. [ABSTRACT FROM AUTHOR]

Abstract Objective To compare the level of quality of life and satisfaction after two years of total knee arthroplasties between individuals above and below 65 years of age and to identify predictor factors of poor clinical outcome and low level of satisfaction in patients undergoing arthroplasty. Methods This is a retrospective cohort with data from patients diagnosed with knee osteoarthritis submitted to primary total knee arthroplasty from 2014 to 2018 (n= 190). Clinical outcomes were assessed using the following scores: visual analog scale (VAS) of pain, EQ-5D-3L and EUROQOL-VAS (quality of life scales), patient satisfaction level, and functional scale of the Knee Injury and Osteoarthritis Outcome Score (KOOS), collected through a questionnaire applied preoperatively, as well as 1, 3, 12 and 24 months after surgery. Results Patients < 65 years old presented significantly lower values (clinical worsening) in KOOS-pain and KOOS-symptoms. There are no differences in the principal clinical scores that assess pain, function, and quality of life after the procedure, as well as in the rate of satisfaction with the procedure, among patients < 65 years old when compared with patients ≥ 65 years old. It was also observed that patients who were not satisfied with the procedure in the 24-month evaluation presented clinical results in some analyzed scores (KOOS-pain and EQ-VAS) similar to patients who declared themselves satisfied. Conclusion Scores that assess pain, function, quality of life, as well as satisfaction rate are similar between patients < 65 years old and those ≥ 65 years old.

Abstract Objective To compare the measurement of patellar height in the pre- and postoperative period of total knee arthroplasties (TKAs) and its variation in patients with and without patellar replacement. Methods Retrospective evaluation of radiographs of patients submitted to TKA between 2014 and 2020. Profile radiographs were evaluated using the modified Caton-Deschamps patellar height index, comparing the pre- and postoperative measurements of 90 patients, with a total of 100 knees. Next, two groups were compared with a different surgical technique, considering the replacement or not of the patella. All patients who had x-rays evaluated had indication of TKA by osteoarthrosis without previous procedures that could interfere at patellar height. Results The statistical analysis showed a statistically significant difference, with the preoperative index superior to the postoperative rate, evidencing an overall decrease in patellar height. The Caton-Deschamps index modified for mean preoperative TKA was 1.41 (±0.25), and it was 1.31 (± 0.25), p< 0.001for postoperative TKA. No significant difference was found in the variation of this index when comparing the groups with and without patellar replacement. The mean difference of the index in the group without patella was 0.11, and 0.08 in the group with patella, and this difference was considered nonsignificant, p= 0.510. Conclusion We can conclude that patellar height had significant variation in the total group, with reduction of patellar height in the postoperative period. However, the height did not vary significantly between the postoperative groups with and without patellar replacement, regardless of the choice of the surgeon.

Objective: To determine the feasibility and estimates of effects of a supervised exercise- and education-based prehabilitation programme aiming to improve knee functioning compared with usual care in patients awaiting total knee arthroplasty. Design: A randomized controlled pilot study. Subjects: Patients receiving primary, unilateral total knee arthroplasty. Methods: Patients randomized to the intervention group participated in a personalized 4–8-week prehabilitation programme before surgery. Feasibility of the intervention and self-reported knee functioning, pain, physical performance and hospital stay were assessed at baseline, immediately preoperatively, 6 and 12 weeks after surgery. Results: Twenty patients (mean age 72.7±5.95 years) were enrolled in this study. The personalized prehabilitation programme was found to be feasible and safe, with an exercise adherence of 90%. Significant medium interaction effects between groups and over time favouring prehabilitation were reported for the sport subscale of the Knee Osteoarthritis Outcome Score (F(3/54) = 2.895, p = 0.043, η² = 0.139) and Tegner Activity Scale (F(2.2/39.1) = 3.20, p = 0.048, η² = 0.151). Conclusion: The absence of adverse events and high adherence to the programme, coupled with beneficial changes shown in the intervention group, support the conduct of a full-scale trial investigating the effectiveness of prehabilitation.

ABSTRACT BACKGROUND: The High Activity Arthroplasty Score (HAAS) is a self-administered questionnaire, developed in British English, that reliably and validly measures the levels of sports activities in patients following hip and knee arthroplasty surgery. OBJECTIVE: To cross-culturally adapt the HAAS to Brazilian Portuguese language. DESIGN AND SETTING: A cross-sectional study was conducted at a public university hospital in Brazil. METHODS: The Brazilian version of the HAAS was created through a six-step process: translation, synthesis, committee review, pretesting, back-translation, and submission to developers. The translation step was conducted by two independent bilingual translators, both native speakers of Brazilian Portuguese. The back-translation was performed by an independent translator, a native speaker of British English. To ensure the questionnaire's comprehensibility, 46 volunteers (51% men; average age 34-63) participated in the pre-testing step. RESULTS: The cross-cultural adaptation process necessitated modifications to certain terms and expressions to achieve cultural equivalence with the original HAAS. CONCLUSION: The HAAS has been translated from English into Brazilian Portuguese and culturally adapted for Brazil. The validation process for HAAS-Brazil is currently underway.

Objective: To evaluate the efficacy of multiple doses of tranexamic acid (TXA) in blood loss in patients undergoing total knee arthroplasty (TKA). Methods: Seven patients of both genders over 50 years old undergoingTKA, who received 15 mg/kg intravenous (IV) TXA 30 minutes before the surgical incision and another 3 doses thereafter were included in this report. Blood loss analysis included blood loss at the drain, hemoglobin loss, and estimated blood loss. Statistical analysis was performed. Results: There was a significant hemoglobin drop after 48 hours, compared to preoperative. Mean blood loss assessed by drain was 20.0 ± 25.17 mL after 24 h. Estimated blood loss was higher after 48 hours compared to 24 hours. No complications were reported in this sample, and no patient received transfusions. Conclusion: The use of TXA in multiple doses did not prevent the drop in postoperative hemoglobin levels and did not correlate with increased complications.

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To investigate preoperative predictors of instrumental activities of daily living (IADL) disability in older adults 6 months after knee arthroplasty (KA). Prospective cohort study. General hospital with an orthopedic surgery department. Two hundred twenty (N=220) patients 65 years or older with total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). Not applicable. IADL status was evaluated for 6 activities. Participants chose "able," "need help," or "unable" according to their capacity of executing these IADL. If they chose "need help" or "unable" for 1 or more items, they were defined as "disabled." Their usual gait speed (UGS), range of motion for the knee, isometric knee extension strength (IKES), pain status, depressive symptoms, pain catastrophizing, and self-efficacy were evaluated as predictors. Baseline and follow-up assessments were conducted 1 month before and 6 months after KA, respectively. Logistic regression analyses with IADL status as the dependent variable were performed at follow-up. All models were adjusted using age, sex, severity of the knee deformity, operation type (TKA or UKA), and preoperative IADL status as covariates. In total, 166 patients completed the follow-up assessment, and 83 (50.0%) reported IADL disability 6 months after KA. Preoperative UGS, IKES on the non-operated side, and self-efficacy were statistically significantly different between those with a disability at follow-up and those who did not and were therefore included in logistic regression models as independent variables. UGS (odds ratio, 3.22; 95% CI, 1.38-7.56; P =.007) was determined as a significant independent variable. The present study demonstrated the importance of evaluating preoperative gait speed to predict the presence of IADL disability in older adults 6 months after KA. Patients with poorer preoperative mobility should be provided careful postoperative care and treatment. [ABSTRACT FROM AUTHOR]

Abstract Objective Aspirin (acetylsalicylic acid, ASA) and rivaroxaban are anticoagulants that have increased in popularity due to ease of use in the prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA). The present study aimed to evaluate the efficacy of ASA compared with that of rivaroxaban on VTE prophylaxis in patients who underwent TKA. Method Forty patients who had primary knee osteoarthritis and would undergo TKA were randomized into two groups. In total, 20 patients in the ASA group used oral aspirin, at a dose of 300 mg/day, for VTE prophylaxis after TKA, while 20 patients in the rivaroxaban group received oral rivaroxaban, at a dose of 10 mg/day. On days 4 and 14 after the operation, deep vein thrombosis (DVT) in the lower limbs on the operated side was detected through duplex ultrasonography. Other complications were recorded for 14 days. Results There were no positive findings of DVT detected with duplex ultrasonography in the groups of patients, and the occurrence of pulmonary embolism was not observed. In total, 4 patients had subcutaneous ecchymosis on the fourth postoperative day (2 patients in the ASA group and 2 patients in the rivaroxaban group; p= 1.0), and another 4 patients on the fourteenth postoperative day (1 patient in the ASA group and 3 patients in the rivaroxaban group; p= 0.292). No cases of wound hematoma, major organ bleeding, wound infection, or reoperation were observed in the sample. Conclusion Aspirin and rivaroxaban had comparable efficacy to prevent VTE, without increasing the incidence of wound complications and bleeding after TKA.

Abstract Objective The management of bone loss represents a challenge in revisions of total knee arthroplasty (rTKA) and in complex primary total knee arthroplasties (TKAs). The purpose of the present study was to evaluate the midterm outcomes (5-year minimum follow-up) of knee reconstructions with tantalum trabecular metal (TM) cones on bone defects Anderson Orthopaedics Research Institute (AORI) 2 and 3. Materials and MethodsA retrospective analysis of the medical records of patients operated on between July 2008 and November 2014 was performed, collecting the following data: age, gender, laterality, body mass index, etiology of arthrosis, comorbidities, AORI classification of bone defects, causes for revision, readmissions, reoperations, perioperative and postoperative complications, radiographic signs of osteointegration, and maintenance of the TM support. Results A total of 11 patients with a mean follow-up of 7.28 years (standard deviation [SD] = 1.88; range = 5.12–10 years) was evaluated, with 1 patient operated upon for a primary arthroplasty, 6 for revision arthroplasties, and 4 for a second revision arthroplasty (re-revision). There were complications with the surgical wound, injury to the extensor mechanism and loosening of the femoral component in three of the patients that led to the necessity of four procedures due to complications with the surgical wound, injury to the extensor mechanism and loosening of the femoral component. Radiological signs of osteointegration of the trabecular cones were observed in all patients. We did not observe migration of the TM cones or the prosthetic components in the sample. Conclusion The tantalum metaphyseal cones were able to provide efficient structural support to prosthetic implants with radiographic signs of osteointegration in the medium term.

Abstract Background Pharmacological and mechanical thromboprophylaxis are frequently used together after total knee arthroplasty (TKA). Most studies in this context compare anticoagulants versus a combination of these drugs with an intermittent pneumatic compression device (IPCD). However, there is uncertainty about the need for the combination of both and whether a unilateral IPCD would alone affect other important clinical outcomes: edema and blood loss. We compared the effects of enoxaparin versus unilateral portable IPCD after TKA on edema and blood loss. We hypothesised that unilateral IPCD would cause the same level of edema and the same blood loss as enoxaparin. Methods In this open, randomized trial (1:1), adults with no history of coagulation disorders, anticoagulant use, venous thromboembolism, liver or malignant diseases underwent TKA. For 10 days, participants received the IPCD, used 24 h/day on the operated leg from the end of surgery, or 40 mg of enoxaparin, starting 12 h after surgery. All underwent the same rehabilitation and were encouraged to walk on the same day of surgery. We measured edema (thigh, leg and ankle circumference) before and on the third postoperative day. Blood loss (volume accumulated in the suction drain and drop of hemoglobin and hematocrit in 48 h) was a secondary outcome. Results We randomized 150 patients and lost 3 to follow-up with enoxaparin and 2 with IPCD. There was no case of symptomatic venous thromboembolism. Four patients needed transfusions (three receiving enoxaparin), one had infection and one hemarthrosis (both in the enoxaparin group). Leg circumference increased by approximately 2 cm for enoxaparin group and 1.5 cm in IPCD (p

ABSTRACT Objective Compare the results of medial unicompartmental knee arthroplasty (UKA) using a mobile platform and total knee arthroplasty (TKA) in patients with isolated medial osteoarthritis. Methods Retrospectivecross-sectional study. Preoperative radiographs of 602 patientswho underwent knee arthroplastybetween February 2017 and February 2020 were evaluated. Isolated medial osteoarthritis was found in 125 patients. Of these, 57 underwent UKA and 68 TKA. With chart analysis and telephone interviews, we compared patients’ clinical outcomes and degree of satisfaction. The statistical analysis used a confidence level of 5%. Results The group of UKA patients obtained 65.8% of favorable results against 79.1% of those undergoing TKA in the function questionnaire (p0.5). Most patients were satisfied or very satisfied in both groups (88.6% of UKA and 91.2% of TKA) (p>0.999). Conclusion Patients submitted to UKA or TKA have presented the same degree of satisfaction and rate of postoperative complications when comparing patients with isolated medial osteoarthritis. UKA patients had less favorable results onthe clinical functional questionnaire than patients undergoing total arthroplasty. Level Of Evidence III;Retrospective Study.

Introduction: This study aimed to evaluate the effectiveness of a computer-assisted circular external fixator used to achieve arthrodesis in elderly patients with failed infected total knee arthroplasty. Materials and Methods: Retrospectively 11 patients who treated with arthrodesis between 2015 and 2020 were included in the study. The average age was 73.5 ±4.73 years (65-81). All patients had recurrent infections after total knee arthroplasty. Radiologic evaluations, the time for fusion, shortening of extremities, visual analog scale scores, Oxford knee scoring system, lower extremity functional scale of all patients were compared pre-and post-operatively. complications of the technique were noted. Results: The mean follow-up was 33.7 ±12.85 (12-52) months. Fusion was achieved in all patients. The average limb length discrepancy after removal of the fixator was 46±0.78 (36-61) mm. The mean visual analog scale score measured pre-op was 6.91±0.94 (5-8), and after fixator removal they were measured as 2.36±0.92 (1-4). The mean Oxford knee score was 10.27±2.68 (4-14) pre-operatively and 28.64±2.69 (23-32) postoperatively. The mean, lower extremity functional scale was 17.06±9.38 (7.5-33.8) pre-operatively and 38.54±12.22 (21.3-56.3) postoperatively. No joint infection recurrence was seen post-operatively. Conclusion: Arthrodesis is a suitable option for elderly patients with limited mobilization who are tired of repeated revision surgeries. Due to its high fusion and low complication rate, computer-assisted circular external fixator is an effective method in the treatment of difficult knee arthrodesis required after infected total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this systematic review was to synthesise the available literature and critically appraise current evidence on the functional and radiographic outcomes as well as reoperation and revision rates of custom partial knee arthroplasty, i.e., unicompartmental knee arthroplasty (UKA), bicompartmental knee arthroplasty (BKA), and patellofemoral arthroplasty (PFA). Material and methods: This systematic review was performed in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and a protocol was registered with Prospero. On 25 May 2021, two authors independently searched and screened Level I–IV studies that reported on outcomes of custom partial knee arthroplasty using the databases of MEDLINE®, EMBASE®, and the Cochrane Library without restriction on date of publication. Findings from eligible articles were synthesised and tabulated, and quality assessments were done according to the guidelines of the Joanna Briggs Institute (JBI) Checklists. Results: Fifteen articles were eligible for data extraction, of which two comparative and four case series were on custom UKA (follow-up, 0–9 months), one comparative and five case series on custom BKA (follow-up, 0.25–72 months), and three case series on custom PFA (follow-up, 2–119 months). Three studies on custom UKA reported mean Knee Society Score (KSS) Knee of 86–94 and mean KSS Function of 94–95, and two studies on custom BKA reported mean KSS Knee of 90–94 and KSS function of 81, whereas one study on custom PFA reported KSS Knee of 91 and KSS Function of 89. Custom implants tended to have less bone–implant mismatch compared to off the shelf (OTS) implants. Revision rates were 3–25% for custom UKA (at 0–109 months), 3–5% for custom BKA (at 12–72 months), and 0–14% for custom PFA (at 2–119 months). Conclusion: Due to the small number of comparative studies and lack of consistency in reported outcomes, it remains difficult to ascertain the benefits of custom partial knee arthroplasty. Anecdotal evidence suggests that, compared to OTS implants, custom implants result in less bone–implant mismatch and that 78–91% of patients are either satisfied or very satisfied after custom partial knee arthroplasty. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Pharmacological and mechanical thromboprophylaxis are frequently used together after total knee arthroplasty (TKA). Most studies in this context compare anticoagulants versus a combination of these drugs with an intermittent pneumatic compression device (IPCD). However, there is uncertainty about the need for the combination of both and whether a unilateral IPCD would alone affect other important clinical outcomes: edema and blood loss. We compared the effects of enoxaparin versus unilateral portable IPCD after TKA on edema and blood loss. We hypothesised that unilateral IPCD would cause the same level of edema and the same blood loss as enoxaparin.Methods: In this open, randomized trial (1:1), adults with no history of coagulation disorders, anticoagulant use, venous thromboembolism, liver or malignant diseases underwent TKA. For 10 days, participants received the IPCD, used 24 h/day on the operated leg from the end of surgery, or 40 mg of enoxaparin, starting 12 h after surgery. All underwent the same rehabilitation and were encouraged to walk on the same day of surgery. We measured edema (thigh, leg and ankle circumference) before and on the third postoperative day. Blood loss (volume accumulated in the suction drain and drop of hemoglobin and hematocrit in 48 h) was a secondary outcome.Results: We randomized 150 patients and lost 3 to follow-up with enoxaparin and 2 with IPCD. There was no case of symptomatic venous thromboembolism. Four patients needed transfusions (three receiving enoxaparin), one had infection and one hemarthrosis (both in the enoxaparin group). Leg circumference increased by approximately 2 cm for enoxaparin group and 1.5 cm in IPCD (p <  0.001). The increase in ankle circumference was about 1.5 cm in the enoxaparin group (p <  0.001), and almost zero in IPCD (p = 0.447). Enoxaparin group lost 566.1 ml (standard deviation, SD, 174.5) of blood in the first 48 h, versus 420.8 ml (SD 142.5) in the IPCD.Conclusions: Exclusively mechanical prophylaxis after TKA with portable IPCD only on the operated leg reduces leg and ankle swelling and post-operative blood loss compared to exclusively pharmacological prophylaxis with enoxaparin. Portable devices that can prevent deep vein thrombosis and pulmonary embolism without increasing blood loss or other risks should be further investigated.Trial Registration: REBEC RBR-8k2vpx. Registration date: 06/04/2019. [ABSTRACT FROM AUTHOR]

Background: Joint arthroplasties are among the most commonly performed elective surgeries in the United States. Surgical outcomes are known to improve with volume but it is unclear whether this has led to consolidation among elective surgeries. We examined trends in volumes per surgeon and hospital to assess whether the known volume-outcome relationship has led to consolidation in elective joint arthroplasty and to determine if there exist volume thresholds above which outcomes do not change.Methods: Among Medicare beneficiaries who underwent either total knee or total hip arthroplasty from 2009 through 2015, we described volume trends and used mixed-effect models to relate annual surgeon and hospital volumes with 30-day complications or mortality. We tested for optimal volume cut points at both the hospital and surgeon level.Results: Adjusted annual complication rates were inversely associated with volume for both procedures at both the surgeon level and hospital level, but there was minimal consolidation between 2009 and 2015. Complications no longer declined after volumes of each case exceeded 260 per year. The vast majority of cases (around 93% of hip and 88% of knee arthroplasties) were performed by surgeons operating at suboptimal volumes.Conclusion: More than 2 decades after the volume-outcome relationship was established for joint arthroplasty, many cases continue to be performed by low-volume surgeons, with far more cases performed by surgeons operating at suboptimal volumes. Further improvement could be expected through consolidation at both the hospital and surgeon level, with a target of at least 260 cases per surgeon annually for each operation. Payers seem best-equipped to drive consolidation. [ABSTRACT FROM AUTHOR]

Introduction: As the US obesity epidemic continues to grow, so too does comorbid hip and knee arthritis. Strict body mass index (BMI) cutoffs for total hip and knee arthroplasty (THA and TKA) in the morbidly obese have been proposed and remain controversial, although current American Academy of Orthopaedic Surgeons guidelines recommend a BMI of less than 40 m/kg 2 before surgery. This study sought to compare patient-reported outcomes and 30-day complication, readmission, and revision surgery rates after THA or TKA between morbidly obese patients and nonmorbidly obese control subjects., Methods: All patients undergoing primary THA and TKA at our institution from May 2020 to July 2022 were identified. Patient demographics, surgical time, length of stay and 30-day readmission, revision surgery, and complication rates were prospectively collected. Preoperative and postoperative Hip and Knee Society (Hip Osteoarthritis Outcome Score [HOOS] and Knee Osteoarthritis Outcome Score [KOOS]) were collected. Patients were stratified by BMI as ideal weight (20 to 24.9), overweight (25 to 29.9), class I obese (30 to 34.9), class II obese (35 to 39.9), and morbidly obese (>40 m/kg 2 )., Results: A total of 1,423 patients were included for final analysis. No difference was observed in 30-day unplanned return to emergency department, readmission, or revision surgery in the morbidly obese cohort. Morbidly obese patients undergoing THA had lower preoperative HOOS (49.5 versus 54.5, P = 0.004); however, there was no difference in postoperative HOOS or KOOS at 12 months across all cohorts., Discussion: No difference was observed in 30-day return to emergency department, readmission, or revision surgery in the morbidly obese cohort. Despite a lower preoperative HOOS, there was no difference in 12-month HOOS or KOOS when stratified by BMI. These findings suggest that such patients may achieve similar benefit from arthroplasty as their ideal weight counterparts., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Aims: Prolonged waits for hip and knee arthroplasty have raised questions about the equity of current approaches to waiting list prioritization for those awaiting surgery. We therefore set out to understand key stakeholder (patient and surgeon) preferences for the prioritization of patients awaiting such surgery, in order to guide future waiting list redesign., Methods: A combined qualitative/quantitative approach was used. This comprised a Delphi study to first inform which factors patients and surgeons designate as important for prioritization of patients on hip and knee arthroplasty waiting lists, followed by a discrete choice experiment (DCE) to determine how the factors should be weighed against each other. Coefficient values for each included DCE attribute were used to construct a 'priority score' (weighted benefit score) that could be used to rank individual patients waiting for surgery based on their respective characteristics., Results: In total, 43 people participated in the initial round of the Delphi study (16 patients and 27 surgeons), with a 91% completion rate across all three rounds. Overall, 73 surgeons completed the DCE. Following the final consensus meeting of the Delphi component, the seven final factors designated for inclusion were Pain, Mobility/Function, Activities of Daily Living, Inability to Work/Care, Length of Time Waited, Radiological Severity, and Mental Wellbeing. Output from the adjusted multinomial regression revealed radiological severity to be the most significant factor (coefficient 2.27 (SD 0.31); p < 0.001), followed by pain (coefficient 1.08 (SD 0.13); p < 0.001) and time waited (coefficient for one month additional wait 0.12 (SD 0.02); p < 0.001)., Conclusion: These results present a new robust method for determining comparative priority for those on primary hip and knee hip arthroplasty waiting lists. Evaluation of potential implementation in clinical practice is now required., Competing Interests: L. Farrow is currently in receipt of a Chief Scientist Office Scotland Clinical Academic Fellowship, and reports which is focused on improving the clinical care pathway in those referred for hip and knee arthroplasty, and reports a grant from University of Aberdeen Knowledge Exchange Commission, related to this study, as well as support for attending meetings and/or travel from LINK, unrelated to this study. R. M. D. Meek reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from DePuy Synthes, Stryker, and Palacademy, unrelated to this study. K. Gillies reports consulting fees from Boehringer & Ingelheim, unrelated to this study. N. D. Clement and R. M. D. Meek are both members of the editorial board of The Bone & Joint Journal., (© 2025 Farrow et al.)

Background: The incidence of total knee replacement (TKR) surgeries has increased, partly attributed to healthcare policies that cause premature and potentially unwarranted interventions. This has raised concerns regarding a potential trend of excessive surgeries., Purpose: This study aimed to propose a predictive model based on digital radiography (DR) radiomics to objectively assess the need for TKR surgery in patients with knee osteoarthritis (KOA) and to improve risk stratification, thereby avoiding unnecessary surgeries., Methods: A retrospective study was conducted on 1,785 KOA patients from January 2017 to December 2022. Radiomics features were extracted from DR images to quantify lesion phenotypes, followed by a two-step feature selection to derive robust signatures. Multiple models were constructed using independent risk factors and radiomics features, and these models were validated using logistic regression. The performance of the models was evaluated via receiver operating characteristic (ROC) curves, area under the curve (AUC), calibration curves, and decision curve analysis. A multivariable Cox regression-derived nomogram was used to predict operation-free survival (OFS), and the patients were categorized into high- or low-risk groups based on risk stratification. Kaplan-Meier curves were used to compare OFS between the two groups., Results: During a follow-up period of at least one year, 962 of 1785 (53.89 %) patients underwent TKR. Age, presence of radiographic KOA (RKOA), and Kellgren-Lawrence (KL) grading were identified as independent risk factors for OFS. The combined RKOA model (including age, presence of RKOA, and Radscore; AUC = 0.969) and combined KL model (including age, KL grading, and Radscore; AUC = 0.968) showed similar performance, with both significantly outperforming other models (p < 0.001). The 1-, 2-, and 3-year AUCs for the RKOA nomogram were 0.891, 0.916, and 0.920, respectively, whereas those for the KL nomogram were 0.890, 0.914, and 0.931. The thresholds of 68.92 (RKOA nomogram) and 64.41 (KL nomogram) were derived from the median nomogram scores and used to stratify patients into high- and low-risk groups. K-M curves demonstrated that the risk stratification system effectively distinguished between high- and low-risk groups, with the high-risk group being more likely to require TKR., Conclusions: Two nomograms incorporating age, RKOA (or KL grading), and Radscore were developed to predict 3-years OFS for KOA patients and establish risk thresholds, potentially guiding personalized non-surgical treatments during the OFS period., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Poor results occasionally occur after unicompartmental knee replacement (UKR). It is often difficult, even for experienced surgeons, to determine why patients have poor outcomes from radiographs. The aim was to compare the ability of experienced surgeons and machine learning to predict whether patients had poor or excellent outcomes from radiographs., Methods: 924 one-year anterior-posterior radiographs post-UKR were used to train a machine learning model (ResNet50v2) with a transfer learning approach based on their one-year Oxford Knee Score categories. Two experienced surgeons and the model assessed and categorised 70 radiographs (14 Poor scores; 56 Excellent scores) not used for training according to their expected outcome., Results: The ResNet50v2 model correctly identified 71% (n = 10) of the patients with a poor score and 46 (82%) of those with an excellent score. In contrast, one surgeon could not identify patients with Poor scores (0%) and the other identified one (7%). Both misidentified 3 of those with Excellent scores. The model visualisation method suggested that estimated classifications were made from image features around the implants., Conclusion: The results suggest that there are radiographical features that relate to poor outcomes, which the surgeons are unaware of. Those the model did not identify may have an extra-articular cause for their poor outcome. Further analysis to identify the features associated with poor outcomes could potentially suggest ways that indications or techniques could be improved so as to decrease the incidence of poor results., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:[One or more of the authors have received or will receive benefits for professional use from a commercial party, Zimmer Biomet, related indirectly to the subject of this article. In addition, benefits have been directed to a research fund, foundation, educational institution, or other non-profit organisation with which more of the authors are associated. (Versus Arthritis & Orthopaedic Research UK)]., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Aim: To evaluate SPECT-CT in the diagnosis of single component aseptic loosening in patients with a problematic cemented stemmed TKR (Total Knee Replacement)., Methods: SPECT-CT was performed where aseptic loosening was suspected but was not clear on plain radiography. Demographics, suspected diagnosis and intention to revise were collected prospectively before and after SPECT-CT., Results: 30 patients were investigated. 43% (95% CI: 0.5-0.9) had clear evidence of loosening on SPECT-CT. In 23% (95% CI: 0.1-0.4) intention to perform revision surgery following SPECT-CT changed (7/30) (p = 0.0004, standard error = 42.1, z = 3.5). Intentions to perform revision surgery according to the radiologist's overall summary were: Normal SPECT-CT - 0% (95% CI: 0.0-0.8) intention to revise (0/2). Possibly abnormal SPECT-CT - 13% (95% CI: 0.0-0.4) intention to revise (2/15). Definitely abnormal SPECT-CT - 77% (95% CI: 0.5-0.9) intention to revise (10/13). We report that SPECT-CT had a test sensitivity of 90.9% (95% CI: 0.6-1.0), a specificity of 100% (95% CI: 0.9-1.0), a positive predictive value of 100% and a negative predictive value of 97.7%. In 70% (95% CI: 0.3-0.9) of cases where revision surgery was performed for aseptic loosening SPECT-CT provided information that guided pre-operative planning with regards single component or both component revision surgery (7/10)., Conclusion: When positive SPECT-CT was useful in determining single component revision. A normal SPECT-CT may have a negative predictive value; however, overall half of our series had a possibly abnormal or equivocal investigation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Preoperative optimization of modifiable risk factors for total hip and knee arthroplasty remains a foundational cornerstone in reducing postoperative complications and enhancing patient outcomes. With an increasing prevalence of high-risk comorbidities among total joint arthroplasty patients with morbid obesity (body mass index ≥40 kg/m2), uncontrolled diabetes (hemoglobin A1c ≥ 7.5%), and active smoking and tobacco use, many joint arthroplasty surgeons face complex ethical decisions when surgical intervention poses a higher risk for potential harm. Creating definitive numerical cutoffs may lead to access-to-care issues with a difficult balance between helping and harming patients., Competing Interests: Disclosures Royalties: Link. Consultant: Link Lia, Exactech, Zimmer-Biomet, Medacta. Editorial Boards: Journal of Arthroplasty, Orthopedics, and Arthroplasty Today (Deputy Editor). Committees: MAOA (Education Committee Chair), AAHKS (Quality Committee), AAOS-EQBV Committee; Knee/Hip Society-Digital Media Committee; BOD OLC. From the author's listed disclosures, there are no relavent or pertinent conflicts of interest contributing to content of this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Stair climbing is a kinematically demanding activity, essential for maintaining independence and quality of life, yet is often impaired in patients with knee osteoarthritis (OA). The purpose of this study was to examine differences in kinematics of a step-up movement between participants with osteoarthritis and asymptomatic controls., Methods: Thirty participants with end-stage OA awaiting total knee arthroplasty (TKA) and twenty-eight sex and age-similar asymptomatic participants were recruited. Participants performed a step-up task which was imaged via single-plane fluoroscopy. 3-dimensional prosthesis computer-aided design models were registered to the fluoroscopy, yielding in-vivo kinematic data. Kinematic variables of position, displacement, and rate-of-change in six degrees of freedom were compared between the two groups., Results: OA knees exhibited significantly different kinematics to asymptomatic knees during step-up. Knees with OA demonstrated a reduced terminal extension angle, inferior translation and increased internal rotation throughout the movement compared to asymptomatic. OA participants exhibited more variability in kinematic parameters compared to asymptomatic controls, reflecting the heterogeneity within OA pathology., Conclusion: The findings of this study indicate that knee kinematics, particularly rotation, differ significantly between OA and asymptomatic knees during step-up. Optimising rotational profiles in OA knee management could help optimise patient function and inform rehabilitation and surgical protocols., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Paul Smith and Jennie Scarvell reports financial support was provided by Zimmer Biomet. Paul Smith reports a relationship with Australian Orthopaedic Association National Joint Replacement Registry that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.)

Background Context: Concurrent degeneration of the lumbar spine, hip, and knee can cause significant disability and lower quality of life. Osteoarthritis in the lower extremities can lead to movement limitations, possibly requiring total knee arthroplasty (TKA) or total hip arthroplasty (THA). These procedures often impact spinal posture, causing alterations in spinopelvic alignment and lumbar spine degeneration. It is unclear if patients with a history of prior total joint arthroplasty (TJA) have different spinopelvic alignment compared to patients without., Purpose: To assess the relationship between a history of previous THA or TKA, as well as combined THA and TKA, and the spinopelvic alignment in patients undergoing elective lumbar surgery for degenerative conditions., Study Design: A retrospective analysis was conducted on patients who underwent lumbar surgery for degenerative conditions. The patients were stratified based on a history of TKA, THA, or both TKA and THA., Patient Sample: A total of 632 patients (63% female) with an average age of 64±11 years and an average BMI of 30±6 kg/m 2 were included., Outcome Measures: Patients were stratified based on a history of THA, TKA, or combined THA and TKA. Spinopelvic parameters (lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI)) were assessed. The relationship between spinopelvic alignment and prior TKA, THA or TKA and THA was analyzed., Methods: The data was tested for normal distribution using the Shapiro-Wilk test. We analyzed the relationship between the spinopelvic parameters and the different arthroplasty groups. Differences in scores between groups were examined using ANOVA. Tukey's Honestly Significant Difference test was used for pairwise comparison for significant ANOVA test results. Multivariable linear regression was applied, adjusted for age, sex and BMI., Results: A total of 632 patients (63% female) were included in the study. Of these patients, 74 (12%) had a history of isolated TKA, 40 (6%) had prior isolated THA, and 15 (2%) had TKA and THA prior to lumbar surgery. Patients with prior arthroplasty were predominantly female (59%) and significantly older (68±7 years vs 63±12 years, p<.001) with a significantly higher BMI (31±6 kg/m 2 vs 29±6 kg/m 2 , p<.001). The LL was significantly lower (45.0°±13 vs 50.9°±14 p=.011) in the arthroplasty group compared to the nonarthroplasty group. A history of isolated TKA was significantly associated with lower LL (Est=-3.8, 95% CI -7.3 to -0.3, p=.031) and SS (Est=-2.6, 95% CI -5.0 to -0.2, p=.012) compared to patients without TJA. Prior combined THA and TKA was found to be significantly associated with a higher PT compared to the nonarthroplasty group (Est=5.1, 95% CI 0.4-9.8, p=.034)., Conclusions: The spinopelvic alignment differs between patients with and without prior TJA who undergo elective lumbar surgery. The study shows that a history of TKA is significantly associated with a lower LL and SS. The combination of THA and TKA was associated with a significantly higher PT. These findings highlight the complex relationship between the hip, spine, and knee. Moreover, the results could aid in enhancing preoperative planning of lumbar surgery in patients with known TJA., Competing Interests: Declaration of competing interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms., (Copyright © 2024. Published by Elsevier Inc.)

Background: There is increasing interest in documenting disparities in pain management for racial and ethnic minorities and patients with language barriers. Previous studies have found differential prescription patterns of opioids for racial and ethnic minority group and patients having limited English proficiency (LEP) after arthroplasty. However, there is a knowledge gap regarding how the intersection of these sociodemographic factors is associated with immediate postoperative pain management. This study aimed to explore language and racial-ethnic disparities in short-term opioid utilization after total hip and knee arthroplasty., Methods: We conducted a retrospective cohort study of adult patients who underwent total hip and knee arthroplasty from 2015 to 2019 at an urban medical center. The primary predictor variables included LEP status and racial-ethnic category, and the primary outcome variables were oral morphine equivalents (OMEs) during 2 distinct postoperative periods: the first 12 hours after surgery and from the end of surgery to the end of postoperative day (POD) 1. Patient characteristics and perioperative metrics were described by language status, race, and ethnicity using nonparametric tests, as appropriate. We performed an adjusted generalized estimating equation to assess the total effect of the intersection of LEP and racial-ethnic categories on short-term postoperative opioid use in mean ratios (MRs)., Results: This study included a total of 4090 observations, in which 7.9% (323) patients had LEP. Patients reported various racial-ethnic categories, with 72.7% (2975) non-Hispanic White, and minority groups including non-Hispanic Asian and Pacific Islander (AAPI), Hispanic/Latinx, non-Hispanic Black/African American, and Others. Patients self-identifying as non-Hispanic AAPI received fewer OME regardless of LEP status during the first 12 hours postoperatively (MR for English proficient [EP], 0.12 [95% confidence interval, CI, 0.08-0.18]; MR for LEP, 0.22 [95% CI, 0.13-0.37]) and from end of surgery to the end of POD 1 (MR for EP, 0.24 [95% CI, 0.16-0.37]; MR for LEP, 0.42, [95% CI, 0.24-0.73]) than EP non-Hispanic White. Hispanic/Latinx patients with LEP received lower amounts of OME during the first postoperative 12 hours (MR, 0.29; 95% CI, 0.17-0.53) and from end of surgery to the end of POD 1 (MR, 0.42; 95% CI 0.23-0.79) than EP non-Hispanic White. Furthermore, within the non-Hispanic White group, those with LEP received fewer OME within the first 12 hours (MR, 0.33; 95% CI, 0.13-0.83)., Conclusions: We identified an association between LEP, racial-ethnic identity, and short-term postoperative OME utilization after total knee and hip arthroplasty. The observed differences in opioid utilization imply there may be language and racial-ethnic disparities in acute pain management and perioperative care., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Background: A patient's decision-making process to undergo surgery is crucial for surgeons to understand for patient-counseling purposes. Total knee and hip arthroplasty, like any other major surgery, is associated with serious, sometimes life-threatening, complications. Using the results of discrete choice experiments (DCEs), we aimed to understand the relationship between a patient's risk tolerance and choosing to undergo surgery in real life., Methods: This is a retrospective study of prospectively collected DCE results for 142 potential knee or hip arthroplasty clinic patients from October 2021 to March 2022. The DCE presented the patient with 2 scenarios, each of which was made up of different combinations of attributes and levels. A hierarchal Bayesian model was used to obtain a risk score that reflected the risk attributes chosen by each patient. Logistic regressions were then used to evaluate the association between a patient's willingness to incur risk and their decision to undergo a total joint arthroplasty., Results: Of the 142 patients enrolled in the DCE, 89 (62.3%) underwent a total joint arthroplasty. Risk score (odds ratio [OR] = 2.6, 95% confidence interval [CI] 1.1 to 6.6, P = 0.04), men (OR = 2.5, 95% CI 1.1 to 5.9, P = 0.028), and patients who have hip osteoarthritis (OR = 2.4, 95% CI 1.1 to 5.5, P = 0.036) increased the odds of undergoing arthroplasty, whereas physical function of at least 75% at the initial visit (OR = 0.3, 95% CI 0.1 to 0.7, P = 0.004) decreased these odds., Conclusions: We found that a patient's willingness to incur risk, lower baseline physical function, and men were all independently associated with undergoing total knee arthroplasty. We believe that these findings prompt much-needed future studies that focus solely on the relationship between patients' inherent risk behavior and surgical and patient-reported outcomes., (Copyright © 2024. Published by Elsevier Inc.)

Background: Arthrofibrosis is a common postoperative total knee arthroplasty (TKA) complication that results in limited range of motion (ROM). There is limited literature on outcomes after revision TKA (rTKA) for arthrofibrosis based on preoperative ROM restriction. The aims of this study were to: (1) examine ROM trajectory after rTKA for arthrofibrosis patients who have severe versus nonsevere limitations; (2) compare ROM gains and final arc of motion (AOM) between severe and nonsevere cohorts; (2a) compare ROM gain in a severe cohort treated with a rotating hinge (RH) versus a non-RH (NRH) construct; and (3) assess the impact of arthrofibrosis severity on patient-reported outcome measures., Methods: Patients were divided into 2 groups: group A had preoperative ROM < 70 ° (severe), and group B had preoperative ROM > 70 ° (non-severe). Patients were assessed clinically using AOM gain, absolute ROM, Knee injury and Osteoarthritis Outcomes Score for Joint Replacement, lower extremity activity scale, and pain scores. Postoperative gains in AOM were compared between both groups., Results: A total of 56 rTKAs (group A (severe): n = 36, group B (non-severe): n = 20) were performed for patients who have postoperative fibrosis. Group B had better ROM at the 1-year time point (group B: 95.9 ± 22.5 degrees versus group A: 83.2 ± 25.7 degrees). Group A had significantly better improvement in absolute AOM than group B (31.1 ± 20.9 versus 11.4 ± 25.0 degrees, P < 0.01). The RH group demonstrated significantly better absolute AOM gain than the NRH group (41.3 ± 19.4 versus 18.3 ± 15.2 degrees, P < 0.001). However, there were no significant differences in patient-reported outcome measures between groups A and B or between RH and NRH groups at the final follow-up., Conclusions: Final ROM achieved between severe and nonsevere arthrofibrosis groups was similar, and patients who have severe arthrofibrosis can expect greater absolute ROM gains and similar functional outcomes than nonsevere arthrofibrosis patients. The RH rTKAs provided greater AOM gains for patients who have severe arthrofibrosis, with equivalent functional outcomes to non-RH implants. For severe arthrofibrosis patients, RH designs provided twice the overall ROM gain; however, longer follow-up is necessary to determine whether RH designs have inferior overall implant survivorship., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: In total joint arthroplasty patients, intraoperative hypothermia (IOH) is associated with perioperative complications and an increased economic burden. Previous models have some limitations and mainly focus on regression modeling. Random forest (RF) algorithms and decision tree modeling are effective for eliminating irrelevant features and making predictions that aid in accelerating modeling and reducing application difficulty., Methods: We conducted this prospective observational study using convenience sampling and collected data from 327 total joint arthroplasty patients in a tertiary hospital from March 4, 2023, to September 11, 2023. Of those, 229 patients were assigned to the training and 98 to the testing sets. The Chi-square, Mann-Whitney U, and t-tests were used for baseline analyses. The feature variables selection used the RF algorithms, and the decision tree model was trained on 299 examples and validated on 98. The sensitivity, specificity, recall, F1 score, and area under the curve were used to test the model's performance., Results: The RF algorithms identified the preheating time, the volume of flushing fluids, the intraoperative infusion volume, the anesthesia time, the surgical time, and the core temperature after intubation as risk factors for IOH. The decision tree was grown to 5 levels with 9 terminal nodes. The overall incidence of IOH was 42.13%. The sensitivity, specificity, recall, F1 score, and area under the curve were 0.651, 0.907, 0.916, 0.761, and 0.810, respectively. The model indicated strong internal consistency and predictive ability., Conclusions: The preheating time, the volume of flushing fluids, the intraoperative infusion volume, the anesthesia time, the surgical time, and the core temperature after intubation could accurately predict IOH in total joint arthroplasty patients. By monitoring these factors, the clinical staff could achieve early detection and intervention of IOH in total joint arthroplasty patients., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Under dual-task (DT), functional mobility and balance testing can detect balance and mobility problems in activities of daily living, especially in situations that cannot be identified under single-task conditions., Objective: Determine the test-retest reliability and concurrent validity of the Four Square Step Test (FSST) under DT conditions for people with total knee arthroplasty (TKA)., Method: A total of 30 patients with TKA participated in this research, and patients were tested with the FSST under DT conditions. In addition, concurrent validity of the dual-task FSST was calculated using Timed Up and Go (TUG) under the single-task condition and Hospital for Special Surgery (HSS) Knee Score. Patients performed two FSST trials on the same day under DT conditions., Results: The intraclass correlation coefficients (ICC 2,1 ) two-way random effects model, and minimal detectable changes with 95% confidence intervals (MDC 95 ) values of the FSST under DT conditions were .97 and 3.43, respectively. The Pearson's correlation coefficient of the FSST with the TUG and HSS was .65 and -.40, respectively., Conclusion: The FSST has been found to be a reliable and valid clinical assessment tool for dynamic balance under DT conditions in patients with TKA. For identify balance disorders in daily life at early points, clinicians and researchers can use the FSST under DT conditions in TKA., Clinical Trial Registration Number: NCT06108466.

Background: Depression is associated with inferior outcomes following hip or knee arthroplasty, though it remains unclear if this relationship is modifiable. This study examined the association between pharmacologic treatment of depression and patient-reported outcomes., Methods: This retrospective cohort study of 1,651 total hip arthroplasty (THA) and 1,792 total knee arthroplasty (TKA) procedures between October 2012 and June 2019 used institutional registry data linked to nationwide pharmaceutical claims. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global score, with pain and function subscales assessed as secondary outcomes. The TKA and THA patients were analyzed separately via mixed-effect linear regression to compare patients who had depression treated with antidepressants (TKA, n = 210; THA, n = 150) to those who had untreated depression (TKA, n = 43; THA; n = 50), and those who did not have depression (TKA, n = 1,539; THA, n = 1,451)., Results: Among patients who had depression, not receiving preoperative antidepressant therapy was associated with smaller improvements in WOMAC global scores (TKA, adjusted mean difference [MD]: -13.1 points, 95% CI [confidence interval]: -21.4 to -4.8; THA, MD: -8.5 points, 95% CI: -15.7 to -1.2) at 2 years after surgery, but not at 1 year (TKA, MD: -5.4 points, 95% CI: -12.9 to 2.1; THA, MD: -6.3 points, 95% CI: -12.9 to 0.3). Those who did not have depression had similar improvements in WOMAC global scores to those who had treated depression at both one (TKA, MD: 0.8 points, 95% CI: -2.7 to 4.4; THA, MD: 1.8 points, 95% CI: -1.8 to 5.4) and 2 years (TKA, MD: -1.1 points, 95% CI: -4.9 to 2.7; THA, MD: -1.6 points, 95% CI: -5.6 to 2.3). The findings were consistent with secondary outcomes., Conclusions: Among patients who have depression, antidepressant therapy before TKA or THA is associated with improved outcomes. Additional studies are needed to establish the impact of interventions to address untreated depression before surgery., (Copyright © 2024. Published by Elsevier Inc.)

This study aimed to compare outcomes and complication rates between posterior cruciate ligament (PCL) retention and excision utilizing a medial congruent (MC) polyethylene insert in total knee arthroplasty (TKA) in a specialized ambulatory surgery center (ASC) dedicated to hip and knee arthroplasty. A retrospective review was performed between May 2023 and October 2023 analyzing 398 patients who underwent primary MC TKA by high-volume joint arthroplasty surgeons ( n  = 9) with either PCL preservation ( n  = 264) or sacrifice ( n  = 134) in a single free-standing ASC. Patients were matched chronologically on a 2:1 basis. Demographics, baseline function, 90-day complications, and patient-reported outcomes were recorded for each patient. There were no differences in preoperative baseline function or patient-reported outcome measures, Charlson Comorbidity Index, or American Society of Anesthesiologists class among patient groups. The PCL-preserve and PCL-sacrifice cohorts showed significant variation in 12-week postoperative Knee Injury and Osteoarthritis Outcome, Junior (KOOS, JR.) scores. Specifically, the number of patients who achieved the minimal clinically important difference (MCID) in KOOS, JR. scores was higher in the PCL-sacrifice group ( p  < 0.05). Yet, no complications within the 90-day period were associated with PCL status and other patient-reported outcomes. This study comparing outcomes between MC TKAs with PCL retention and sacrifice suggests that both techniques are viable options with similar functional outcomes, pain scores, and complication rates, which may have benefits in an ASC setting. The PCL-sacrifice group exhibited a statistically significant increase in patients who achieved the MCID in KOOS, JR. score compared with the PCL-preserving at early follow-up. Future research should employ prospective, randomized designs to further validate these findings and explore long-term implications., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: To evaluate clinical effect of transcutaneous acupoint electrical stimlation (TEAS) on perioperative immune function and postoperative recovery in patients with total knee arthroplasty (TKA)., Methods: From November 2021 to July 2022, 80 patients with unilateral TKA were selected and divided into TEAS group and sham TEAS group according to different treatment methods. There were 40 patients in TEAS group, including 9 males and 31 females;aged from 61 to 79 years old with an average of (66.90±5.86) years old;body mass index (BMI) ranged from 19.53 to 30.47 kg·m -2 with an average of (25.34±2.83) kg·m -2 ;21 patients on the left side, 19 patients on the right side;according to American Society of Anesthesiologists (ASA), 30 patients with gradeⅡ, 10 patients with grade Ⅲ;TEAS were administered at the bilateral Hegu (LI4), Neiguan (PC6) and non-operative Zusanli (ST36) and Sanyinjiao (SP6) points from 30 min before anesthesia to the end of operation, the frequency was 2/10 Hz, current intensity was tolerable and/or muscle rhythmic twitches of limbs were performed. There were 40 patients in sham TEAS group, including 9 males and 31 females;aged from 60 to 80 years old with an average of (67.35±4.29) years old;27 patients on the left side and 13 patients on the right side;BMI ranged from 20.02 to 30.09 kg·m -2 with an average of (25.02±2.23) kg·m -2 ;28 patients with gradeⅡand 12 patients with grade Ⅲ according to ASA;Electrodes were attached to the same points without electrical stimulation. Percentage contents of 24 h CD3+, CD4+, CD8+ and NK cells, postoperative infection, incidence of nausea, vomiting, abdominal distension and pruritus within 48 h after surgery, the first time on the ground, length of hospital stay and quality of recovery-15 (QoR-15) score were compared between two groups., Results: Compared with pseudoteas group, expressions of CD3+ and CD4+ T lymphocytes in TEAS group were significantly increased at 24 h after surgery ( P <0.05). The incidence of nausea within 48 h after surgery and the time spent on the ground early after surgery were significantly decreased ( P <0.05). There was no significant difference in postoperative secondary infection, adverse reactions such as vomiting, abdominal distension, pruritus and hospitalization days ( P >0.05)., Conclusion: Percutaneous acupoint electrical stimulation could improve perioperative cellular immunity in patients with total knee replacement, alleviate immunosuppression, reduce incidence of postoperative adverse reactions, and promote early postoperative recovery.

Introduction: Recent studies have increasingly provided evidence that one-stage septic revisions for hip and knee are a safe treatment option for periprosthetic joint infections (PJI) in selected patients. However, there is still a wide treatment variation concerning indications and execution among different practices. This study aimed to describe these differences., Methods: We set out an online questionnaire among members of the European Bone and Joint Infection Society (EBJIS) in September 2023. The questionnaire consisted of questions investigating indications, execution, and preferences regarding one-stage hip and knee septic revisions. Descriptive analysis was performed of all results and Chi-squared tests were used to test for differences in opinions between subgroups of respondents., Results: Sixty-five orthopaedic revision arthroplasty surgeons completed the questionnaire. 68% prefer to standardly perform two-stage revisions and only do one-stage revisions in selected patients. However, there was no consensus on which (contra-)indications should be used to select these patients. The most important reason to not perform one-stage revisions was fear of a higher reinfection risk, partly due to inconclusive literature. There was also no consensus on which perioperative antimicrobial measures should be applied., Conclusions: Notable differences in indications for and execution of one-stage septic revisions persist. We encourage others to share their experiences with this procedure. Moreover, clinical trials should be undertaken to provide stronger evidence for the safety of one-stage septic revisions and to provide clear and uniform guidelines., Competing Interests: Declarations. Ethical approval: No human or animal subjects were involved in this study. No patient data were collected in the questionnaire. Financial and non-financial interests: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Depression is among the most common mental illnesses, with an estimated 8.1% of adults in the United States living with the condition. Despite its prevalence, the effect of depression on surgical outcomes is not well studied. The aim of this study is to assess the effect of diagnosed major depressive disorder on postoperative outcomes following total knee arthroplasty (TKA)., Methods: This retrospective cohort study used the National Readmissions Database from 2016 to 2019 to evaluate the effect of depression on 30-day outcomes following TKA. Patients with and without a diagnosis of depression were identified using International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10) codes. Propensity score matching was employed to balance patient demographics, socioeconomic status, and comorbidities, between the two groups. Multivariate regression analyses were used to assess postoperative outcomes, 30-day readmission, and revision surgery rates., Results: Overall, 1,906,980 patients undergoing TKA, 302,853 (15.68%) with a diagnosis of depression, were included in our analysis. After matching, those with depression were more likely to have both medical (odds ratio [OR] 1.90; P < 0.001) and surgical complications (OR 1.86; P < 0.001), including periprosthetic fracture (OR 2.27; P < 0.001). In addition, they had increased odds of 30-day readmission (OR 1.98; P < 0.001) and revision surgery (OR 1.83; P < 0.001)., Conclusion: Depression is common in the TKA population, with 15.9% of patients having a diagnosis at the time of surgery. Furthermore, these patients experience a greater risk of complications following surgery. They are also at greater risk of requiring readmission or revision surgery. Overall, patients with depression may experience worse outcomes following TKA., Study Design: Level III; Retrospective Cohort Study., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Background: This study aims to report and analyze disease-specific patient-reported outcome measure (PROM) effect size (ES) variations, in patients undergoing major arthroplasty surgery., Material and Methods: All institution-based data of primary knee, hip, or shoulder arthroplasty patients at Turku University hospital (Finland) between January 2020 -December 2022 were collected, and treatment outcome assessed as a PROM difference between baseline and one-year follow-up. PROM ES were calculated for each patient and patient group separately, and patients with ES >0.5, were considered responders. Factors contributing to patient outcome and differences between patient groups were investigated using linear models and non-parametric methods., Results: 2580 patients were operated (complete follow-up data on 1828 patients). 1110 (61%) of the patients were female, and mean age was 69 years (SD 10). The mean ES across all patient groups was 2.64 (SD 1.29) and the biggest ES was observed in shoulder patients and the smallest in knee patients. Smaller ES was statistically significantly associated with higher preoperative PROM, higher ASA class, and old age. The percentage of responders was highest for shoulder patients (97.7%), followed by hip patients (96.8%), and lowest for knee patients (92.5%)., Conclusion: The observed ES for joint arthroplasty surgeries is high. However, there are significant disparities among patients with primary knee, hip, and shoulder joint arthroplasty surgery. These variations are mainly due to differences in preoperative PROM score and may be attributed to differences in patient selection. We recommend that prior to shared decision-making, preoperative scores are thoroughly reviewed with the patient, along with other patient specific factors that may influence the end result of the treatment., Competing Interests: Ville Äärimaa has received grants from the Academy of Finland, the Social Insurance Institution of Finland, and the Turku University hospital. Ville Äärimaa has received payment for expert testimony given to National Patient Injury Board. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Inari Laaksonen have received grants from the State Research Funding of Southwestern Finland. Turku University Hospital has supported Ville Äärimaa, and Inari Laaksonen to attend meetings and/or travel., (Copyright: © 2024 Äärimaa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)