Objectives
Knee osteoarthritis (KO) is a leading contributor to disability years, with a prevalence ranging from 22% to 39%. Tibia stress fractures (TSFs) are well-described for end-stage arthritis patients undergoing TKA. This study primarily aims to compare and determine the clinical, functional, and radiological outcomes of TSFs in end-stage KO treated with TKA by propensity score-based matching.
Methods:
It is a retrospective study. The TSF group included all patients of end-stage KO who underwent primary TKA with TSFs, and the TKA group included matched patients without TSF. Cases were 3:1 (TKA: TSF) propensity score-matched (PSM). The primary outcome was a PSM comparison of patient-reported outcome measures (PROMs) and 1-year Postoperative Complications and Adverse Events (POCAE).
Results:
Study includes thirty-seven patients. Both groups showed no statistically significant difference in KSS FA and KSS PS scores. At the final follow-up, MCID for KSS FA was achieved by 31 patients (96.9%) in the TSF group compared to 92 patients (95.83%) in the TKA group. MCID for KSS PS was achieved by 29 patients (90.63%) in the TSF group compared to 91 patients (94.79%) in the TKA group.
Conclusion:
End-stage KO patients with coexisting TSFs who undergo primary TKA with stem/ plate fixation as per fracture location may expect favorable PROMs, POAECs, radiological outcomes, and rates of achieving the MCID at a minimum 2-year follow-up. Accurate management of such cases results in excellent outcomes and minimized revision rates. All patients achieved complete bone union. These results were comparable to the PSM control group.

It remains unclear whether the clinical outcomes of total knee arthroplasty (TKA) for valgus knees are comparable to those for varus knees. This study aimed to compare the clinical outcomes of TKA in varus and valgus knees in a background-matched cohort. Patients who underwent primary TKAs from eleven hospitals were enrolled. Preoperative and 2-year postoperative scores, specifically the Original Knee Society Score (OKSS) and New Knee Society Score (2011KSS), were obtained. Clinical assessments were performed on the propensity score-matched cohorts of TKA for valgus and varus knees with malalignment ≥5° each, ensuring age, sex, primary diagnosis, body mass index, deviation angle from neutral alignment, hospital type, surgical approach, patellar resurfacing, and implant type parity. From included 1145 TKAs of 104 valgus, 200 neutral, and 841 varus knees, propensity score-matching yielded 62 valgus-varus knee pairs. Preoperatively, both groups showed similar clinical scores. At two-year, the median 2011KSS functional activities (59, interquartile range: 36–73) and OKSS Function Score (70, interquartile range: 55–80) of valgus knees were 10.5 (p = 0.01) and 10 points (p = 0.01) inferior to those of varus knees, respectively. Valgus knees also showed inferior 2011KSS symptom and satisfaction scores. In conclusion, Postoperative clinical scores related to function after TKA were inferior in valgus knees compared to varus knees in the background-matched comparison. Valgus knee itself, carries the risk of limited postoperative function after TKA.

Introduction: The clinical results of total knee arthroplasty (TKA) have been proved to be influenced by previous mental health status. Postoperative patient reported outcomes (PROMs) one year after TKA were compared with preoperative results of the SF-12 scale to evaluate the correlation of mental health status with postoperative results in a prospective cohort of patients. Methods: Patients receiving a TKA completed the SF12, Oxford and WOMAC questionnaires preoperatively and one year after surgery. The preoperative SF12 mental health component was compared with the results in the postoperative Oxford and WOMAC questionnaires and pain in a Visual Analogue Score (VAS) one year after surgery using the Pearson method. Results: A total of 100 patients completed the questionnaires pre and postoperatively. The preoperative SF12 mental component showed a correlation of 0.43 with the results of the Oxford questionnaire, -0.50 with the pain component of WOMAC, -0.44 with the rigidity component of WOMAC and -0.39 with de function component of WOMAC, all of them with a p-value <0.001. Similarly, SF12 compared with VAS postoperatively showed a correlation of -0.37 with p=0.001. A SF12 mental score above 29.73 correlates with a postoperative Oxford score greater than 30. Discussion and conclusion: The final result of TKA is influenced by the mental health status measured by the SF12 before surgery, with a moderate correlation with PROMs one year after surgery. A minimum score of 29.73 in SF12 mental questionnaire shows a greater probability of obtaining a good or excellent result in the postoperative Oxford questionnaire.

Introduction: Diabetes represents a substantial risk factor for complications in surgical procedures due to its profound effects on wound healing, infection control, and immune function. Elevated blood glucose levels disrupt microcirculation, impede tissue repair, and increase susceptibility to infections. Total knee arthroplasty (TKA), a common orthopedic intervention, aims to alleviate pain and improve joint function in patients with severe knee arthritis. This article delves into the correlation between blood sugar levels at preoperative day 1 and the occurrence of postoperative complications in TKA patients. Methodology: This retrospective analysis focused on preoperative blood sugar levels in TKA patients measured one day before surgery. Postoperative complications, including surgical site infections, delayed wound healing, and prosthesis-related issues, were documented and correlated with preoperative blood sugar levels. Results: Preliminary findings indicate a significant correlation between elevated blood sugar levels at preoperative day 1 and increased incidence of postoperative complications in TKA patients. Patients with poorly controlled diabetes exhibited a higher likelihood of experiencing complications such as infections, prolonged hospital stays, and a slower recovery process. Conclusion: The observed correlation underscores the importance of preoperative glycemic control in TKA patients with diabetes. Recognizing the impact of diabetes on surgical outcomes and managing blood sugar levels effectively in the preoperative period may contribute to a reduction in postoperative complications, ultimately enhancing the overall success of the surgical intervention. Further research and prospective studies are warranted to validate these findings and establish clear guidelines for managing diabetic patients undergoing TKA.

Purpose: The objective of this study was to compare the accuracy of robotic-assisted surgery (ROSA) and gyroscope-based surgery in primary total knee arthroplasty

Material and methods: A randomized controlled trial was conducted with 72 participants who had moderate knee osteoarthritis (Kellgren and Lawrence grade 2-3). The patients were randomly assigned to either the robotic-assisted or gyroscopic-assisted group. Baseline characteristics, including age, BMI, length of stay, and estimated blood loss, were recorded. The primary outcome measure was the accuracy of the hip-knee angle, measured by scannogram film preoperatively and postoperatively at 3 months. Secondary outcomes included functional outcomes (KOOS, Oxford knee score, EQ-5D-5L, range of motion) assessed preoperatively and postoperatively at 3 months, as well as at 6 months postoperatively.

Results: No significant differences were found in the accuracy of robotic-assisted surgery (ROSA) and gyroscope-based surgery, with mean differences of 1.59 ± 1.46 degree and 1.38 ± 1.58 degree, respectively (P=0.248). Additionally, there were no significant differences observed in the functional outcomes, including KOOS, Oxford knee score, EQ-5D-5L, and range of motion.

Conclusions: The robotic-assisted surgery (ROSA) in primary total knee arthroplasty did not significantly enhance the accuracy of the hip knee angle at 3 months compared to gyroscope-based surgery in cases of moderate knee osteoarthritis

Keywords: Comparison of accuracy, robotic-assisted surgery (ROSA), gyroscope-based surgery, Total knee arthroplasty

Background: Recent advancements have introduced computer-assisted (CAS) and robot-assisted (RA-TKA) surgical techniques as alternatives to conventional methods in Total Knee Arthroplasty (TKA), promising improved accuracy and patient outcomes. However, comprehensive comparative studies evaluating outcomes and prostheses survivorship among these techniques are limited. Methods: This prospective controlled study compares Five-year outcomes and prostheses survivorship following TKA using conventional, CAS, and RA-TKA techniques. One hundred seventy-eight patients requiring TKA were randomly assigned to one of the three surgical groups. The primary outcomes were knee function (KSS knee score) and functional recovery (KSS function score) assessed before surgery and annually for five years postoperatively. Secondary outcomes included prosthesis alignment, knee range of movements, and complication rates. Survivorship analysis was conducted using Kaplan-Meier curves, with revision surgery as the endpoint. Results: Five-year results indicate that while all three groups showed significant improvements in knee function postoperatively, the CAS and RA-TKA groups demonstrated superior prosthetic alignment and higher survivorship rates than the conventional group (98,2%, 96,8% and 96,3% respectively). But although the RA-TKA group had a 98,2% survivorship rate, its knee score was significantly lower than following CAS and conventional techniques (mean 91±3SD vs. mean 93±3SD). Conclusions: The RA-TKA technique offers advantages over conventional and CAS methods regarding alignment accuracy and five-year survivorship of TKA prostheses, presented research data has a promising indication of the improved TKA prostheses long term survivorship by implementing RA-TKA.

Background: Restoration of proper joint line position after TKA is improves knee function and kinematics. We reviewed magnitude of joint line alteration and its effect on knee outcomes scores at one year.

Materials and methods: 120 patients of Primary TKA were included. Joint line position assessment before and after surgery was performed: Medial epicondyle joint line distance (MEJL), Lateral epicondyle joint line distance (LEJL) and fibula head joint line distance (FHJL). Post-operative knee function was assessed using WOMAC and KSS scores at one year follow-up.

Results: Joint line was elevated in 104/ 120 (86.7%) patients and 16 (13.3%) patients had no elevation. Mean joint line elevation was 3.00 (±2.13) mm. No depression in joint line seen. KSS and WOMAC scores for every 1 mm change was calculated. A rising trend in WOMAC score and declining trend in KSS score with every 1 mm rise was seen. Group A- Joint line elevation <5mm and Group B- Joint line elevation ≥ 5mm. KSS score was significantly higher in patients in Group A compared to Group B {52.82±7.564 vs. 40.73±7.146; p<0.001}. WOMAC score was lower in patients in Group A compared to Group B {65.51±14.762 vs. 75.64±8.203} and the difference was statistically significant (p<0.002).

Conclusion: Elevation of joint line ≥ 5 mm has a negative impact on post-operative functional outcome in primary TKA. It is advisable to perform minimum bone cuts and use distal and posterior femoral augments in cases of bone loss even in primary TKA to prevent proximalisation of femoral components.

Introduction: The Coronal Plane Alignment of the Knee (CPAK) classification in the field of Total Knee Arthroplasty (TKA) distinguishes knee phenotypes based on anatomic hip knee angle (HKA) and joint line obliquity (JLO).This study aims to firstly describe the epidemiological CPAK distribution of arthritic knees in the Asian population; secondly, to divide the most prevalent CPAK phenotype (CPAK 1) into mild, moderate, and severe subtypes. Lastly, to determine if KA or MA affects post-operative outcomes in different CPAK phenotypes. Methods: Prospectively collected data from 2014 to 2021 was obtained from a high-volume single-institution involving 342 patients. Outcomes were recorded at pre-operative, post-operative 6 months and post-operative 2 years using oxford knee score(OKS), Functional score (FSC) , Knee society clinical score (KSCC),and SF-36 scores. Restricted KA-TKA were performed using stryker makoplasty technique and unrestricted KA-TKA was performed using Howell's technique.
Knees were further classified into Mild (MTPA ≥ 85°), Moderate (MTPA < 85° with no coronal bowing of the femur) and Severe (MTPA < 85° with coronal bowing of the femur) varus subtypes. Student’s t-test, or one-way ANOVA with post-hoc Bonferroni adjustment were used. Results: CPAK I (varus, apex distal) was the most prevalent (45.32%) in the Asian population , followed by CPAK II (varus, neutral) (23.68%) ; in contrast to CPAK II most prevalent in caucasians. Patients with severe varus and coronal bowing showed better 2 year post-operative outcomes with restricted-KA compared to unrestricted-KA. Results: unrestricted-KA preferable in moderate deformities, whereas restricted-KA preferable in severe deformities.

Background
Neutral Mechanical Alignment (MA) in total knee arthroplasty (TKA) aims for perpendicular alignment of components to the limb's mechanical axis. However, individual knee anatomy variations raise concerns about suboptimal outcomes with MA, leading to a debate on its universal applicability. In contrast, Kinematic Alignment (KA) aligns implants with the knee's pre-arthritic anatomy, optimizing function and satisfaction. Research, especially in the Indian population, lacks comparative data between MA and KA techniques.

Purpose
This randomized controlled trial (RCT) aims to compare functional, radiological outcomes, joint awareness, and complications between MA and KA in TKA

Methods
A prospective RCT with 27 patients (54 knees) undergoing bilateral simultaneous TKA, randomized one knee to KA and the other to MA. Pre, intra, and post-operative data were recorded. The primary outcome was the Forgotten Joint Score (FJS) at a minimum 6-month follow-up. Secondary outcomes included intraoperative parameters, limb preference, Knee Society Score, and radiographic parameters.

Results
Comparing clinical, radiological, and functional parameters, KA showed a higher FJS (70.9 vs. 66.88), with more patients preferring KA for appearance and rehabilitation. KA induced proximal tibia varus and distal femur valgus. KSS scores and overall limb alignment were similar. KA required fewer soft tissue releases and bone resections. More patients preferred KA over MA in questionnaire assessment.
Conclusion
KA and MA demonstrated comparable outcomes, with early preference for KA. KA didn't increase complications at 12 months, suggesting it a viable alternative. Concerns about long-term aseptic loosening with KA warrant further multicenter trials with larger cohorts and longer follow-ups.

Abstract: Introduction: Debridement, Antibiotics and Implant retention (DAIR) has been the mainstay of treatment for acute periprosthetic joint infection in spite of variable results. Modular component exchange is a widely recommended strategy to improve success rates with DAIR though very strong evidence to support its practice is still lacking. Materials and Methods: patients underwent DAIR for acute PJI following primary hip and knee arthroplasty were divided into two groups for this retrospective review. 45 patients (group 1) underwent DAIR with modular component exchange and 41 patients without exchange (group 2). We compared success rates based on infection eradication (primary outcome variable) and need for revision surgical procedures between these two groups. We also assessed differences in primary outcome based on type of arthroplasty, timing of DAIR and addition of local antibiotics. Results: The overall success rate after DAIR was 71%. The outcome was similar in both groups (69% vs 74%, P = 0.66). The need for revision surgical procedures was 27% which was similar in both groups (P = 0.98) with 23% needing revision of prosthetic components. Type of arthroplasty (hip or knee) and addition of local antibiotics had no bearing on infection eradication after DAIR with or without modular component exchange. DAIR within 45 days of primary arthroplasty had significantly higher success rate compared to DAIR after 45 days in both groups. Conclusion: We observed that modular component exchange did not improve infection eradication after DAIR for acute PJI following hip and knee arthroplasty.

The standard practice of considering modular component exchange is rooted in the belief that it can improve surgical access and disrupt biofilm, potentially enhancing the efficacy of debridement. However, it's not clear if this exchange contributes to lower revision rates. This study aims to contrast the results of debridement antibiotic implant retention (DAIR) procedures with and without modular component exchange in patients experiencing persistent wound discharge (PWD) after primary total knee arthroplasty (TKA).
Methods:
This retrospective study involved 16551 consecutive patients who underwent primary TKA at a tertiary centre from January 2007 to December 2022. The comparison focused on patients with PWD within 30 days of primary TKA undergoing DAIR with modular component exchange versus those without. The primary outcome assessed was any-cause revision surgery, while secondary outcomes involved identifying risk factors for poor outcomes. Statistical analysis included Student t-test, chi-square, and logistic regression.
Results:
77 patients underwent DAIR of which 24 had modular component exchange, while 53 did not. The average days to wash out post-primary surgery were 20.6 +/- 4.8 days. Revision surgery rates were 16.7% (4/24) for DAIR with modular exchange and 15.1% (8/53) for DAIR without modular exchange (Odds ratio: 0.889; 95% CI 0.24-3.27). Factors positively correlated with revision risk were CRP on readmission and BMI>30, while age, sex, and Charlton comorbidity index showed no correlation.
Conclusions:
The exchange of modular components did not result in improved revision rates among patients undergoing DAIR for persistent wound discharge in the early postoperative period following total knee arthroplasty.

Purpose: The present study examined five common inflammatory markers [IL-6, CRP, LDH, AST and ESR] in patients who underwent robotic knee replacement surgery using the CORI robotic system. Methods: Baseline venous blood samples were collected 12 hours before,12 hours, 24 hours after surgery, and every 24 hours after that until the patient was discharged. A total of 48 participants were included in the study. In group I, 13 patients underwent bilateral knee replacements; in group II, 35 underwent unilateral knee replacements. Results: IL-6 increased significantly, 229.69 at 12 hrs in the bilateral group and 115.51 post 24 hrs in the unilateral group. CRP peaks were observed at 60 hrs post in the bilateral group at 34.87 and 16.71 in the unilateral group. It was found that ESR levels differed significantly preoperatively, and a postoperative peak was observed at 60 hrs in both the groups, 89 in the bilateral group and 46 in the unilateral group. In terms of serum LDH, the absolute rise at post 48hrs in both the groups was 245.67 in the bilateral and 244.15 in the unilateral group. AST level peak was observed at 48hrs, with 32.74 in the bilateral and 32 in the unilateral group. Conclusion: This study may be one of the first to comprehensively describe five common inflammatory markers trends among patients who undergo unilateral or bilateral robotic total knee replacement surgery. The only two markers that showed statistically significant increases in bilateral knee replacements compared to unilateral knee replacements were IL-6 and CRP.