Introduction: This prospective study investigated the patterns of sleep and daytime sleepiness following total knee arthroplasty (TKA), evaluating the factors affecting sleep and their impact on functional outcomes and health-related quality of life.
Methods: The sleep quality of 68 TKA patients was monitored using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (EPSS) at various intervals: preoperatively, 1 week, 2 weeks, 6 weeks, 3 months, and 6 months post-surgery. Concurrent evaluations of pain, anxiety, and functional outcomes were conducted using the Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale (HADS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Results: PSQI scores initially rose from a baseline of 11.37 to 15.13 at one week, indicating worsened sleep patterns immediately post-surgery. Scores peaked at two weeks but gradually improved, returning to baseline by 3 to 6 months and surpassing initial values by six months (P<0.01). Daytime sleepiness also showed notable peaks at two weeks and six weeks. Regression analysis identified increased pain, anxiety, and depression as factors negatively impacting sleep and functional outcomes, correlating with poorer WOMAC and SF-12 PCS and MCS scores. Furthermore, female gender and an ASA grade > 2 were predictors of poorer sleep quality, with no significant differences noted between unilateral and bilateral TKA patients.
Conclusion: Sleep cycle disruption following TKA is common but temporary, typically resolving within 3 months and improving beyond preoperative levels after six months. Key factors associated with poorer sleep outcomes include female gender and higher comorbidity scores (ASA>2).

Introduction: Total knee arthroplasty (TKA) is gold standard treating knee arthritis with satisfactory results. The incidence of unexplained pain after TKA ranges from 8-19% with most of cases reporting peri-patellar pain. Etiology is sometimes difficult to establish. When the cause is identified, 80% of revision surgery are successful. Component malrotation may lead to an unexplained anterior knee pain. Methods: Clinical case 70 yo male who made a TKA in 2022. Always complained for anterior knee pain. No signs of infection, no instability, range of motion 0-100º. CT scan revealed tibial component internal rotation of 30º. Results: We performed a revision surgery where only the tibial component was replaced for a new one with external rotation (with short stem due to bone loss). 1 month after surgery the range of motion is 0-90º and the patient has no anterior pain. Discussion: A painful TKA is a huge challenge in knee surgery. Systematic approach is very important to identify its cause and treat it successfully. Many are subtle with no evident complication in plain radiographs. Extrinsic cause, infection, patellar maltracking, component malalignment, instability, stiffness due to scar tissue and trauma should be excluded. In our case we could only find tibial internal rotation. Some studies found that component rotation alone was not significant for anterior pain but most of them defend that it is responsible for patellar maltracking. Conclusion: Painful TKA should be approached in a systematic way and if there is an identifiable cause, revision should be performed expecting good results.

Introduction: Complex primary or revision TKA is challenging procedure requiring expertise and special resources. NHS Highland is the largest health boards in Scotland providing secondary Orthopaedic care with a catchment area of 32500 km2 (larger than Belgium). As per Scottish arthroplasty project data 2023, 4833 TKAs were done, knee revision within first 5 years accounted 1.5%. We analysed demographic and the geographic data with outcomes for patients who underwent complex and revision TKR living in rural and remote areas. Objective: The aim of this study is to evaluate patient location, ASA grade, average waiting time for surgery, length of stay ( LOS), AORI classification. Secondary outcomes were measured. Method: A retrospective cohort study was performed and 16 patients (n=16) who underwent this procedure from January 2022 to February 2024 were included in the study. Descriptive statistics was used to summarise the patient demographics, distance from hospital, average waiting time and complication rate. Paired t test and non parametric equivalents were used to analyse the changes in ROM and PROM. Results: T1 defect was most common (AORI classification criteria). The average LOS was 7.8 days, average distance from the hospital to the patient’s listed address was 42.88 miles (69km), the average waiting time was 8.13 months, the median ASA grade was 2 and the average BMI was 29.9 Conclusion: This is a unique study conducted in the Scottish highland, the geographical context and the impact of covid pandemic on Revision knee service for remotely located patients providing a valuable insight.

Conflict between tendons and implants in total knee prosthesis often is a reason for a chronic pain and long-term disability in knee prosthetic patients in the below described technique ultrasound is used to diagnose the condition this imaging modality far outcomes the CD or MRI all the steps are followed in this presentation it's a novel technique with 100% guaranteed excellent outcome is properly applied under ultrasound guidance the tendon is identified then cut through using the Kamis knife from Newclip techniques images and a minincision is the only surgical portal. In my series 7 patients are included all underwent the aforementioned procedure with an excellent outcome and pain-free a day behind the surgery no complications so far.

Introduction : Aseptic loosening (AL) is one of the leading causes for revision of failed primary unicompartmental knee arthroplasty (UKA). The failed UKAs may need special implants like augments or constrained or Hinged total knee arthroplasty (TKA) . In this study, we described a novel surgical technique of conversion to TKA using double cut tibial technique (DCT). Methods: This prospective, observational study took place in a tertiary care hospital during May 2022 – June 2024 under single surgeon. DCT technique was used to manage tibial defect. All the patients were followed to latest follow up. Mean follow up duration was 6 months. Outcomes were assessed using the Knee Society Score (KSS). The radiological assessment was done using CT scan at 3 months. Results: The study included 8 revision TKAs (4 females, 4 males; mean age: 58 years) performed following failed aseptic UKA. The Mean preoperative KSS was 52.2 and 82 after TKA. There were 3 excellent, 4 good and 1 fair results. We observed less need of augments during management of tibia defect using DCT technique in UKA revision. Conclusion: This surgical technique is useful resulting good functional and radiological outcome during UKA revision to TKA after aseptic loosening without the need of special implants.

Obesity has been reported as a pro-inflammatory state with elevated baseline CRP, ESR, & Interleukin-6 values. The study is a prospective observational design conducted from Nov 2022 to Aug 2023 in patients who underwent primary TKA for osteoarthritis. A total of 240 patients were included. The difference in IL6, CRP and ESR levels between the obese (BMI ≥ 30,108 patients) and non-obese (BMI ≤ 30, 132 patients) was analyzed at preoperative, 48 hours, day 30 and at 3rd month along with knee function scores.
The preoperative IL – 6 in non-obese vs obese patients was 6.58 ± 6.02 vs 9.42 ± 13.4( p 0.04), CRP 5.24 ± 6.92 vs 9.70 ± 16.14( p 0.01) & ESR 26.03 ± 17.43 vs 39.37 ± 22.18(p 4.53).
Obese patients (BMI > 30) had a higher range of inflammatory markers in the perioperative period at 48 hours. The mean 48 hours IL – 6 in non-obese vs obese patients was 45.2 ± 35.69 vs 55.53 ± 59.49(p 0.05), ESR 31.6 ±19.4 vs 38.8± 21.8 (p 0.008) & CRP 51.5 ±29.4 vs 51.76 ±34.2 ( p 0.92). There was no significant difference at 30 days and 3 months including the KSS value. The incidence of superficial SSI was 2 % in both groups. There was no deep infection.Patients with BMI > 30 can have higher preoperative and 48 hrs postoperative inflammatory markers primarily because of obesity. This should be interpreted with caution and should be followed up to avoid unnecessary over-treatment.

Primary total knee arthroplasty has long been proven effective in the treatment of stage 3–4 knee osteoarthritis. It is well known that this intervention not only improves the quality of life, but also helps to restore the function of the joint and eliminate axial deformities. Purpose: To compare early results of total knee arthroplasty using robot-assisted technology with conventional manual technique. Materials and Methods: 20 patients diagnosed with stage 3 osteoarthritis of the knee joint and varus deformity of the knee joint axis were included in a prospective randomized study.
Patients were divided into 2 representative groups, 10 subjects underwent robot-assisted knee arthroplasty, and the conventional manual technique was used in the other 10 patients. For clinical assessment, functional scales KSS, WOMAC, Lysholm Score were used, postoperative radiographs were evaluated.

【Purpose】In this study, we report on a retrospective study of the outcomes of 13 patients with a failed knee extension mechanism after TKA. 【Subjects and methods】 1712 patients who underwent TKA between 2011 and 2019 were included. Of these, 11 patients with knee extensor mechanism injuries and 13 joints that were observable were included.The breakdown of extension mechanism failure sites included eight patellar fractures, four patellar tendon ruptures and one quadriceps rupture. Three patellar fractures with fracture dislocation and extension lag were treated surgically and five patients were treated conservatively. Four patients with patellar tendon rupture and one with quadriceps rupture were treated surgically. 【Results】The range of motion after surgery in the four patients with patellar tendon ruptures averaged 0° in extension and 97.5° in flexion, with an extension lag of more than 10° in one case. One patient with quadriceps rupture had flexion limitation of 0° in extension and 75° in flexion, but no extension lag. In three patients with patellar fractures who underwent surgical treatment, bony fusion was achieved in one case and extension lag of more than 10° was observed in two cases. Conservative treatment resulted in bony fusion in 3 out of 5 cases, and extension lag of more than 10° in 1 case. 【Discussion】 Aggressive surgical treatment is recommended for quadriceps ruptures and patellar ligament ruptures, while careful selection of treatment strategy is necessary for patellar fractures, as there have been cases of revision surgery.

We designed this randomised controlled trial to compare buprenorphine patch (BTP) and ketoprofen transdermal patches( KTP) in controlling postoperative pain after primary total knee arthroplasty.
Patients in the BTP group received a BTP (10 mcg/h) patch which was changed on the 7th day and was continued for 14 days. Patients in the KTP group received a KTP (20 mg) on the day of surgery, and was changed daily for 14 days. Pain intensity was measured using the VAS score.
VAS scores at rest were significantly lower in the BTP group for the initial 5 days, p=0.0027, p=0.0001, p=0.0050 at Day 1, Day 2 and Day 3 respectively . VAS scores on activity were also found to be significantly lower in the BTP group for the initial 5 days . There was no significant difference in VAS scores at day 14 p=0.5437 at rest and p=0.3170 at activity. ROM in BTP group at all days postoperatively were higher as compare to that in KTP group but values were not statistically significant
On all days of admission, the patient satisfaction scores were statistically higher in the BTP group at 12 hours (p=0.0002) , at day 2 (p=0.0012), at day 3 (p=0.0000) as compared to the KTP group (Table 5). Patient satisfaction score were comparable in both BTP and KTP group at day 14 (p=1.0000)
The incidence of adverse effects was not statistically significant between the two groups. However, the incidence of PONV, urinary retention and constipation were higher in the BTP group.

Total knee arthroplasty (TKA) is an effective solution to treat end-stage knee OA.The application of antifibrinolytic agent such as tranexamic acid (TXA) in TKA can significantly decrease total blood loss and transfusion requirement without increasing the incidence of deep vein thrombosis (DVT). Therefore, we realized the present study to perform a preliminary evaluation of the efficacy and safety of TXA in primary TKA .
We retrospectively reviewed a consecutive series of patients with primary unilateral TKA. Patients were divided into TXA group and control group (who did not receive TXA). Outcome measures included drainage volume; hemoglobin and hematocrit levels recorded preoperatively and during the first 5 postoperative days; amount of blood transfusion and the presence of thrombosis. 96 cases were included in the study. Demographic data, general health status, and preoperative conditions were comparable between the two groups. However, significantly lower drainage volume (P < 0.001), blood loss (P < 0.001), and blood transfusion volume (P = 0.046) were noted in the TXA group. Hemoglobin and hematocrit levels were significantly higher in the TXA group on the first postoperative day (P = 0.006), but overall the decline in hemoglobin and hematocrit levels during the first 5 postoperative days was similar between groups (P = 0.763), as did the incidence of VT (P = 0.794).
TXA has a positive role for patients in the setting of primary total knee arthroplasty, TXA decreases blood loss and the need for blood transfusion, which seems mainly effective on the first postoperative day of TKA.

Robotic Assisted Total Knee Arthroplasty (RATKA) claims to have superior results in having lesser surgical trauma and hence lower estimated blood loss. Post operative anaemia is a underrated complication following TKA having an incidence of 53.2%. We conducted a clinical audit at a tertiary care hospital in India with to compare our management guidelines with the global standards. 176 consecutive RATKA were identified from January 2022 to April 2024 performed by a single surgeon using CORI robotic system. We considered moderate anaemia for a haemoglobin (Hb) value between 8 to 11 mg/dl and severe anaemia below 8 mg/dl. The Post operative Moderate to Severe Anaemia (PMSA) rate in our series was 72.72%, out of which 63.63%(n=112) constituted for moderate and 9.09% (n=16) for severe levels. The average pre-operative Hb was 12.03 mg/dl and the average drop in Hb post operatively was found to be 2.09 mg/dl. Bilateral TKA constituted 50.56%(n=89) and 49.44 % were unilateral TKA (45 right, 42 left).

With the advent of robotic arm assistance, Total Knee Arthroplasty (RATKA) has produced largely predictable outcomes. However, the cost effectiveness of using a robot routinely for TKA hasn’t been followed up enough in the literature. We aim to evaluate whether RATKA are associated with lesser length of stay (LOS). A consecutive series of 248 patients (n=330 knees) were studied from 1st January 2021 to 1st June 2024 in a tertiary care hospital in India. 166 unilateral (uni) and 82 (n=164) bilateral (B/L) were performed by 14 experienced surgeons. 47% (n=153) were RATKA and 53% were done by conventional techniques. A benchmark of 3 days for unilateral and 5 days for bilateral TKA, was determined by local statistical policies from the preceding years, as the anticipated stay of patients undergoing TKA. A total of 71.16 %(58.33% uni, 84% B/L) RATKA managed to fall within the benchmark as opposed to 80.35% (70.71% uni, 90 % B/L) in cTKA. The reasons for delayed discharge included pain & physiotherapy (10%), altered haemodynamic status post-operatively (18%) and patient requests (9%). To bring about a standardisation in health care policies, a town hall meeting for TKA patients with patient testimonials, distributing discharge handouts and conducting clinical audits is the way forward. In conclusion, RATKA did not significantly alter the LOS as compared to cTKA. The pain and rate of haemodynamic instability was similar in both groups. The patient requests were due to sociopath-economic factors.

Background : The tibial valgus osteotomy is a conservative intervention that has proven its worth for beginner arthritis on varus axis deviation. Despite its prominent place, many patients reach advanced stages without benefiting from it and only arthroplasty becomes a savior. The purpose of this study was to identify the reasons that would explain why patients with a little osteoarthritis on a varum did not achieved an osteotomy in time. Methods : We investigated 100 women with knee osteoarthritis on a varum, in witch a primary total knee arthroplasty was firstly conducted. Results : Our survey found favorable socio-economic conditions: 73% urban, 95% homeowners, 91% near hospitals. Despite early consultations (48% within a year), treatment guidelines for gonarthrosis were often disregarded. 65 received no dietary advice, 60 had arthroplasty without rehabilitation. Only 3 of 100 potential osteotomy candidates were informed. Clinical findings pre-arthroplasty showed treatment inadequacies: 77% had reduced walking perimeter, 27% had flessum, mean varus was 13.8°. Conclusion : Knee osteoarthritis is a pathology whose evolution can be slowed down by conservative surgery. In practice this management is still insufficient and several shortcomings have been noted. An organized clinical and radiological follow-up and a hierarchy of therapeutic means must be instituted.