Background: Randomized Controlled Trials (RCTs) comparing Cemented versus Uncemented TKR reviewed, to conclude based on functional outcomes, if any one method of fixation is superior.

Methods: In this literature review, an extensive search was carried out across EMBASE, CINHAL and Medline databases. 7 RCTs were selected as part of the evaluation process, which was published in the intervening period between 1st January 2014 to 30th June 2019. A detailed assessment for bias and ethical consideration was carried out for each of the studies. Key data extracted: number of patients, mean follow up (in years), range of motion, Knee Society Score (KSS)- Clinical and Functional, WOMAC score and Oxford Knee Score (OKS).

Results: A total of 749 patients were recruited with a mean follow-up of 7.4 years, across the 7 studies. From the age demographics, an increasing trend in TKR among the younger population. Knee ROM was reported by 5 studies, with a mean ROM of 117 degrees in both the cemented and uncemented groups. The mean KSS clinical score was 90.9 in the cemented group as compared to 91.1 in the uncemented group. The mean KSS functional score was 89.4 in the cemented group and 88.8 in the cementless group. WOMAC score has been reported by 3 studies and were comparable between the two groups. OKS was reported by 2 studies, and there was no significant difference between the groups at final follow- up.

Findings: This study has highlighted no significant difference in functional outcomes between the 2 groups.

Background: Implant positioning and knee alignment are two primary goals of successful unicompartmental Knee Arthroplasty (UKA), as malalignment is correlated with aseptic loosening. This study aimed to evaluate the incidence and relation between inherent coronal tibial bowing and post-operative tibial plate orientation in patients who underwent mobile bearing medial UKA. Method: This study was performed on 200 patients. Pre- and post-operative tibial CORA, HKA, tibial plate orientation angle measured as the medial proximal tibial angle (MPTA) and knee joint line orientation angle (KJLOA) were measured. Coronal tibial bowing in the form of preoperative CORA was correlated with postoperative MPTA. Multiple regression was performed to evaluate the effect of various radiological parameters on postoperative MPTA and KJLOA. Results: 105 (52.5%) patients had an extra-articular tibial deformity (EAD) (four proximal, 75 middle and 26 distal). For the whole study cohort, HKA improved significantly from a mean of 172° preoperatively to 178° postoperative (p=0.001), MPTA improved from 85° to 88.5° (p=0.001). For between-groups differences, the postoperative HKA was better in patients without EAD compared to EAD, 178° versus 177° respectively (p= 0.001), for the MPTA, it was better in the non-EAD group (89°) compared to the EAD group (88°) (p=0.025). No significant difference was found regarding the KJLOA (p=0.446). Conclusion: Tibial EAD is present in about 50% of our patients with a correlation between preoperative coronal tibial bowing and post-operative tibial plate orientation; we believe that this should be taken into consideration when planning for unicompartmental knee arthroplasty. Clinical correlation to be determined.

Shell patellar defect is a problem commonly encountered during revision total knee arthroplasty. The treatment outcomes are often unsatisfying with persisting extensor mechanism impairment and patellofemoral pain.
We present a 58-year-old active patient with Shell-type patella resurfaced by a novel technique during primary TKA. We restored the Type 1A patella defect with a central residual thickness of 5mm with remodeled autologous cancellous bone graft harvested of the Tibial cut.
The bone graft was fixed to the patellar shell with three cannulated cortical screws, which also acted as a Rebar augmentation, restoring the patella thickness to 16mm. We then cemented the Patellar implant into the construct with strategically placed peg holes.
At 1-year follow-up, the patient returned to work with an excellent range of motion and quadriceps strength. Patient reports of no knee pain, difficulty in kneeling, and CT scan after 1-year revealed bone-graft incorporation.

Introduction:
Total knee arthroplasty (TKA) success depends on accurate bony cuts and soft tissue balancing. However an anthropometrically well matched prosthesis is a challenge for surgeons.
Materials & methods:
Prospective study included 304 knees of 192 Indian patients (44 male and 148 female patients) who underwent TKA. Anthropometric measurements were performed according to Akagi’s method.
Results
The average ML dimension was 71.3 ± 6.1 mm (range, 62-95 mm),78.0 ± 6.7 mm (range, 62-95 mm), and 69.5 ± 4.4 mm (range,62-82 mm) for the total, male, and female patients, respectively. The average AP dimensions were 47.3 ± 4.9 mm (range, 39-80 mm), 51.3 ± 3.0 mm (range, 46- 58 mm), and 46.2 ± 4.7 mm (range, 39-56 mm) for the total, male, and female patients, respectively. The mAP dimensions were significantly longer than lAP dimensions by 5.2 ± 1.0 mm on average. A significant positive correlation was found between lAP & mAP and lAP & ML dimensions. ML dimension was undersized in 14 males and 22 female patients with smaller AP and overhang was observed in 5 male patients and 7 female patients for larger AP dimensions.
Conclusion
In view of the wide dispersions in proximal tibia in anteroposterior and mediolateral dimensions, the implant sizes should ideally accommodate change in aspect ratios along with usual ML and AP dimensions. Also, Western implants are not suitable for Indian population as the aspect ratio (AR) decreases in Indian patients with increase in anteroposterior dimensions.

Introduction:
Multiple strategies, used either in isolation or combination, are available to reduce the need for post-operative blood transfusion in joint replacements. Amongst them, the use of tranexamic acid (TXA) has been rising and this study was conducted to compare the efficacy of topical and intravenous TXA in bilateral total knee replacement patients.
Materials and methods:
Randomised prospective study with 120 patients (male: female: 25:95) undergoing bilateral TKA. Patients were divided into two groups A and B after computer randomization, who received intravenous or topical (intra-articular) TXA respectively.
Results:
The average haemoglobin loss in intravenous group was 90.2379 g/L as compared to 39.137 g/L in topical group (p < 0.005).Moreover, there was reduction in blood loss in topical (330.1602 ml) as compared to intravenous group (764.9622 ml). The blood transfusion rate was more for the intravenous group (average 1.73 units) than for the topical group (average 0.75, unit). WOMAC score at 6 weeks in the intravenous group was 12.50, and in the topical group was 7.23 (p value < 0.001).
Conclusion:
Topical TXA is better than intravenous TXA for reduction of blood loss, which also reduces the need for blood transfusion in bilateral TKA patients.

Introduction: Knee arthroplasty is one of the most commonly performed surgical procedures world-wide, although a number of technical qualms remain. The technique has been developed by the introduction of robotic-assisted surgery. This allows visual, auditory, and haptic feedback to be relayed to the operating surgeon to ensure greater adherence to the pre-operative surgical plan in a more precise and accurate manner, reducing inadvertent soft tissue damage. We reviewed the early outcomes of our robotic-assisted experience in knee replacements. Methods:
This was a prospective single-centre cohort study to compare physiotherapy and early patient outcomes between two groups: conventional manual knee replacement versus MAKO robot-assisted knee replacement. Results: The study included all patients undergoing knee replacement over a two-month period, 61 underwent knee replacements manually; 56 total knee arthroplasty (TKA), 4 uni-compartmental knee arthroplasty (UKA), and 1 patellofemoral arthroplasty. 18 patients underwent knee arthroplasty using the MAKO robot-assisted system; 13 TKA’s and 5 UKA's. Data analysis suggested that the MAKO group demonstrated improved physiotherapy and early patient-reported outcomes, particularly the duration of hospital stay required with an average of 2.08 days in the MAKO group vs 2.95 days in the conventional group (p=0.0009). There was a trend towards lower post-operative pain scores in the MAKO group at 5.06 vs 6.06, improved post-operative flexion (80 degrees vs 60 degrees) and ability to straight leg raise (76% versus 62%) on the first post-operative day. Conclusion: Our data supports improved short-term patient-reported and physiotherapy outcomes following MAKO robotic-assisted knee replacements.

Background
: Postoperative pain associated with a knee replacement surgery is difficult to control, delays ambulation and worsens results. All of this has increased interest in new techniques such as local infiltration analgesia (LIA). 
 

Objectives
: To evaluate the clinical and functional results and the length of hospital stay in patients undergoing total knee arthroplasty after the use of the LIA technique.
 

Study Design & Methods
: A retrospective study was carried out in which 200 patients were included. A group of 100 patients who underwent total knee arthroplasty who were treated with the LIA technique was selected and compared with a historical sample of 100 in whom LIA had not been given. There were no differences between the two groups regarding surgical technique and analgesic protocol. All patients in the LIA group received a single 80 ml injection with ropivacaine, tobramycin, betamethasone, morphic chloride, and epinephrine. Results
: 62% of the patients in the LIA group were discharged on the first postoperative day compared to 14% in the group without LIA (p <0.0001). Patients with LIA had a shorter hospital stay (2.08 days on average versus 3.02 days; p <0.001), they required fewer opioids during the 48 hours after surgery (16.3 versus 27 morphine equivalents; p <0.0001).
 

Conclusions
: The use of the LIA technique in patients who underwent knee arthroplasty has shown better control of postoperative pain and, consequently, early ambulation, a reduction in opioid consumption, and a shorter hospital stay compared to no use of LIA technique.

Introduction: Both mobile-bearing (MB) and fixed bearing (FB) unicompartmental knee arthroplasty (UKA) have multidimensional benefits, including but not limited to clinical and functional benefits in patients with Unicompartmental osteoarthritis. There is no level I evidence in the literature comparing both designs with similar instrumentation on functional, radiological, and gait outcomes. Methods: 40 patients were randomized using CONSORT guidelines into 2 groups by a computer-generated randomized table- (1) MB and (2) FB to receive imageless navigated UKAs using two implant designs from the same manufacturer by a single surgeon over a period of 1 year. Both the patient and independent assessor were blinded. The patient-reported outcomes (Oxford Knee Score (OKS), EuroQol Group 5-Dimension Self-Report Questionnaire score (EQ-5D), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner Activity Scale), gait analysis (temporal, spatial, kinematics and kinetic parameters), mechanical alignment on radiographs and navigation were measured and compared with postoperative measurements in the two groups at minimum one-year follow-up. Results: 12 male and 28 female patients received 21 fixed-bearing and 19 mobile-bearing UKA with no loss to follow up at one year. There were significant improvements in patient-reported outcomes in both groups at follow up. Both implant designs showed similar postoperative alignment under the navigation and in lower limb radiographs. Gait analysis correlated with clinical results with comparable outcomes found in gait analysis in temporal, spatial, kinematic and kinetic parameters. Conclusion: Both, MB and FB UKA provide improved outcomes in patients with anteromedial osteoarthritis with no significant difference between the two groups.

Background, Metaphyseal augmentation has in recent years formed a key strategy in management of bone loss in revision knee arthroplasty. There are studies reporting excellent short-term results, however long-term data is lacking. There is also a paucity of studies comparing the most frequently utilised augments, metaphyseal sleeves and cones. We conducted a systematic review and meta-analysis to evaluate and compare the mid to long survivorship of metaphyseal cones and sleeves.
Methods: We conducted systematic search of 4 databases (Medline, Embase, CINALH and PubMed). Seventeen studies were found to be eligible for inclusion of which ten investigated metaphyseal sleeves and the remaining seven investigated cones. Mean follow up across all studies was 6.2 years. The total number of patients included in the studies was 1319 and the number of knees operated on was 1431. Results, We noted a higher revision rate of metaphyseal cones when compared to sleeves 10.85% vs 6.31 (p=0.007). Reoperation rates were also higher in cones compared to sleeves, 13.78% vs 3.68% (p<0.001). Prosthetic joint infection was the most common reason for revision. The difference in conversion rates, based on augment location was statistically significant p=0.019. When undertaking further sub-analysis; there was no statistically significant difference when comparing survivorship of; tibial vs femoral augments p=0.108, tibial vs tibial & femur p=0.54 but a difference was seen between femoral vs tibial & femoral augments p=0.007. Conclusion, Based on our data, sleeves demonstrate better survivorship compared to cones. However overall, both demonstrate reliable long-term outcomes.