OBJECTIVE: The aim of this study was to determine the effect of transcutaneous electrical nerve stimulation (TENS) on pain, functionality, quality of life, and analgesic consumption in patients undergoing TKR.
METHODS: A single center, randomized controlled trial.
METHODS: A total of 52 participants were randomly assigned to the intervention (n = 26) and control (n = 26) groups. The intervention group was exposed to conventional TENS. Data were collected with a Patient Identification Form, the Visual Analogue Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Quality of Life Scale (SF-36), and the Analgesic Tracking Form.
RESULTS: VAS and WOMAC scores significantly decreased in the intervention group, over time, while they increased in the control group. SF-36 scores significantly increased in the intervention group over time. It was determined that analgesic consumption was significantly lower in the intervention group than in the control group.
CONCLUSIONS: TENS significantly reduced pain and increased functionality and quality of life. Our findings suggest that TENS may be an effective adjunctive analgesic therapy in patients receiving TKR; however, more testing is needed in larger and more heterogeneous populations.
CONCLUSIONS: Nurses can provide effective postoperative pain control in patients undergoing TKR, increase functionality, accelerate the healing process, and improve their quality of life by using TENS, a non-pharmacological treatment method, in the perioperative period.

Multifunctional materials have been described to meet the diverse requirements of implant materials for femoral components of uncemented total knee replacements. These materials aim to combine the high wear and corrosion resistance of oxide ceramics at the joint surfaces with the osteogenic potential of titanium alloys at the bone-implant interface. Our objective was to evaluate the biomechanical performance of hybrid material-based femoral components regarding mechanical stress within the implant during cementless implantation and stress shielding (evaluated by strain energy density) of the periprosthetic bone during two-legged squat motion using finite element modeling. The hybrid materials consisted of alumina-toughened zirconia (ATZ) ceramic joined with additively manufactured Ti-6Al-4V or Ti-35Nb-6Ta alloys. The titanium component was modeled with or without an open porous surface structure. Monolithic femoral components of ATZ ceramic or Co-28Cr-6Mo alloy were used as reference. The elasticity of the open porous surface structure was determined within experimental compression tests and was significantly higher for Ti-35Nb-6Ta compared to Ti-6Al-4V (5.2 ± 0.2 GPa vs. 8.8 ± 0.8 GPa, p < 0.001). During implantation, the maximum stress within the ATZ femoral component decreased from 1568.9 MPa (monolithic ATZ) to 367.6 MPa (Ti-6Al-4V/ATZ), 560.9 MPa (Ti-6Al-4V/ATZ with an open porous surface), 474.9 MPa (Ti-35Nb-6Ta/ATZ), and 648.4 MPa (Ti-35Nb-6Ta/ATZ with an open porous surface). The strain energy density increased at higher flexion angles for all models during the squat movement. At ∼90° knee flexion, the strain energy density in the anterior region of the distal femur increased by 25.7 % (Ti-6Al-4V/ATZ), 70.3 % (Ti-6Al-4V/ATZ with an open porous surface), 43.7 % (Ti-35Nb-6Ta/ATZ), and 82.5% (Ti-35Nb-6Ta/ATZ with an open porous surface) compared to monolithic ATZ. Thus, the hybrid material-based femoral component decreases the intraoperative fracture risk of the ATZ part and considerably reduces the risk of stress shielding of the periprosthetic bone.

BACKGROUND: In total knee arthroplasty (TKA), cementless fixation is initially weaker than cement fixation. This study aimed to examine whether filling the tibial peg holes with bone improves initial fixation strength in cementless TKA.
METHODS: This prospective, comparative study examined 88 joints in 66 patients randomized to the bone filling (48 joints) or conventional group (no bone filling; 40 joints). All patients underwent TKA with the NexGen® trabecular metal modular tibial component. In the bone filling group, resected cancellous bone was filled into the peg holes before insertion of the tibial component. We performed clinical and plain radiographic evaluations after the operation and measured bone mineral density (BMD) at five sites below the component at 1, 3, 6, and 12 months postoperatively.
RESULTS: Operative time and clinical evaluations were not significantly different. Plain radiography showed significant longitudinal thickening of the trabecula below the peg (P<0.05) and decreased occurrence of reactive lines (P=0.07) in the bone filling group compared with the conventional group. BMD was significantly higher in the bone filling group in the medial region below the peg at 1, 3, and 6 months and in the central region at 1 and 3 months (all P<0.05).
CONCLUSIONS: When using the NexGen trabecular metal modular tibial component, concurrent peg hole bone filling increases the initial component fixation strength. Possible effects on long-term stabilization warrant further study.

BACKGROUND: The survival of total knee arthroplasty (TKA) in patients with poliomyelitis remains a debated topic due to the high recurrence of postoperative genu recurvatum. This study aims to report the long-term survival of TKA in patients with poliomyelitis, using data from the Italian Register of Prosthetic Implantology.
METHODS: A registry-based population study was conducted, utilizing data from the Emilia Romagna orthopedic arthroplasty implants registry (RIPO - Registro Implantologia Protesica Ortopedica). The cohort consisted of 71 patients with poliomyelitis-related arthritis who underwent TKA. The study assessed and analyzed demographic data, implant type, fixation method, insert type, and level of constraint. Additionally, variations in preoperative and postoperative both clinical and functional Knee Society Scores (KSS) were collected.
RESULTS: Eight implants required revision surgery (16%), and three patients died (6.1%), resulting in a 10-year survival rate of 86.6% and a 15-year survival rate of 53.9%. Aseptic loosening was the primary cause of revision, accounting for 37.5% of failures, followed by insert wear (25%). No statistically significant correlation was found between the level of constraint and implant survival (p=0.0887, log-rank). Both the clinical and functional KSS improved postoperatively.
CONCLUSIONS: TKA is a viable alternative to knee arthrodesis and, in properly selected patients, might represent the first-choice treatment for articular degeneration due to its high survivorship. Despite the complexity of these cases, TKA can effectively alleviate articular pain, instability, and angular deviation, thereby preserving knee functionality.

UNASSIGNED: Although total knee replacement (TKR) surgery has succeeded in improving pain and deformity, a proportion of patients remain incompletely satisfied with their outcome. This prospective study aims to assess the survivorship, clinical, and radiological outcomes using a novel \'kinematic retaining\' (KR) implant.
UNASSIGNED: 156 patients underwent TKR surgery for primary osteoarthritis using the Physica KR implant at three European Centres. Patients were followed up for five years using both radiographic and clinical evaluations.
UNASSIGNED: Within 6 months post-operatively, 79.4% and 85.9% had good-excellent clinical and functional KSS values, this was maintained to 76.9% and 79.5% at five years. Mean Knee Society Score (KSS) improvement at 5 years was 32.8 (from 23 to 40) and 37.4 (from 30 to 50) (p < 0.01). All Knee Injury and Osteoarthritis Outcome Score (KOOS) sub-scores showed statistically significant improvement from before surgery at a mean of 34.7 (SD ± 16.1) to a mean of 86.6 (SD ± 16.1) at five years. The mean Oxford Knee Score (OKS) was 43.7 (±5.6), with over 80% of the patients having a good-excellent outcome at five years. OKS improved significantly by six weeks after surgery (p < 0.01) and remained constant throughout the 5-year follow-up. Visual Analogue Score (VAS) Satisfaction scores improved significantly after the post-operative time point of six weeks. From 1 year to 5 years, the average VAS was over 85 mm. The Forgotten Joint Score (FJS) increased from 64.5 at 1 year to 79.2 at 5 years after surgery (p < 0.01). No progressive adverse radiographic features were noted. Two patients were revised during the study period: one for infection and the other for aseptic loosening.
UNASSIGNED: This novel \'kinematic retaining\' knee prosthesis has shown exceptional clinical and patient-reported improvements, with a remarkable 99.4% survivorship (95.5-99.9) at five years.

BACKGROUND: With the increasing number of joint replacement surgeries, periprosthetic joint infection (PJI) has become a significant concern in orthopedic practice, making research on PJI prevention paramount. Therefore, the study will aim to compare the effect of combined usage of povidone-iodine and topical vancomycin powder to the use of povidone-iodine alone on the PJI incidence rate in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA).
METHODS: The prospective randomized clinical trial will be conducted in two independent voivodeship hospitals with extensive experience in lower limb arthroplasties. The studied material will comprise 840 patients referred to hospitals for primary THA or TKA. The patients will be randomly allocated to two equal groups, receiving two different interventions during joint replacement. In group I, povidone-iodine irrigation and consecutively topical vancomycin powder will be used before wound closure. In group II, only povidone-iodine lavage irrigation will be used before wound closure. The primary outcome will be the incidence rate of PJI based on the number of patients with PJI occurrence within 90 days after arthroplasty. The occurrence will be determined using a combined approach, including reviewing hospital records for readmissions and follow-up phone interviews with patients. The infection will be diagnosed based on Musculoskeletal Infection Society criteria. The chi-square test will be used to compare the infection rates between the two studied groups. Risk and odds ratios for the between-groups comparison purposes will also be estimated. Medical cost analysis will also be performed.
CONCLUSIONS: A randomized clinical trial comparing the effect of combined usage of povidone-iodine irrigation and vancomycin powder to the use of povidone-iodine irrigation alone in preventing PJIs after primary arthroplasty is crucial to advancing knowledge in orthopedic surgery, improving patient outcomes, and guiding evidence-based clinical practices.
BACKGROUND: ClinicalTrials.gov NCT05972603 . Registered on 2 August 2023.

OBJECTIVE: Preoperative anxiety is considered a common part of the surgerical experience and can be associated with serious postoperative side effects. This study aims to determine the relationship between preoperative anxiety level and postoperative pain outcomes in patients undergoing total hip replacement (THR) and total knee replacement (TKR).
METHODS: The study used a cross-sectional and correlational research method.
METHODS: The study was conducted with a total of 104 participants, who underwent 17 THR and 87 TKR, at the Orthopedic Clinic of a state hospital in southern Turkey between June 2021 and June 2022. The State-Trait Anxiety Inventory (STAI) was used to determine preoperative anxiety level, and the Visual Analog Scale (VAS) and the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) were used to assess postoperative pain level.
RESULTS: The mean preoperative STAI-I and STAI-II scores of the participants who underwent THR and TKR were 53.95 ± 10.51 and 44.20 ± 10.55, respectively. There was a moderate positive correlation between STAI-I scores and VAS pain scores at preoperative and postoperative 6th, 12th, 24th, and 36th hours. There was a moderate positive correlation between STAI-I scores and affective subdimension scores, a moderate positive correlation with pain severity and sleep interference and activity interference, and a weak positive correlation between STAI-II scores and pain severity and sleep interference, activity interference and affective. The factors independently affecting the 6th-hour VAS pain score were determined as male gender, THR procedure, and increasing STAI score.
CONCLUSIONS: We found that high preoperative state anxiety was associated with early postoperative pain outcomes. State anxiety was associated with pain in the 6th postoperative hour. Considering the multidimensional nature of anxiety, further research is recommended to understand the anxiety domain in surgical patients.

OBJECTIVE: The risk of new-onset fibromyalgia after total knee replacement (TKR) in osteoarthritis patients is not well-established. This study aimed to assess the risk of developing fibromyalgia post-TKR, considering potential variations across age and sex.
METHODS: Utilizing a multicenter retrospective cohort design and data from the TriNetX research network, electronic health records of osteoarthritis patients who underwent TKR and the same number of matched controls were analyzed. Propensity-score matching was performed by matching critical confounders. Hazard ratios were evaluated to assess fibromyalgia risk in the TKR cohort compared to non-TKR controls.
RESULTS: The hazard ratio of future fibromyalgia for the TKR cohort was 2.08 (95% confidence interval=1.74-2.49) for 1 year after the index date, 1.81 (95% confidence interval=1.62-2.02) for 3 years, and 1.69 (95% confidence interval=1.54-1.86) for 5 years compared with non-TKR controls. The significant association remained in sensitivity models and stratification analyses in different age and sex subgroups.
CONCLUSIONS: Clinicians should be vigilant about the potential for fibromyalgia development post-TKR and consider tailored interventions; our findings emphasize the need for further research to elucidate underlying mechanisms and identify modifiable risk factors.

BACKGROUND: Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement.
OBJECTIVE: The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge.
METHODS: Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app.
RESULTS: For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range -3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire.
CONCLUSIONS: The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw.

An objective of a total knee arthroplasty (TKA) is to restore native (i.e. healthy) function, and a crucial step is determining the correct insert thickness for each patient. If the insert is too thick, then stiffness results, and if too thin, then instability results. Two methods to determine the insert thickness are by manually assessing the joint laxity and by using a trial insert with goniometric markings that measures the internal-external rotation of the trial with respect to a mark on the femoral component. The former is qualitative and depends on the surgeon\'s experience and \'feel\' and while the latter is quantitative, it can be used only with an insert with medial ball-in-socket conformity. An unexplored method is to measure the force required to push a trial insert into position. To determine whether this method has merit, the push force was measured in 30 patients undergoing unrestricted kinematically aligned TKA using an insert with ball-in-socket medial conformity, a flat lateral surface, and retention of the posterior cruciate ligament. During surgery, the surgeon determined three appropriate thicknesses to test from a selection ranging from 10 mm to 14 mm in 1 mm increments. The peak push forces going from an insert 1 mm thinner than the correct thickness as determined by an insert goniometer and from the correct thickness to 1 mm thicker were measured. Mean peak forces for the different insert thicknesses were 127 ± 104 N, 127 ± 95 N, and 144 ± 96 N for 1 mm thinner, correct, and 1 mm thicker, respectively, and did not differ (p = 0.3210). As a result, measurement of peak force during trial positioning of a tibial insert cannot be used to identify the correct thickness for all insert designs.