OBJECTIVE: Resecting the posterior cruciate ligament (PCL) increases posterior laxity and increases the flexion gap more than the extension gap in the native (i.e. healthy) knee. These two effects could lead to significant anterior displacement of the medial femoral condyle in kneeling following total knee arthroplasty even when using a tibial insert with a high degree of medial conformity. Using an insert with ball-in-socket medial conformity and a flat lateral articular surface, the primary purpose was to determine whether the medial femoral condyle remained stable with and without PCL retention during kneeling.
METHODS: Two groups of patients were studied, one with PCL retention (22 patients) and the other with PCL resection (25 patients), while kneeling at 90º flexion. Following 3D model-to-2D image registration, A-P displacements of both femoral condyles were determined relative to the dwell point of the medial socket.
RESULTS: With PCL resection versus PCL retention, the medial femoral condyle was 5.1 ± 3.7 mm versus 0.8 ± 2.1 mm anterior of the dwell point (p < 0.0001). Patient-reported function scores were comparable (p ≥ 0.1610) despite a significantly shorter follow-up of 7.8 ± 0.9 months with PCL retention than 19.6 ± 4.9 months with PCL resection (p < 0.0001). Range of motion was 126 ± 8° versus 122 ± 6° with and without PCL retention, respectively (p = 0.057).
CONCLUSIONS: Surgeons that use a highly conforming tibial insert design can stabilize the medial femoral condyle during kneeling by retaining the PCL. In patients with PCL resection, the 9 mm high anterior lip of the insert with ball-in-socket medial conformity was insufficient to prevent significant anterior displacement of the medial femoral condyle when weight-bearing on the anterior tibia.

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.

The diagnosis of periprosthetic joint infections (PJI) presents a formidable challenge to orthopaedic surgeons due to its complex and diverse manifestations. Accurate diagnosis is of utmost importance, as even mild pain following joint replacement surgery may indicate PJI in the absence of a definitive gold standard diagnostic test. Numerous diagnostic modalities have been suggested in the literature, and international societies have continually updated diagnostic criteria for this debilitating complication. This review article aims to comprehensively examine the latest evidence-based approaches for diagnosing PJI. Through a thorough analysis of current literature, we explore promising diagnostic strategies that have demonstrated effectiveness in identifying PJI. These strategies encompass the utilization of laboratory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), alongside imaging techniques such as magnetic resonance imaging (MRI) and leukocyte scintigraphy. Additionally, we highlight the importance of synovial fluid analysis, including the potential role of alpha-defensin as a biomarker, and examine evolving international diagnostic criteria to standardize and improve diagnostic accuracy.

UNASSIGNED: Arthroplasty registers can provide feedback information on the results of arthroplasties performed by a certain institution or surgeon. The use of real-world data to achieve real-world evidence can help evaluate the performance of the implants used and help counsel our patients. The main objective of our study was to determine the survivorship of the total knee implant we are currently using.
UNASSIGNED: A retrospective cohort study of patients who received a total knee arthroplasty from January 2009 to December 2020 in our hospital was conducted, using data from the Catalan arthroplasty registry and the Catalan health service database. Demographic and surgical data were analysed using the Kaplan-Meier method, log-rank test and Cox proportional hazards models with the R Project software (p < 0.05).
UNASSIGNED: A total of 1336 total knee arthroplasties were included in the study, of which 992 were women. The causes for revision included aseptic loosening (17), infection (29), instability (13), patellar implantation (13), arthrofibrosis (5) and quadriceps tendon rupture (1).The cumulative risk for revision at 5 years using the Kaplan-Meier method was 6.0% and at 10 years 6.5%. Considering gender, this risk was 7.0% and 7.5% at 5 and 10 years, respectively, in women and 3.3% in men, both at 5 and 10 years (p = 0.009). A higher risk for revision in women was seen, which is considered statistically significant (p = 0.012).
UNASSIGNED: Our survivorship results are comparable to those published in the literature, but with a higher revision risk in women that is only statistically significant for the whole group of reoperations and for patellar implantation, but not for the rest of the diagnoses.
UNASSIGNED: Level IV.

Robotic total knee replacement (TKR) surgery has evolved over the years with the aim of improving the overall 80% satisfaction rate associated with TKR surgery. Proponents claim higher precision in executing the pre-operative plan which results in improved alignment and possibly better clinical outcomes. Opponents suggest longer operative times with potentially higher complications and no superiority in clinical outcomes alongside increased costs. This editorial will summarize where we currently stand and the future implications of using robotics in knee replacement surgery.

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.

UNASSIGNED: As the population is growing older, incidence of knee osteoarthritis is largely increasing and the rate total knee arthroplasty surgery is following that same trend. However, patients post-operatively are retaining weakness in the quadriceps and hip abductors for a period reaching up to 3 years following surgery. The current literature results on the effectiveness of rehabilitation programs that also includes hip strengthening exercises are still highly contradicting. This meta-analysis studies and assesses the efficacy of hip strengthening exercises following total knee arthroplasty surgery.
UNASSIGNED: PubMed, Embase, Cochrane and Google Scholar (page 1-20) were searched till January 2024. The clinical outcomes consisted of the post-operative tests (6MWT, TUG, SLS), pain, and range of motion (flexion and extension).
UNASSIGNED: Three randomized clinical studies were included in the meta-analysis. When compared to the standard rehabilitation, hip strengthening exercises proved a better improvement of single leg stance with no difference observed in the remaining outcomes.
UNASSIGNED: Hip strengthening exercise protocols ensured a better improvement of single leg stance scores. However, no difference was observed in the remaining analyzed outcomes. This contradictions between studies can be explained by the different physical therapy protocols used. Nevertheless, more randomized controlled studies are needed to confirm such results.

OBJECTIVE: To evaluate the efficacy and quality of life in long-term period (1 year) after total knee replacement in various age groups.
METHODS: We studied 134 patients after unilateral primary total knee replacement. The KOOS and SF-36 questionnaires were used to assess the therapeutic effect (functionality and symptoms) and quality of life in patients with knee osteoarthritis.
RESULTS: At baseline, group I (young patients) had low KOOS pain scores (39.42±16.42), function scores (50.18±19.16) and QoL scores (18.2±15.9) compared to other age groups. A year after surgery, group I (<55 years) had significantly lower KOOS scores of pain, function and quality of life compared to group III (>65 years). Multiple regression analysis showed that age was a significant predictor of pain, but not a function after a year.
CONCLUSIONS: Total knee replacement gives a noticeable improvement in pain, functionality and quality of life in all age groups. However, there are significant age-related differences in preoperative assessment of pain, quality of life and mental health, as well as in final indicators of postoperative pain and quality of life. Indeed, young patients (<50 years) report more intense pain and worse quality of life. These data may be used in clinical practice to improve decision-making and patient expectations before total knee replacement.
Тотальное эндопротезирование коленного сустава (ТЭКС) является одной из наиболее распространенных операций, проводимых для лечения пациентов с тяжелыми повреждениями и заболеваниями коленного сустава.
UNASSIGNED: Оценить и сравнить лечебный эффект и качество жизни в отдаленном периоде (через 1 год) после проведения ТЭКС в различных возрастных группах.
UNASSIGNED: Нами было проведено проспективное когортное исследование на выборке из 134 пациентов с односторонним первичным ТЭКС. Для оценки лечебного эффекта (функциональность и симптомы) и качества жизни у пациентов с остеоартрозом коленного сустава III—IV степени использовались опросники KOOS и SF-12.
UNASSIGNED: Перед операцией в 1-й группе (молодые пациенты) были получены низкие показатели по KOOS оценки боли (38,8), функции (49,2) и качества жизни (18,2) по сравнению с другими возрастными группами пациентов. Через 1 год после ТЭКС в 1-й группе (<50 лет) было установлено, что значения показателей по KOOS — боли, функции в повседневной жизни и качества жизни — по сравнению с 3-й группой (старше 65 лет) были статистически ниже. Множественный регрессионный анализ показал, что возраст является значимым предиктором боли, но не функции (KOOS ADL) через 1 год.
UNASSIGNED: Полное эндопротезирование коленного сустава дает заметное облегчение боли, улучшение функциональности и качества жизни во всех возрастных группах. Однако существуют клинически значимые возрастные различия в предоперационной оценке боли, качества жизни и психологического здоровья, а также в конечных показателях послеоперационной боли и качества жизни, при которых молодые пациенты (<50 лет) сообщают о более интенсивной боли и худшем качестве жизни. Полученные данные об оценке пациентами своего состояния могут использоваться в клинической практике для улучшения совместного принятия решений и ожиданий пациентов перед тотальным эндопротезированием коленного сустава.

BACKGROUND: Wearable devices provide the ability for clinical teams to continuously monitor patients\' rehabilitation progress with objective data. Understanding expected recovery patterns following total knee arthroplasty (TKA) enables prompt identification of patients failing to meet these milestones. The aim of this study was to establish normative values for daily functional recovery in the first 6 weeks after TKA using a wearable device.
METHODS: This prospective study included patients who underwent TKA between 2020 and 2023, treated by 11 surgeons from 8 institutions. Eligible participants were aged 18 or older, had a primary unilateral TKA, and owned a smartphone. Knee range of motion, total daily steps, cadence, and device usage were measured continuously over 6 weeks. Statistical analysis included analysis of variance using post hoc Tukey honest significant difference tests.
RESULTS: The cohort of 566 participants had a mean age of 65 and 69 for men and women, respectively (range, 50 to 80). Women comprised 61% (n = 345) of study participants. There were 82% of women and 90% of men who had a body mass index > 30. The average daily wear time of the device was 12 hours (±4) for a total of 45 days (±27). Recovery was nonlinear, with the greatest gains in the first 3 weeks postsurgery for all metrics. Men demonstrated greater total daily step counts and cadence when compared to women. Obese patients demonstrated poorer performance when compared to lower body mass index patients.
CONCLUSIONS: To our knowledge, this study presents the first normative data for tracking daily functional recovery in TKA patients using wearable sensors. Standardizing the TKA recovery timeline allows surgeons to isolate factors affecting patients\' healing processes, accurately counsel them preoperatively, and intervene more promptly postoperatively when rehabilitation is not within standard recovery parameters.