Introduction: Most cases of revision knee arthroplasty involve bone defects. In this study, we compared the use of double cementing method and modular metal augments to replace bone defects. Methods: A prospective randomized trial was conducted. In the main group, the double cementing method was used to replace bone defects during revision knee joint replacement, and in the control group, modular metal augments were used (40 patients in each group). Bone defects were assessed using the AORI scale and joint function was assessed the Knee Society Score (KSS) and Oxford Knee Score (OKS). Knee radiography was used to assess the stability of the endoprosthesis. Results: The follow-up period was up 12 to 36 months (average 28.3 months, σ=8.5). There were no statistically significant differences between two groups in days in the hospital (p=0,18), operation time (p=0,5), knee (p=0,5) and functional (p=0,24) KSS scores, OKS scores (p=0,16). Blood loss in the main group was on average 300 ml less than in the control group (p=0,00014). There were 2 cases of periprosthetic infection development in the first group and 4 cases in the second group. In the first group, there were four cases of radiolucent lines at the bone/cement interface, while the second group had seven. Conclusions: The research found no significant difference in outcomes between the groups except for less blood loss in the main group. The double cementation technique has the potential to reduce the risk of recurrent periprosthetic infection, reduce the incidence of radiolucent lines, and be more cost-effective.

Medial stabilised total knee arthroplasty (TKA) aims to recreate the medial pivot kinematics of the native knee. These have shown improved stability and patient satisfaction. The Medial Congruent (MC) system allows for retention or sacrifice of the posterior cruciate ligament (PCL) without changing polyethylene design. Current literature is limited on whether retaining the PCL will improve outcomes post operatively. We assess the differences in clinical outcomes depending on whether the PCL is retained or sacrificed.

This is a retrospective study comparing 26 MC with PCL retained and 50 MC with PCL sacrificed TKAs. We evaluated parameters preoperatively as well as 3 and 12 months post operatively.

Both groups were similar in terms of age, gender, BMI, and ASA score (p ≥ 0.05). There were no significant differences between both groups preoperatively. At 1 year, the ROM and all outcome scores were similar between both groups (ROM: p=0.8; OKS: p=0.66; KS-FS: p=0.30; KS-KS: p=0.70). At the 3 month mark, OKS and KS-KS improved statistically for both groups but KS-FS only improved statistically for the retained PCL group.

The MC implant is designed to substitute the function of the PCL with increased constraint in the medial compartment.
It has good post operative outcomes regardless the status of the PCL. As preserving the PCL does not improve post operative outcomes, surgeons may routinely sacrifice the PCL. This can make ligamentous balancing easier and can shorten surgical time.

Introduction. According to literature above 20% patients are unsatisfied. The most common patient’s complaint is pain. Materials and methods. In our prospective study 196 patients were examined from 2016 to 2023 with chronic pain after primary TKA. The mean time after TKA was 32 months, mean age was 67 y.o. All patients were examined юwith the accurate algorithm, which include medical history, CT scans, special X-rays and PJI examination tests. Results. The reason of pain was identified in all patients. PJI was identified in the most part of our cohort – 76 (34%) patients. Among PJI patients the components malposition was founded in12 (15.8%) patients. The second group was with components malalignment – 61 (27%). Aseptic loosening was identified in 38 (17%) and 9 (23.7%) patients in this group has the components malalignment according to early X-rays after TKA. The ligament instability was in 24(11%) patients. Extraarticular reason was identified in 19(9%) patients and among them 5 (2%) patients were with periprosthetic fractures. It’s very important, that in 27 (13.7%) patients several reasons of knee pain were identified. Conclusion. It’s very difficult to identify the real problem. The most common definition as “arthrofibrosis” is usually only a symptom. According to our research, the most frequent reasons of unsatisfied knee were PJI and component malalignment. Only 19 (9%) patients had an extraarticular reasons. The comprehensive examination can help to identify the real problem. But in different National registries very often reason for revision is pain without its course verification.

Total knee arthroplasty(TKA) stands as a cornerstone in osteoarthritis management,yet the impact of patellar height on postoperative success remains pivotal.This retrospective study aims to scrutinize the correlation between patella height and functional outcomes post-TKA.A cohort of 210 patients who underwent primary TKA between January 2018 and February 2023 were analyzed.Patella height was assessed preoperatively via the Insall-Salvati ratio(ISR).Functional outcomes were evaluated using pre and postoperative Knee Society Scores(KSS) and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) scores.Patients were stratified into two groups based on ISR:Group 1 (ISR ≤1.20) and Group 2 (ISR >1.20).Comparative analysis encompassed preoperative characteristics and postoperative functional scores.Exclusion criteria comprised patients undergoing reoperation due to aseptic loosening (n=5) or periprosthetic joint infection (n=3),resulting in final cohort of 202 patients.Mean preoperative ISR was 1.068 in Group 1 and 1.306 in Group 2.Postoperatively, Group 1 with preoperative ISR values that are within normal and acceptable upper limit exhibited significantly superior improvements in both KSS and WOMAC scores compared to Group 2 with ISR values higher than 1.2, which can also be defined as patella alta (p < 0.05).Moreover, Group 1 demonstrated a lower incidence of complications, notably patellar subluxation and anterior knee pain,compared to Group 2.Our findings underscore significant impact of patella height, as gauged by ISR, on functional outcomes post-TKA.Patients with lower but within normal preoperative ISR values are predisposed to achieve superior functional scores and experience fewer postoperative complications.Hence, preoperative assessment of patella height holds promise in prognosticating functional outcomes and refining surgical strategies in TKA procedures.

Distal femoral replacement has been shown to be effective but little comparative data exists between replacement and fixation. The aim of the study was to perform a systematic review comparing the clinical outcomes of fixation and DFR.

Methods:
EMBASE, CINAHL AND Medline databases were searched for all appropriate literature. Studies were screened according PRISMA protocols. Relevant data was extracted from included studies. In total 18 studies from the original 247 retrieved were included with patients pooled. Clinical outcomes relating to mortality, length of stay, revision surgery and PROMs were compared between interventions. Meta-analyses were performed for those studies directly comparing both cohorts.

Results:
317 fractures were treated with DFR and 726 with LCP/RIMN. Fixation was associated with 6.0% incidence of non-union. No significant difference was noted between length of hospital stay (p=0.81). Mortality rates at 12 months were lower in the DFR group in comparison to those undergoing fixation 10.8% vs 13.8% respectively (OR 0.65 CI 0.41-1.01 p=0.029). Revision surgery was significantly higher in the LCP/RIMN cohort (OR 0.21(0.092-0.50 p=0.002). Infection rates were marginally higher in LCP/RIMN cohort. PROMs were improved for the DFR cohort although this did not reach statistical significance. Meta-analyses of the two interventions suggest there is lower mortality and revision rates with DFR with no difference in infection rates. Conclusion
DFR permits early weight bearing and has a similar profile for patient length of stay and infection when compared to fixation. DFR is a valid treatment modality in periprosthetic distal femoral fractures.

Introduction: Pregabalin stands as a vital component in multimodal analgesic strategies for postoperative pain management following total knee arthroplasty (TKA). The current standard recommends a daily dose of 150-300 mg for 14 days post-surgery. Demonstrated side effects include sedation, dizziness and visual disturbances. Our study aimed to pinpoint the most effective postoperative Pregabalin dosage with minimal side effects. Methods: We conducted a double-blind, randomized controlled trial of patients undergoing unilateral primary TKA, comparing 75 mg of postoperative Pregabalin to 150 mg of postoperative Pregabalin prescribed for 14 days post-surgery. Visual Analog Scale (VAS) for pain at rest and on motion was the primary outcome measure. Secondary outcomes were morphine and antiemetic consumption, adverse events, and functional outcomes. Results: Our results revealed no statistically significant difference in VAS scores between the 75 mg and 150 mg groups at various time points up to 12 weeks post-surgery. However, the 75 mg group exhibited significantly lower incidences of dizziness (17% vs. 61% in the 150 mg group, p-value<0.001) and faster time to ambulation (27±4 hours vs. 30±4 hours in the 150 mg group, p-value<0.001). Other outcome measures showed no notable variances between the two groups. Conclusion: A dosage of 75 mg of Pregabalin for 14 days post-TKA yielded comparable pain control outcomes to 150 mg with the added benefits of quicker ambulation and reduced dizziness. Therefore, we advocate for the use of 75 mg of Pregabalin as part of a multimodal analgesic regimen for postoperative pain management following TKA.

Introduction: double-stage revision arthroplasty remains the gold standard for the treatment of the knee periprosthetic infection. There still needs to be a consensus on the interval between stages. Methods: we compared the results of treatment in 67 patients who were treated with short intervals (mean 16.32.5 days) with the results of treatment in 77 patients in whom intervals were longer (mean 16170,4 days). We assessed treatment results using the following criteria: range of motion in the knee joint, VAS, WOMAC, OKS and FJS-12 scores and infection recurrence rate. Results: the mean time to evaluate patient results after the second stage was 31.7±9.1 months (minimum 14 months). A statistically significant difference was obtained in the knee joint's flexion after the second stage: 98.4±16 degrees in the short-interval group and 89.7±18.7 degrees in the long-interval group (p0,01). The mean results on the VAS scale after the second stage of revision arthroplasty were 1.1±1.5 in the short-interval group and 1.6±2.1 in the long-interval group (p=0.04); 18,6±12,4 and 23,7±17,2 respectively on the WOMAC scale (p<0.03), 21±7,1 and 25,3±8,7 on the OKS scale (p<0.01); 13,4±8,7 and 16,8±11,6 on the FJS-12 scale (p=0.03). Recurrences of periprosthetic infection were noted in 7 patients (10.4%) in the short-interval group and 9 patient (11.6 %) in the long-interval group. Conclusion: patients in the short-interval group had better results in terms of the amount of flexion in the knee joint, according to the VAS, WOMAC, OKS and FJS-12 scales, and the same infection recurrence rate.

This study aimed to evaluate the safe zone of joint line elevation for the treatment of flexion knee contracture preventing mid-flexion instability in total knee replacement.
Methods 51 knees with varus osteoarthritis undergoing TKA were evaluated. 39 knees with flexion contracture < 15°and 12 knees with flexion contracture >15°. 2-mm joint line elevation was performed in just 4 knees with >15° flexion contracture. The extension and flexion gaps were measured with traditional spacer block. Stability in coronal plane (varus & valgus stress) was assessed at 0,30,60 & 90 degrees. Sampling Technique was nonprobability consecutive. SPSS 23 was used for statistical analysis.
Results: The study comprises 51 patients undergoing total knee replacement (TKA) for osteoarthritis, with a notable gender distribution (84.3% women, 15.7% men) and a mean age of 60.24±8.54 years. Of these, 41.2% had both knees affected, and joint elevation was performed in 23.5% with flexion contracture >15°. No instability was found in cases with joint line elevation. Flexion contracture analysis revealed asymmetry across sides, yet no statistically significant differences. Detailed comparisons show variability in flexion contracture and range of motion, emphasizing the complexity of side-specific outcomes. The study underscores the importance of tailored evaluation and intervention for flexion contracture >15° to optimize postoperative results.
Conclusions: This study has shown that in patients with varus osteoarthritis of the knee and flexion contracture > 15°, a 2-mm joint line elevation is safe to treat knee flexion contracture and is not associated with mid-flexion laxity.

Knee swelling after a total knee replacement (TKR) typically peaks around 2-3 days after surgery and gradually decreases over the following weeks to months. Most patients experience significant improvement in swelling within the first 6-12 weeks after surgery, but some residual swelling may persist for up to 6 months or longer. Factors such as preoperative knee swelling, BMI , age, and comorbidities considered as patient characteristics that influence the level of knee swelling. The post-operative instructions for managing swelling, such as elevating the leg, using ice packs, and performing prescribed exercises should be followed .warning signs & symptoms
1. Sudden and severe pain in the knee
2. Excessive redness, warmth, or tenderness around the knee
3. Increased swelling that does not improve with rest and elevation
4. Difficulty in performing simple knee exercises
5. Fever or chills
Our study examines the course of knee swelling after total knee arthroplasty (TKA) and its associations with knee function . Twenty-five patients had TKA. post-operative weeks (POWs) 1, 4, 8, and 12, knee swelling was measured using bioimpedance spectrometry, the study observed that knee swelling increased by approximately 27% from the day of admission levels after total knee arthroplasty, and although it reduced over time, it remained high at around 11% by post-operative week 24. Furthermore, knee swelling was found to be associated with quadriceps weakness in longitudinal, multivariable analyses, highlighting the potential importance of interventions to reduce post-TKA knee swelling to enhance quadriceps strength and knee functions

Objectives: It was observed that robotic assistance improves the implant placement accuracy in relation with conventional technique. Despite this, different robotic systems were developed in the last years. The aims of this study were to compare the accuracy of implant positioning in image-based robotic-assisted UKA versus imageless robotic-assisted UKA in a large cohort. Methods: This is a radiographic retrospective study which included all the medial consecutive UKAs that were done using two different robot assistance systems between 2011 and 2023. The radiological measurements were done preoperatively and in the last postoperative control. The evaluation included the residual hip-knee-ankle (HKA), JL restoration, posterior tibial slope (PTS) and coronal positioning of tibial implant according to Cartier angle (Δ Cartier). Outliers were defined as follows: post-operative HKA < 175° or > 180°, JL change ≥ 2 mm, PTS < 2° or > 8° and Δ Cartier > 3° or < − 3°. Results: Out of the 292 knees included, 95 underwent image-based robotic-assisted UKA (32.5%) and 197 (67.5%) imageless robotic-assisted UKA. Image- based robotic UKA was associated with better accuracy compared to imageless robotic-assisted UKA in relation to HKA (77,1% vs 67,5%, p = 0.03), JL restoration (80,2% vs 69,5%, p < 0.02), PTS (93,7% vs 82,7%, p < 0.02), and tibial varus restoration (87,6% vs 65%, p = 0.01). Conclusions: Image-based robotic assistance in patients undergoing medial UKA was associated with better accuracy compared to imageless robotic- assisted medial UKA with respect to tibial implant positioning, post-operative limb alignment, and JL restoration.

Femoral component rotation in total knee replacement (TKR) can significantly impact patient outcomes and benefits. Proper femoral component rotation is crucial for achieving optimal alignment and stability of the knee joint after TKR. When the femoral component is accurately rotated, it can lead to improved function, reduced risk of complications, and enhanced patient satisfaction.While a certain degree of rotation is necessary for optimal function and stability, excessive rotation can lead to complications such as dislocation, impingement, and increased wear of the implant. Current literature suggests that a range of 5-15 degrees of anteversion and 0-20 degrees of internal rotation is considered acceptable. Beyond these ranges, the risk of complications significantly increases. It is essential for surgeons to carefully assess and optimize femoral component rotation during surgery to achieve the best possible outcomes for patients undergoing total hip arthroplasty.

objective: to study the reasons for failure of my oxford unicompartmental knee replacements (OUKAs.) Materials and methods: retrospective study. total 542 OUKAs, 352 patients. 432 knees, 280 patients followed. 16 failures ,16 knees (2.95% ). 81 knees had 15% varus. Followed 1 to 9 years. . Level of evidence EBM 4.Results: entire cohort, the average age 67, BMI 28. Male to female 39:61. Preop HKA 11.5. Post-op HKA 5. Average age of the sub-cohort 64 years, BMI 31, preop HKA 12.85 post-op HKA was 6.7. 15 females, one male. 16 failures, ( 11 bearing dislocations,3 fractures and 2 aseptic loosenings ). average time to revision 2 years and 5 months after index surgery. 4 underwent exchange of bearing, 1 MCL augmented. 3 fractures fixed. 7 underwent TKR .one refused surgery. One lost to follow up. Superficial MCL found lax in all patients with bearing dislocation. Discussion: out of 16, 4 patients (25%) had severe varus (as compared to 3.9% in entire cohort). Sub-cohort preop HKA 12.85,( entire cohort 11.5) and post-op HKA 6.7, (entire cohort 5). superficial MCL appears to get lax over a period in some patients although tight at time of surgery . Conclusion: wear a hinged brace in obese, short ladies with residual varus> 6 degrees post-op for six weeks. Avoid OUKA in varus over 14 degrees. tibial cut with 3G instead of 4G clamp and plus-2 guide. Smallest possible bearing to have more options if it dislocates. There was no conflict of interest.

Background:
Surgical treatment of distal femur fractures and periprosthetic fractures around Total Knee Replacement (TKR) is challenging. The nail-plate hybrid construct offers improved biomechanical stability and the advantage of a locked plate and intramedullary nail to allow immediate weight-bearing in the setting of complex fracture patterns and osteoporosis.

Objectives
To evaluate the functional outcomes of the patients treated with the combined NPC on the basis of fracture union in a satisfactory position, knee range of motion (ROM), pain, deformity, walking ability, and return to the pre-fracture status of mobility.

Study Design & Methods
We evaluated a retrospective cohort of 21 patients with a mean age of 79.4 years (66- 92 years) who had complex distal femur fractures of all types treated by NPC. We fixed the retrograde intramedullary nail first followed by a lateral anatomical locking plate although there is no consensus on the sequence of the procedure.

Results
We evaluated our results based on the Injury characteristics, fracture pattern, operative variables, radiographic information (X -rays and CT Scans), and postoperative outcome. All patients treated with the combined nail-plate construct proceeded to fracture union (100%). Functional outcomes improved significantly in all patients.

Conclusions
Treatment of complex distal femur native or periprosthetic fractures is challenging but can be safely addressed with a combined Nail Plate Construct (NPC), which allows enhanced biomechanical stability, promotes immediate weight bearing, and reduces complication risk. This technique requires meticulous planning and is reliable, efficient, and reproducible.

Background: The high coprevalence of obesity and end-stage osteoarthritis requiring arthroplasty, with the former being a risk factor for complications during arthroplasty, has led to increasing interest in employing preoperative weight loss interventions such as bariatric surgery, diet modification, etc. However, the current evidence on it is conflicting, and this study aimed to investigate the effect of weight loss intervention before arthroplasty in prospective randomized controlled trials. Methods: Four electronic databases (MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials) were searched for prospective randomized controlled trials that compared weight loss interventions with usual care from inception to October, 2023 following the PRISMA guideline. The Cochrane Risk of Bias tool and GRADE framework were used to assess the quality of the studies. Meta-analyses were performed when sufficient data existed from 2 or more studies. Results: Three randomized controlled trials involving 198 patients were identified. Two studies employed diet modification, and one study employed bariatric surgery. All three studies reported significant reductions in body weight and body mass index, and intervention groups had fewer postoperative complications reported. There was no difference in the length of stay between the intervention group and the control group. Variable patient- reported outcome measures were used by different research groups. Conclusion: Weight loss intervention can achieve significant reductions in body weight and body mass index before arthroplasty, with fewer postoperative complications reported. Further studies with different populations would allow confirming its effect among population with different obesity characteristics.