Purpose : A flexion deformity of the knee is the inability to fully straighten the knee, also known as flexion contracture. It may develop as a result of adherences in the popliteal fossa after surgery like TKA.
Materials and Methods : the authors describe a surgical technique in case of for failed rehabilitation in obtaining full extension and ROM after TKA. The incision is located at the medial side of the knee at the level of the distal medial femur. It reaches the posterior side of the distal femur close to the posterior aspect of the bone and advances on the distal posterior femur towards the medial condyle , the intercondylar notch and towards the lateral femoral condyle debriding and detaching the formal adherences causing the flexion contracture. Rehabilitation with extension posture allows for FWB gait ( sometimes supported by an extension brace ).
Results : a limited series of patients is reported with adequate results . Revision arthroplasty could be avoided in this series.
Conclusions : in case of postoperative fixed flexion contracture with gait limitation and pain a posterior release of fixed adherences through a medio posterior approach can easily obtain full extension without flexion loss.

Purpose:
Enhanced recovery after surgery (ERAS) protocols aim to reduce length of hospital stay, complications, readmissions and costs. Patient selection is crucial for achieving successful outcomes for patients under ERAS protocol post-total knee arthroplasty (TKA). The aim of this study is to evaluate reliability of preoperative range of motion (ROM) of the affected knee as a predictor of postoperative clinical outcomes in patients under ERAS protocol post-TKA.
Methods:
Records of patients who had undergone TKA with ERAS protocol in a single center were reviewed retrospectively. Analysis of association, including correlation analysis and regression analysis were performed to assess the predictive ability of preoperative ROM of affected knee on various postoperative clinical outcomes.
Results:
The present study included 339 patients. There were 217 (64.01%) females and 122 (35.98%) males with a mean age of 67.29±7.12 years. There was a statistically significant positive correlation between preoperative and postoperative degree of fixed flexion deformity (FFD) (r=0.294, P<0.001). There was a statistically significant negative correlation between preoperative degree of FFD and postoperative maximum degree of flexion achieved (r=-0.164, P=0.006). There was a statistically significant negative correlation between preoperative degree of FFD and the Knee Society Knee Score (r=-0.118, P=0.049).
Conclusion:
Patients with greater degree of preoperative FFD are at higher risk of developing poor functional and surgical outcomes. Such patients should be subjected to closer follow ups during outpatient physiotherapy to ensure the desirable long-term functional outcomes.

Introduction: Gel-based ACI (GACI) enables a simpler and more effective delivery of chondrocytes with reproducible three-dimensional structural restoration of the articular cartilage surface. Materials and methods: An unicentric retrospective study analysed data of patients who had undergone gel-based ACI (CARTIGROW®) for the treatment of focal articular cartilage defects of the knee between 2019 to 2022 and had a minimum 3 year follow-up after surgery. The outcome measure were changes in Lysholm Knee Scoring Scale, Knee Outcome Sports Activity Scale (SAS), and MOCART score. Results: 107 patients (110 knee joints) with mean age 31.0±10.5 years were included in the study. 39 of the articular cartilage defects (35.4%) were ICRS grade III, 20 (18.2) were ICRS grade IV, whereas 51 (46.4%) were osteochondritis dissecans (ICRS OCD II to IV). The mean Lysholm score and SAS score improved significantly at latest follow-up with p<0.0001. MOCART scores in 39 patients who had undergone a postoperative MRI at minimum 2 years follow-up ranged from 45 to 100 with a mean of 84.5+4.3. Of the 5 patients who underwent a routine relook arthroscopy at minimum one year follow-up, repair assessment was graded as normal (ICRS grade I) in 3, and nearly normal (ICRS grade II) in 2. One patient underwent a postoperative biopsy that confirmed a hyaline-rich cartilage repair. No major intra-operative or post-operative complications were noted. Conclusion: Gel-based ACI is an effective treatment option for repair of large focal articular cartilage defects of the knee.

The debate remains whether high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA) is more beneficial for the treatment of unicompartmental knee osteoarthritis. The purpose of this study was to compare functional outcomes, knee scores, activity levels and complications between the two procedures.
This is a prospective, comparative and randomized clinical study carried out on 70 patients split into two groups: HTO (closed wedge) and UKA(cemented metal backed) equally. The inclusion criteria were: Medial unicompartmental osteoarthritis, age: 50-65 years, BMI less 30, Axial varus less 15°, Knee contraction less 10°, Central ligaments integrity, Reducible peripheral laxity , AHLBACK: 2 to 3 and IWANO: from 1 to 2.
Patients were randomized by computer .all interventions performed by same surgeon,The mean follow-up was 24 months. The clinical data were analyzed according to the HSS; KOOS and Oxford scores.
No significant difference between the two groups was noted in: free walking (speed), knee scores, deterioration of the control-lateral or patello-femoral compartment, revision rates by TKA. However, UKA produces better results compared to HTO in terms of functional outcomes, pain assessment and complications, although patients who have undergone HTO tend to have slightly better range of motion.
HTO and UKA are the two treatments of choice for medial unicompartmental knee osteoarthritis.
We believe that both techniques are effective provided that they respect their respective specifications.
Based on our results and analysis of recent studies, UKA appears to be as effective and safe as HTO in the treatment of medial knee osteoarthritis.

Introduction:To compare the difference between the weight of different TKA prothesis subtract the weight of resected tissue during operation.Useing Lysholm score，Berg score，Barthel index score，to estimate on proprioceptive sensation and function of knee and Analysis of the correlation between the difference of the weight of knee joint prosthesis subtract the weight of resected tissue and the proprioceptive sensation of knee.In order to evaluate the effect of the weight difference between the weight of TKA prosthesis and the removed tissue on the proprioceptive sensation and function.
Methods: According to the inclusion criteria and exclusion criteria, 200 patients underwent unilateral primery TKA operation in our hospital from 2021 to 2022. Complete recording of general data such as sex, age, BMI, etc. measurement of the weight of the implant and resection of bone and soft tissue intraoperative.Lysholm score, Berg balance scale score and Barthel index scale were used to evaluate the related scores of patients before operation and 1 month and 3 months after operation.According to the weight difference of three different kinds of prothesis, they were divided into three groups: group A, group B and group C. The data of observation nodes before and after operation were compared and statistically processed. P < 0.05 has statistical significance.
Results:.here was a negative correlation between the weight difference of the three groups and the related scores of 1 month and 3 months after operation.That is, the greater the weight difference, the worse proprioceptive sensation and function postoperation.

Introduction: Various patient reported scores have been used to determine the outcome of total knee arthroplasty (TKA) over decades. Most recently, Behrend/colleagues introduced Forgotten Joint score (FJS), which has gained popularity in the last few years. We wanted to investigate the outcome of FJS in patients who had undergone TKA using medial pivot knee implant with patient specific instrument.

Method: All consecutive patients who had medial pivot implant and available FJS were included in this study. The data was extracted from prospectively collected institutional database. A single consultant surgeon operated on all patients. Baseline demographics, body mass index and FJS up to most recent follow up were recorded.

Results: Between the period of August 2015 and August 2022, a total of 273 patients were identified and analysed for their FJS scores. The average age of the patients was 69 yrs. (r 45-93). The average BMI was 30.5 (r 17.4 – 50.2). According to the duration of the follow up (table 1), the scores were {less than 6 months – 43.49 (0-93.75)}, {6 to 12 months – 50.25 (0-100)}, {12 to 24 months – 60.39 (0-100)} and {> 24 months – 70.15 (0-100) respectively. The ceiling effect was noted to change from 8.86 percent before 6 months to 47.22 percent after 24 months.


Conclusion: Based on the above results, we conclude that medial pivot total knee arthroplasty using patient specific instrument has shown promising results when FJS is considered. We also noted that FJS improved with length of post-operative duration.

Purpose

The purpose of this study was to compare the predictive value of the valgus stress angle (SA), varus SA and varus-valgus SA difference (VVD) in predicting the degree of medial release in varus deformity during total knee arthroplasty (TKA).

Materials and Methods

One hundred eight TKAs (78 patients), which were performed in primary osteoarthritis with varus knee deformity, were retrospectively classified into three groups according to the degree of medial release (group A, mild release; group B, moderate release; and group C, severe release). Medical charts were reviewed, and long weight bearing standing anteroposterior radiographs and varus-valgus stress radiographs were evaluated.

Results

The valgus SA was significantly different between group A and B and between group A and C. However, it was not significantly different between group B and C. The varus SA was significantly different between group B and C and between group A and C. However, it was not significantly different between group A and B. The VVD was significantly different in all intergroup comparisons.

Conclusions

Evaluation of the VVD is more valuable in predicting the degree of medial release in TKA performed in varus knee deformity than evaluation of the simple valgus and varus SA.

UKA is an appropriate bone-sparing solution for advanced unicompartmental osteoarthritis of the knee in young patients. The expectations of patients under 60 being different from those of an older population, we sought to assess the quality of life and the level of activities after UKA in this population.
The aim of this study is to compare the results of our serie with the recent literature, to see the short and medium-term complications that can be encountered with this young population.
This is a prospective, monocentric study of 20 UKA Cemented, with a fixed bearing, The average age of the patients was 52.5 years (43—59 years). There was any revision with an average follow-up of 18 months was . Clinical data were analyzed according to HSS; KOOS and Oxford scores. The rate of satisfied or very satisfied patients was 95%. No soreness or pain mild were found in 55% of cases. The mean flexion was 110°. The score of the knee HSS went from 60 before the intervention to 90, the OXFORD from 29 to 46 and the KOOS at more than 75 points in 90% of the patients, 83% of the patients had resumed their daily activities and even sports. No loosening or progression of osteoarthritis to the opposite compartment was observed until the last follow-up.
Medial fixed-bearing UKA is a durable option for young patients with medial femoro-tibial osteoarthritis, with good clinical and functional results in the short and medium term in this young and demanding population.

The aim of this study is to determine whether in complex revision surgeries, the outcome, in terms of Knee Society Score and satisfaction, and survival depend on the hinge total knee prosthesis design used. We conducted a single-centre retrospective observational study of 96 patients with primary or revision total knee replacements who, regardless of the degree of constriction and the cause of failure, required revision using a hinged implant between 2002 and 2020. The main variables were the percentage of new revisions correlated with survival time, Knee Score (KS), Function Score (FS), postoperative range of motion (ROM) and patient satisfaction. As secondary variables, complications, postoperative mechanical axis and influence of age, sex and comorbidities on new revision were analysed. Survival analysis and Cox regression analysis were used for statistical analysis. The mean follow-up was 37.6(19.3-116.4) months. A total of 44 hinged TKA(45.8%) were S-ROM Noiles, 26(27.1%) Rotating Monogram and 26(27.1%) GenuX. The GenuX TKA had the lowest percentage of revisions at the end of follow-up (19%). However, when taking into account the follow-up times, the S-ROM TKA obtained the best survival (161.37 months), although no significant differences were observed (p=0.51). Cox regression analysis did not identify any variable as a predictor of failure. At the end of follow-up KS, FS, ROM and patient satisfaction were statistically superior for GenuX TKA. The data suggest that S-ROM type hinged prostheses have a better survival rate. However, newer prostheses such as the GenuX have better clinical and functional outcomes and higher patient satisfaction.

Background: High tibial Osteotomy ( HTO) is offered to young individuals with unicompartmental knee Arthrosis . The elderly ( aged 60-75 ) population today is more healthy , physically active , exercises and has evolving medical demands. Objective : To assess efficacy of HTO in the “ physiologically young “ elderly population compared to the classic cohort Setting : Tertiary Care Hospital in Kolkata, Urban population Design & Methods – 50 patients ( 25 elderly{aged 60-75 } and 25 aged 45-55 ) satisfying the classical criteria for HTO – medial compartmental arthritis , no vascular deficit, no significant deformity, no history of rheumatoid arthritis – underwent lateral based closed wedge HTO . The patients underwent clinical , radiological examinations and Pre operative and post operative Visual Analogue Scale , Knee Society Scores . The elderly had no prior systematic illness , no history of knee trauma , were engaged in exercises and performed a satisfactory treadmill mill test Results : Patients had similar VAS and KSS pre op . Younger patients showed better KSS scores upto six month follow up . However both groups had similar VAS scores . At 1st and 2nd year follow up , both had similar KSS and VAS . Conclusion : Elderly patients showed similar results following HTO as the traditional patients at 1 & 2 years follow up . Keywords: HTO , Lateral Closed Wedge Osteotomy , Medial compartment osteoarthritis Knee, Physiologically Fit Elderly