Back ground and objectives:
This prospective study was designed to study pain perception following total knee replacement, robotic assisted versus manual method.

Methods:
The study was done between september 2019 and april 2020 in a single center. The patients were divided into two groups, group A included patient who underwent TKR using robotic assistance and group B included manual method. Visual analog score (VAS) was used to assess the pain outcome at the end of every week for six weeks. All surgery was done under spinal regional anesthesia. Multimodal pain management protocol including preoperative medication, intra operative cocktail infiltration and postoperative pain blocks and medication remained the same for 2 groups.


Results:
Comparison of pain using VAS score in both groups showed significant difference (P value = 0.00) in the first week (Ro botic TKA - 4.0, Conventional TKA – 5.0) .There was increase in the pain in the first week following surgery when comparing to preoperative pain (VAS – 4), later on from third week pain severity came down and at the end of sixth week patient was comfortable without pain (VAS -0)

Conclusion:
Our findings suggest that robotic assisted surgery may help to reduce immediate post operative pain in comparison with the manual method. However at the end of six weeks follow up the overall pain comparison appears similar with no statistical advantage in both groups.

Purpose: To identify the ideal medial joint gap in extension to prevent post-operative flexion contracture following total knee arthroplasty (TKA) in varus osteoarthritic knees by the modified gap balancing technique.
Materials and Methods: This is a prospective cohort study of 150 patients diagnosed with osteoarthritic varus knee who underwent TKA using the modified gap balancing technique. Operative and clinical records were assessed to determine factors including age, BMI, pre-operative extension angle, and the medial extension laxity. We followed patients for 6-months post-operatively and reviewed for knee extension angle.
Results: Pre-operative knee extension and BMI were significantly associated with postoperative knee extension. Post-operative flexion contracture of ≧10 degrees was not seen in any of 34 patients with a medial extension laxity ≧0mm who had no pre-existing flexion contracture and in 1/9 (11.1%) patients with a medial extension laxity ≧1mm who had pre-existing flexion contracture.
Conclusion: Pre-operative extension angle and BMI significantly influence the post-operative knee extension angle in TKA using the modified gap balancing technique. A medial extension laxity of at least 1mm is ideally needed to prevent post-operative flexion contracture in patients with a pre-existing contracture ≧10 degrees.

Introduction: Increasingly young and active patients are concerned about revision arthroplasty forcing the manufacturers to think about revision prostheses that fit to this population. One of those industrials claims that its system allows the surgeon to rise the constraint from a posterior stabilized (PS) prostheses to a semi-constraint total stabilized (TS) prostheses without modifying the gait pattern thanks to a similar single radius design. The aim of the study was to compare gait parameters in patients receiving either PS or TS knee prostheses.
Methods : Nineteen patients in each groups were prospectively collected for this study and compared between each other. All subjects were assessed with a 3D knee kinematics analysis, performed with an optoelectronic knee assessment device (KneeKG®). Were measured for each knees range of motion (ROM) in flexion–extension, abduction–adduction, internal–external rotation and anterior–posterior displacement.
Results : There were no significant kinematic differences between PS and TS groups. The ROM in flexion-extension was 45.7° in PS group vs 45.6° in TS group, the ROM in internal-external rotation was 4.6° in PS group vs 4.1°in TS group. Peak varus angle during loading was equal (2.5°) and higher in PS group during swing phases (5.5° vs 3.7°) without any significancy. There appeared to be less antero-posterior translation in the TS group (maximum posterior displacement of 0.5 mm vs 4.7 mm) linked to the larger central post-cam without any significancy.
Conclusion : TS designed have comparable gait parameters than PS prostheses. Its use won’t prejudice the patient concerning the walking pattern.

Under our supervision were 50 patients with complications after revision knee replacement (RTKR), with a follow-up period after the primary operation to 5 years. KSS (Knee Society Score), WOMAC, the results were evaluated as good in 76.7% of patients, satisfactory - in 16.4% of observations and unsatisfactory - 6.9% for the comprehensive clinical evaluation of the results of the revision knee replacement. Also, authors use the AORI (Anderson Orthopedic Research Institute, USA) classification of knee joint bone defects.The reasons for unsatisfactory results were: an early infection - 4,5,5% of cases, a late infection - 1,4%. The necessity of applying different methods of replenishing bone defects arose during the course of 71,4%. In 31.3% of the observations, metallic modular units that were implanted with the femoral or tibia components were used and 33.5% were bone and allograft, 12.5% - these methods were applied jointly and in 22.5% of observations during the revision intervention massive structural allograft of the distal end of the femur and proximal end of the tibia. Complications of the revision knee replacement were repeated aseptic instability of the components of the endoprosthesis and septic instability of the component. Factors that led to the repeated instability were: implantation of the endoprosthesis without additional fixation elements (extenders), lack of ligamental stabilization and bone grafting, and replacement of defects with bone cement, septic instability of the revision component was the result of contamination by the microorganisms of the knee joint and improper antibiotic prophylaxis

The optimal antibiotic prophylaxis remains a topic of paramount importance for the prevention of surgical site infections (SSIs). Whilst general guidelines remain, local protocols differ slightly across hospital trusts in prevention and treatment of SSIs. Our elective cold site changed its prophylactic antibiotic for all elective hip and knee replacements from Teicoplanin to Cefuroxime/Cefazolin. This decision was made based on observations that Teicoplanin was associated with increased risk of anaphylaxis intra- and post-operatively, leading to one death.

A retrospective review of all primary hip and knee joint replacements performed at our unit over the last year, including six months before the implementation of the new protocol (January-June 2020) and six months later (July-Decemeber 2020), was undertaken. Primary outcome was periprosthetic joint infection (PJI) rates and anaphylactic reaction rates. Type of other infections was also recorded.

There were 313 joint replacements performed in the first semester with Teicoplanin and Gentamicin, as antibiotic prophylaxis. 2 patients had a PJI (0.6%), 7 patients had soft tissue infection (2.2%) and 1 patient had an anaphylactic reaction (0.3%). 352 joint replacements were performed between July-December 2020 with Cefuroxime/Cefazolin as antibiotic prophylaxis. No deep joint infections, 5 soft tissue infections (1.4%) and no anaphylactic reactions were recorded. There were no recorded incidents of C. difficile infection in both groups.

The recent change on the local guidelines regarding surgical prophylaxis for joint replacement surgery, demonstrates a decreased rate of post-operative SSIs and anaphylactic reactions. Further data are needed to monitor and support the effectiveness of this change.

Multimodal analgesia is practised for pain management in TKA. The aim of this study was 1) To compare clinically the effectiveness of intraoperative DACB versus USG guided ACB in post-operative pain management for TKA patients. 2) to ascertain the safety of the DACB and compare the complication rate between two techniques. 3) to compare the theatre time difference with use of the two techniques.
200 consecutive patients were included in the study. Hundred patients operated by surgeon A and received intra operative DACB were included in Group A; while hundred patient operated by surgeon B and received USG guided ACB were included in Group B. All the patients operated in group A and group B were given spinal anaesthesia and standard surgical approach was used. The VAS score for group A patients was 1.41 ± 1.08 on day 0 and 2.41 ± 1.26 on day 1, while the VAS score for group B patients was 1.88 ± 1.18 on day 0 and 2.19 ± 1.29 on day 1. The mean OR time was 140.02 ± 19.46 minutes for group A patients and 150.40 ± 28.74 minutes for group B [statistically significant (p = 0.0031)] . 1 patient in both groups had postoperative arrhythmia. USG guided ACB had 1 catheter breakage, needing exploration at the injecting site.
In surgeon administered DACB patients, analgesic efficacy was similar, complication rate and overall operating room time were less as compared to USG guided ACB. This clinical study demonstrates the effectiveness of surgeon administered DACB.

Background
Both Patellofemoral Arthroplasty (PFA) and Total Knee Arthroplasty (TKA) are accepted surgical options for end-stage isolated patellofemoral osteoarthritis (PFOA). We performed a systematic review and meta-analysis to compare outcomes of PFA and TKA by evaluation of the patient-reported outcome measures (PROMs).
Methods
We systematically identified publications reporting on patients that underwent either TKA or modern PFA for isolated PFOA. Meta-analysis software was used to screen for potential articles with at least two years follow-up. Data was extracted and analysed for all PROMs. We included five studies in our cumulative meta-analysis and reviewed them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used random-effect models.
Results:
No significant difference was found between both TKA and PFA in the context of operating time. No significant difference after five years follow-up was found between the two treatment options in terms of UCLA score and patient satisfaction. PFA showed significant improvement in WOMAC score at five years follow up, less postoperative inpatient time, better cost effectiveness and significantly less blood loss.
Conclusion
PFA seems to be a viable alternative to TKA for treatment of isolated PFOA in appropriately selected patients.

Introduction: Kinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and outcomes following TKR, and to evaluate published treatments for kinesiophobia following TKR. Materials and Methods: A primary search of electronic databases, grey literature, and trial registries was performed in March 2020. English-language studies recruiting adult primary TKR patients, using the Tampa Scale of Kinesiophobia (TSK) were included. Outcome measures were grouped into short (≤six months), medium (six-12 months), and long term (≥12 months). Results: All thirteen included papers (82 identified) showed adequately low risk of methodological bias. TSK1 (activity avoidance) correlated with WOMAC functional score at 12 months in three studies (r=0.20 p≤0.05, R=0.317 p=0.001, and correlation coefficient 0.197 p=0.005). TSK score significantly correlated with mean active range of motion (ROM) at two weeks (65.98 (SD=14.51) vs 47.35 (SD=14.48) p=0.000), four weeks (88.20 (SD=15.11) vs 57.65 (SD=14.80) p=0.000), and six months (105.33 (SD=12.34) vs 85.53 (SD=14.77) p=0.000) post-operation. Three post-operative interventions improved TSK score vs control following TKR: a home-based functional exercise programme (TSK -14.30 (SD=0.80) vs -2.10 (SD=0.80) p≤0.001)), an outpatient cognitive behavioural therapy (CBT) programme (TSK 27.76 (SD=4.56) vs 36.54 (SD=3.58), and video-based psychological treatment (TSK 24 (SD=5) vs 29 (SD=5) p≤0.01). Conclusions: Kinesiophobia negatively affects functional outcomes up until one year post-operatively, while active ROM is reduced six months post-procedure. Post-operative functional and psychological interventions can improve kinesiophobia post-TKR.